The ABCs of DKA: Development and Validation of a Computer-Based Simulator and Scoring System

• Published in: Journal of general internal medicine : JGIM 2015-09, Vol.30 (9), p.1319-1332
• Main Authors: Yu, Catherine H. Y., Straus, Sharon, PhD, Ryan Brydges
• Format: Article
• Language: English
• Subjects: Adult; CAI; Clinical Competence; Computer assisted instruction; Diabetes; Diabetic Ketoacidosis - therapy; Disease management; Education, Medical, Graduate; Education, Medical, Undergraduate; Educational Measurement - methods; Endocrinology - education; Female; Health education; Humans; Internal Medicine; Internal Medicine - education; Male; Medical schools; Medicine; Medicine & Public Health; Middle Aged; Original Research; Simulation Training - methods
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-015-3273-y

Background Clinical management of diabetic ketoacidosis (DKA) continues to be suboptimal; simulation-based training may bridge this gap and is particularly applicable to teaching DKA management skills given it enables learning of basic knowledge, as well as clinical reasoning and patient management skills. Objectives 1) To develop, test, and refine a computer-based simulator of DKA management; 2) to collect validity evidence, according to National Standard’s validity framework; and 3) to judge whether the simulator scoring system is an appropriate measure of DKA management skills of undergraduate and postgraduate medical trainees. Design After developing the DKA simulator, we completed usability testing to optimize its functionality. We then conducted a preliminary validation of the scoring system for measuring trainees’ DKA management skills. Participants We recruited year 1 and year 3 medical students, year 2 postgraduate trainees, and endocrinologists ( n  = 75); each completed a simulator run, and we collected their simulator-computed scores. Main Measures We collected validity evidence related to content, internal structure, relations with other variables, and consequences. Key Results Our simulator consists of six cases highlighting DKA management priorities. Real-time progression of each case includes interactive order entry, laboratory and clinical data, and individualised feedback. Usability assessment identified issues with clarity of system status, user control, efficiency of use, and error prevention. Regarding validity evidence, Cronbach’s α was 0.795 for the seven subscales indicating favorable internal structure evidence. Participants’ scores showed a significant effect of training level (p