SAT-865 - A Case-Based Learning Intervention Improves Physician Competence and Confidence in Managing Hospitalized Patients with Automated Insulin Devices

Introduction:
Continuation of a person’s automated insulin delivery (AID) system while hospitalized is encouraged when clinically appropriate. However, improper management can result in safety events, noncompliance with hospital policies, and the need for endocrine consultation. We surveyed resident physicians to evaluate their confidence and competence in managing hospitalized patients with AID systems and then measured these outcomes following a one-hour, case-based learning session.

Methods:
Internal medicine residents completed anonymous, voluntary surveys before and after a case-based learning session led by endocrinologists. Likert scales measured confidence and competence in managing AID systems in-hospital. The pre-survey captured prior education, experience with AID systems, and use of endocrine-consult service.
The survey evaluated the learning session’s goals: understanding AID system features, placing related orders in the electronic medical record (EMR), and managing common inpatient scenarios such as diabetic ketoacidosis, hyperglycemia, hypoglycemia, altered mental status, and AID system malfunction. Institution-specific policies were reviewed. Pre- and post-survey results were compared with a one-sample Wilcoxon test.

Results:
63 residents completed the pre-activity survey. 94.6% and 87.5% reported no formal insulin pump education in medical school or residency, respectively. 87.5% reported caring for an inpatient with an AID system in the last year. 39% of residents reported consulting endocrinology over 75% of the time, while 14% reported never consulting.
45 residents attended the learning activity, and 35 completed the post-activity survey. The results showed improvements in self-reported confidence in assessing whether an inpatient is appropriate for AID system use (Median Pre=2, Median Post=4, W=630, p< 0.001), accurately placing pump orders in the EMR (Median Pre=2, Median Post=4, W=630, p< 0.001), determining AID system functionality and maintenance (Median Pre=2, Median Post=4, W=630, p< 0.001), adjusting AID system settings for both hyperglycemia and hypoglycemia (Median Pre=2, Median Post=4, W=595, p< 0.001), and converting AID system settings to subcutaneous insulin regimens (Median Pre=2, Median Post=4, W=741, p< 0.001). Residents reported increased confidence in their overall ability to safely manage patients with AID systems (Median Pre=2, Median Post=4, W=630, p< 0.001).

Conclusion:
An endocrinologist-led, case-based learning session significantly improved resident physician short-term confidence and self-reported competence in managing hospitalized patients’ AID systems. Further work is needed to determine whether such interventions provide durable learning, decrease reliance on endocrine consultation for routine AID system management, and if they improve safety and adherence to hospital policies.

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