Canadian family medicine residents' clinical training in diabetes mellitus

Problem. The College of Family Physicians of Canada (CFPC) has identified diabetes as one of the top five priority topics for assessment of competence in residency training, and has established evaluation objectives to clearly describe the domain of competence that should be tested for managing diabetes. Unfortunately, little is known as to whether Canadian Family Medicine Residency programs are providing adequate training to residents in managing diabetes.;Results. The final response rate was 30.56% (n=136). Residents within the intensified survey approach had a significantly higher response rate (X2=30.108; 1 df; p<.001) than residents who only received the electronic survey method.;Results demonstrated that residents did not receive adequate training in the areas of diabetes management cited within the CFPC evaluation objectives. Training was considered most adequate in diagnosing of diabetes, however results showed that 94% of respondents had little to no experience in diagnosing Type 1 diabetes. Training in diabetes medications noted that 74% of respondents had little to no experience in initiating insulin, and routines that were initiated were representative of traditional approaches (sliding scales and BID routines). Residents noted that training in initiating oral anti-hyperglycemic agents was adequate in only 40% of respondents, with exposure occurring only within first line therapies. Finally, clinical experience in managing acute diabetes complications was low for hypoglycemia (68.7% of respondents), DKA (64.2% of respondents), and HHNS (88.0% of respondents).;Conclusions. Residency programs need to improve diabetes training to ensure that residents receive the key features identified by the CFPC as essential for competent management of diabetes in clinical situations.;Methods. A multi-method self reported survey approach (paper and electronic) was utilized for this study to determine the level of diabetes experience received by graduating family medicine residents in Canada. Eleven Family Medicine departments provided permission to survey graduating residents (5 in Western Canada and 6 in Eastern Canada). All subjects were surveyed using the electronic questionnaire, and residents in Western Canada received an intensified survey approach using both electronic and paper methods.