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The treatment landscape for type 2 diabetes (T2D) is continually evolving; therefore, ongoing education of health care professionals (HCPs) is essential. There is growing interest in measuring the impact of educational activities, such as through use of the Moore framework; however, data on the benefits of continuing medical education (CME) in the management of T2D remain limited.
This study aimed to evaluate HCP satisfaction; measure improvements in knowledge, competence
Two faculty-led, CME-accredited, web-based educational activities on T2D and obesity, touchIN CONVERSATION and touch MultiDisciplinary Team, were developed and made available on a free-to-access medical education website. Each activity comprised 3 videos lasting 10 to 15 minutes, which addressed learning objectives developed based on a review of published literature and faculty feedback. Participant satisfaction (Moore level 2) was evaluated using a postactivity questionnaire. For both activities, changes in knowledge and competence (Moore levels 3 and 4) were assessed using questionnaires completed by representative HCPs before or after participation in the activities. A second set of HCPs completed a questionnaire before and after engaging in activities that assessed changes in self-reported performance (Moore level 5).
Each activity was viewed by approximately 6000 participants within 6 months. The participants expressed high levels of satisfaction (>80%) with both activities. Statistically significant improvements from baseline in knowledge and competence were reported following participation in touchIN CONVERSATION (mean score, SD before vs after activity: 4.36, 1.40 vs 5.42, 1.37;
Short, case-based, web-based CME activities designed for HCPs to fit their clinical schedules achieved improvements in knowledge, competence, and self-reported performance in T2D management. Ongoing educational needs identified included setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies.
Diabetes is a major public health concern worldwide. In 2021, it was estimated to affect 537 million adults (9.8% of the world’s population) and was responsible for 6.7 million deaths [
As the treatment landscape and guidelines for T2D are continually evolving, innovative educational activities are required to ensure that HCPs remain up to date with clinical developments in the management of the disease. In addition, a multidisciplinary and person-centered approach is recommended for the management of patients with diabetes [
Traditionally, ongoing medical education for HCPs worldwide involves live symposia, face-to-face workshops, and training events. However, for many HCPs, these can be cost and time prohibitive [
The need for interdisciplinary medical education has arisen because medicine has become increasingly specialized in recent decades; this can be effectively met by various specialties presenting content to a multidisciplinary audience of HCPs [
For many years, HCPs only had to provide documentation of attendance at educational activities to qualify for certification by their professional associations or the reregistration of their medical licenses [
In 2009, Moore et al [
In this study, we developed and implemented 2 faculty-led, CME-accredited, web-based educational activities on T2D and obesity and analyzed the educational outcomes up to Moore level 5. The objectives of this analysis were to (1) evaluate the learners’ satisfaction with the educational activities, as well as the changes in knowledge, competence, and performance that were achieved following their implementation and (2) identify the remaining educational gaps in the clinical management of T2D and obesity.
Educational gaps were identified at the start of activity development, in March 2021, by touch Independent Medical Education (touchIME), a provider of independent medical education for the global HCP community. The identification process included a thorough review of the relevant published literature on T2D and feedback from expert faculty specializing in diabetes care and research.
The expert faculty and patient faculty member were identified and recruited by the medical directors at touchIME. The expert faculty was identified through searches of the literature, relevant congress websites, and web-based educational videos, for diabetes experts with an established background in diabetes research and clinical practice. The Patient faculty member was identified through searches for videos or blogs detailing the firsthand experience of a patient with T2D and obesity. Recruitment was conducted by email invitation, which included details of the proposed activity. Conflict of interest statements from all faculty participants were gathered during the recruitment stage. All the expert faculty members involved in the educational activities are authors of this manuscript or mentioned in the acknowledgments.
Learning objectives were designed based on the educational gaps, and 2 faculty-led, web-based, CME-accredited activities were developed, each comprising 3 recorded 10- to 15-minute videos that addressed the learning objectives (
The first activity, touchIN CONVERSATION, featured an endocrinologist and a diabetes specialist and focused on the management of specific patient cases in the clinic. The learning objectives were to (1) evaluate the unmet need for achieving glycemic control and the associated reasons, (2) decide how to apply individualized glycemic targets according to patient characteristics, and (3) choose appropriate treatments with properties relevant to the individual patient to help achieve glycemic control. For the activity to be immediately relevant to participants’ daily practice, the target audience was precanvassed for questions related to specific patient cases. Precanvassing was carried out by touchIME starting 4 weeks before the videos were recorded, whereby HCPs were invited to submit questions based on patient cases on the following key topics: (1) challenges faced in achieving glycemic control, (2) applying individualized glycemic targets according to patient characteristics, and (3) treatment choices for achieving glycemic targets safely. Canvassing through social media took place using Facebook, LinkedIn, and Twitter, with announcements targeting relevant HCPs, identified using keywords in their profiles linked to diabetes and endocrinology. Canvassing through organic social media involved nontargeted announcements on the same 3 channels, as well as on touchENDOCRINOLOGY and touchCARDIO websites. In addition, an announcement was sent directly to 11,586 HCPs who had subscribed to emails from the touchENDOCRINOLOGY and touchCARDIO sites. No financial incentives were provided to submit the questions. For each video, 3 questions were developed by the faculty for discussion. The questions were based on the precanvassing and learning objectives of the activity.
The second activity, a touchMDT, featured an endocrinologist, a primary care physician (PCP), a nurse specializing in diabetes, and a patient with T2D. This study focused on the relationship between T2D and obesity, and the learning objectives were to (1) describe the relationship between T2D and obesity, (2) predict the beneficial effects of weight loss with glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-1 RA)–based therapy and/or sodium-glucose cotransporter 2 inhibitor (SGLT2i) therapy on outcomes in patients with T2D and obesity, and (3) perform appropriate selection of antihyperglycemic therapy with weight loss benefits for patients with T2D and obesity. Each of the three 10-minute discussions involved a different combination of clinicians and the patient and was based on 3 or 4 discussion points focused on the practical management of patients with T2D and obesity from both the clinicians’ and the patient’s perspectives.
Both activities are available as free to access on the touchENDOCRINOLOGY website (
CME accreditation for both activities was provided by the University of South Florida Health, which is accredited as a provider of continuing professional development by the ACCME and the American Nurses Credentialing Center.
Outcomes for both activities were assessed according to the Moore expanded outcomes framework (levels 1-5) [
Level 1 was assessed over the first 6 months after launch as 2 variables: the number of participants who engaged in the activity and the average time spent by participants viewing the videos. Google Analytics was used to capture geolocation, participant numbers, and the overall average time HCPs spent on the activity. Data on specialty and the country from which participants connected were collected from HCPs who viewed the activity using their touchENDOCRINOLOGY account and from learners who completed the level 3 and level 4 outcome questionnaires.
Levels 2 to 5 were assessed using the outcome questionnaires. To avoid bias, all data from the level 2 to level 5 questionnaires were collected by an independent third-party vendor (nuaxia Limited) that was not involved in the development of the activities. A target audience was specified for fielding the questionnaires so that the sample was taken from relevant respondents (HCPs who completed the preactivity questionnaire) and learners (HCPs who participated in the activity and completed the postactivity questionnaire). Financial incentives were provided by nuaxia Limited for the HCPs to complete the questionnaires. For both activities, the target audiences were predefined by specialty (diabetologists, endocrinologists, and primary care specialists) and country (France, Germany, Italy, Spain, and the United States). A database of 203,744 HCPs was sampled based on a predefined target audience. To avoid any pre-exposure bias and obtain a statistically representative sample size, data were collected using an independent sample model both before and after the launch of each activity. All questionnaires were fielded to the database and then closed once a prespecified number of HCPs responded. Levels 3 and 4 are assessed using a single questionnaire. Preactivity scores were obtained by fielding this questionnaire 1 to 2 weeks before launch (to ensure that the sample was from HCPs who had not interacted with the activity) and were closed after 50 respondents had completed it. Postactivity scores were obtained by fielding this questionnaire to another set of HCPs immediately after the launch and closed after 50 learners responded. The level 2 questionnaire assessing satisfaction with the activities was included with the level 3 and level 4 questionnaire that was fielded after the activity. For level 5, the questionnaire was fielded 1 to 2 weeks before the launch—to a different set of HCPs to those who answered the level 3 and level 4 questionnaires—and was closed after 50 respondents had completed it. At 26 weeks after the launch, the level 5 questionnaire was administered to the same 50 learners who had responded before the activity; of these, 34 (68%) responded to the postactivity fielding, and data are presented as paired samples from these 34 learners only. For levels 2 to 5, the learners who responded to the postactivity questionnaires viewed the activity as part of the questionnaire process.
The level 2 satisfaction questionnaire included the following 5 statements that were to be scored using a 1- to 5-point Likert scale (where 5 is the highest satisfaction): this activity was of high quality, this activity met the stated learning objectives, the presenters were knowledgeable and effective, the activity contained content relevant to my clinical practice, and the information presented is likely the help change my management strategies in this therapeutic area. Levels 3 and 4 (knowledge and competence) and level 5 (performance) were assessed using questionnaires developed by the medical directors at touchIME and approved for scientific and medical accuracy by the faculty (
To assess levels 3 and 4, separate questionnaires were developed for touchIN CONVERSATION and touch MultiDisciplinary Team activities
touchIN CONVERSATION
Factors contributing to clinical inertia
Achieving glycemic control in nonadherent patients
Selecting individualized glycemic targets and add-on therapies
Emerging therapies for patients with type 2 diabetes (T2D) and overweight or obesity
touchMDT (touch MultiDisciplinary Team)
Mechanisms linking obesity to T2D
Benefits of weight loss for T2D prevention
Clinical benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is)
Treatment intensification after a GLP-1 RA or metformin
To assess level 5, a single questionnaire was sent to the respondents of both activities
Appropriate second-line treatment selection for patients with T2D and overweight or obesity
Eligibility criteria for treatment with a GLP-1 RA
Outcomes expected for patients treated with an SGLT2i
Treatment intensification in patients with T2D, obesity, and atherosclerotic cardiovascular disease, who have not achieved their glycemic target
To assess the impact of the educational activities on HCPs’ willingness to change their clinical practice, learners who took part in the level 2 to level 5 questionnaires after participating in the activities were asked the following multiple-choice question: “As a result of your participation in this session, will you make a change in your practice?” There were 5 possible mutually exclusive responses: yes, uncertain—more education needed, uncertain—practical limitations, no—more education needed, and no—practical limitations.
To collect information on the learners’ perspective on the need for further education in the management of T2D, those who completed the level 2 to level 5 questionnaires after the activity were asked the question, “What do you think is the most important unmet educational need in this therapy area?” They were required to rank 4 predefined potential educational gaps (12 in total over the 3 questionnaires) by importance. Potential educational gaps were drafted by the medical directors at touchIME, with input from the faculty on the respective activities, and were included at the end of the questionnaires after the multiple-choice questions. The results were analyzed using a single transferable vote system. In the first round of voting, all first-choice votes were counted to determine the most important educational gap for the participants; in the second round, all second-choice votes were counted to determine the second most important educational gap. Any first-choice vote, not from the winning option in the first round, was also counted in the second round. The voting rounds continued until all options were placed in order. In addition, questions in the level 3 and level 4 questionnaires that were answered incorrectly by ≥40% of learners after completion of the activity were identified as outstanding educational gaps.
Data were analyzed using SPSS Statistics (version 28.0.1; IBM Corp). On the basis of target population of learners and the sample size, a statistical power calculation was used to determine the number of respondents (N=50) and learners (N=50) required to detect a statistically significant difference between surveys conducted before and after the activity, with a margin of error of approximately 10% for both touchIN CONVERSATION and touchMDT. For the satisfaction (level 2) questionnaire, the mean scores were calculated for the individual questions, and an overall satisfaction score was calculated as the average across all satisfaction fields, with a maximum possible satisfaction score of 5 points out of 5. For the knowledge and competence (levels 3 and 4) analysis, the mean and median numbers of correct answers were calculated for both the pre- and postactivity data sets, and the results were compared using an independent sample 2-tailed
The faculty for touchIN CONVERSATION and touchMDT consented to the necessary use, distribution, and reproduction of their contribution to the activities and assigned the entire copyright and all other intellectual property rights existing in their contributions to touchIME. According to the European Union General Data Protection Regulation [
Data collected between 6 and 7 months after launch showed that 6759 and 5998 participants had engaged with the touchIN CONVERSATION and touchMDT activities, respectively. The average length of participation was 8.50 minutes for the touchIN CONVERSATION and 13.09 minutes for the touchMDT (
Engagement results and demographics of participants in the touchIN CONVERSATION and touch MultiDisciplinary Team (touchMDT) activitiesa.
|
touchIN CONVERSATION | touchMDT | ||
Participant engagement, n | 6759 | 5998 | ||
Countries reached, n | 25 | 25 | ||
Length of participation (minutes), mean (SD) | 8.50 | 13.09 | ||
|
||||
|
Endocrinology | 3109 (46.00) | 3178 (52.98) | |
|
Diabetes | 2500 (36.99) | 1979 (32.99) | |
|
Primary care | 1149 (17.00) | 839 (13.99) | |
|
Not reported | 1 (0.01) | 2 (0.03) | |
|
||||
|
Physician | 4731 (70.00) | 4138 (68.99) | |
|
Physician assistant | 676 (10.00) | 659 (10.99) | |
|
Nurse practitioner | 1352 (20.00) | 1199 (19.99) | |
|
||||
|
United States | 2064 (30.54) | 1319 (21.99) | |
|
Philippines | 1323 (19.57) | N/Ac | |
|
Italy | 872 (12.90) | 574 (9.57) | |
|
India | 507 (7.50) | 100 (1.67) | |
|
Bangladesh | 466 (6.89) | N/A | |
|
Australia | 242 (3.58) | 148 (2.47) | |
|
Pakistan | 222 (3.28) | N/A | |
|
United Kingdom | 161 (2.38) | 1470 (24.51) | |
|
Spain | 137 (2.03) | 338 (5.64) | |
|
Ireland | 107 (1.58) | N/A | |
|
Portugal | N/A | 657 (10.95) | |
|
Canada | N/A | 280 (4.67) | |
|
Netherlands | N/A | 149 (2.48) | |
|
Mexico | N/A | 116 (1.93) |
aData collected on April 22, 2022, and at 203 and 190 days after the launch of touchIN CONVERSATION and touchMDT, respectively.
bCountry where the participant was based at the time of completing the activity. Data are reported for countries represented by ≥2% of the participants for at least one activity.
cN/A: not applicable.
The overall satisfaction scores were 84% (4.2/5) for touchIN CONVERSATION and 82% (4.2/5) for touchMDT. For touchIN CONVERSATION and touchMDT, respectively, satisfaction scores of 4.2 and 4.1 for the quality of the activity, 4.2 and 4.2 for meeting the stated learning objectives, 4.3 and 4.3 for the knowledge and effectiveness of the presenters, 4.4 and 4.1 for relevance to clinical practice, and 4.0 and 3.8 for impact on management strategies were achieved out of a maximum score of 5.0.
Before the launch of the touchIN CONVERSATION activity, 22% (11/50) of the respondents answered at least 6 of the 7 questions of the level 3 and level 4 questionnaires correctly, whereas after participating in the activity, this increased to 60% (30/50). There was a significant increase in the average number of correctly answered questions from before to after the activity (median, IQR 4.5, 3.0-5.0 vs 6.0, 4.75-6.0; mean, SD 4.36, 1.40 vs 5.42, 1.37;
There was also improved knowledge from before to after the activity in the selection of individualized glycemic targets for older patients (22/50, 44% answered correctly before the activity vs 35/50, 70% answered correctly after the activity) and of emerging therapies for T2D and obesity (31/50, 62% vs 44/50, 88%). In addition, improved competence in selecting individualized glycemic targets for younger patients (13/50, 26% vs 21/50, 42%) and in selecting an add-on therapy for patients at a high risk of cardiovascular disease (35/50, 70% vs 45/50, 90%) was observed (
For the touchMDT, there was no significant increase in the number of correct answers from before to after the launch of the activity (median, IQR 5.0, 4.0-5.0 vs 5.0, 4.0-5.0; mean, SD 4.36, 1.24 vs 4.58, 1.07;
For both activities, the change in the mean number of questions answered correctly was similar across countries (touchIN CONVERSATION,
Summary of the number of correct responses for the level 3 and level 4 outcome questionnaires before and after the launch of touchIN CONVERSATION and touchMDT (touch MultiDisciplinary Team).
Summary of correct responses for individual topics for the level 3 and level 4 outcome questionnaires before and after the launch of touchIN CONVERSATION. CV: cardiovascular; T2D: type 2 diabetes.
Summary of correct responses for individual topics for the level 3 and level 4 outcome questionnaires before and after the launch of touchMDT. CV: cardiovascular; GLP-1 RA: glucagon-like peptide-1 receptor agonist; SGLT2i: sodium-glucose cotransporter-2 inhibitor; T2D: type 2 diabetes; touchMDT: touch MultiDisciplinary Team.
Before the launch of the touchIN CONVERSATION and touchMDT activities, 32% (11/34) of the respondents selected the answer representing the best clinical option for all 4 questions. This increased to 59% (20/34) after participating in the activities (
Summary of responses for the level 5 outcome questionnaire before and after the launch of touchIN CONVERSATION and touchMDT (touch MultiDisciplinary Team).
Summary of correct responses for individual topics for the level 5 outcome questionnaire before and after the launch of touchIN CONVERSATION and touchMDT. ASCVD: atherosclerotic cardiovascular disease; GLP-1 RA: glucagon-like peptide-1 receptor agonist; SGLT2i: sodium-glucose cotransporter-2 inhibitor; touchMDT: touch MultiDisciplinary Team.
The change in the mean number of best clinical options selected was similar across the years of experience (
More than two-thirds (34/50, 68%) of the learners stated that they would change their practice following their participation in touchIN CONVERSATION. Of the remaining learners, 14% (7/50) were uncertain and 18% (9/50) would not make a change. In total, 12% (6/50) of the participants indicated that more education on the subject would be beneficial.
For the touchMDT, more than half (27/50, 54%) of learners stated that they would change their practice following their participation in the activity. A total of 24% (12/50) of the learners were uncertain, mostly owing to practical limitations (7/50, 14%), whereas 22% (11/50) stated that they would not make a change, owing to practical limitations (8/50, 16%). In total, 16% (8/50) of the participants indicated that more education on the subject would be beneficial.
When responding to the level 5 questionnaire, 59% (20/34) of the learners stated that they would make a change to their practice following their participation in the touchIN CONVERSATION and touchMDT activities. Of the remaining learners, 12% (4/34) were uncertain, and 29% (10/34) would not make a change. In total, 18% (6/34) felt that more education would be required, and 21% (7/34) noted that practical limitations would affect their ability to change their practices.
Two educational gaps were identified from the questions that were frequently answered incorrectly in the level 3 and level 4 questionnaires: (1) selecting individualized glycemic targets in younger patients and (2) communicating the benefits of SGLT2i therapies. Questions on the first topic were answered correctly by only 42% (21/50) of the learners after participating in the touchIN CONVERSATION activity (
The 3 most important unmet educational needs identified by touchIN CONVERSATION and touchMDT learners after the activity, in response to the question, “What do you think is the most important unmet educational need in this therapy area?” in the level 2 to level 5 questionnaires, are shown in
Unmet educational needs identified by the touchIN CONVERSATION and touch MultiDisciplinary Team (touchMDT) learnersa.
touchIN CONVERSATION (level 2 to level 4 questionnaires) | touchMDT (level 2 to level 4 questionnaires) | touchMDT and touchIN CONVERSATION (level 5 questionnaire) |
1. Use of time-in-range metrics in continuous glucose monitoring to help optimize glycemic control | 1. Strategies for achieving sustained weight loss in patients with T2Db and obesity | 1. Efficacy data for emerging antihyperglycemic agents for type 2 diabetes and obesity and their use in clinical practice |
2. Managing treatment regimens to avoid hypoglycemia in patients with T2D | 2. Understanding the data from cardiovascular and renal outcomes trials for antihyperglycemic medications in patients with T2D at high cardiovascular or renal risk | 2. Managing the side effects of antihyperglycemic medications in patients with T2D and obesity |
3. Efficacy data for emerging antihyperglycemic agents for T2D and their use in clinical practice | 3. Use of time-in-range metrics in continuous glucose monitoring to help optimize glycemic control | 3. Managing treatment regimens to avoid hypoglycemia in patients with T2D |
aThe top 3 unmet educational needs are shown, as identified by learners who completed the level 2 to level 4 and level 5 questionnaires following the launch of the touchIN CONVERSATION and touchMDT activities. Learners were required to rank 4 predefined, potential educational gaps in response to the question “What do you think is the most important unmet educational need in this therapy area?”
bT2D: type 2 diabetes.
This study evaluated outcomes following 2 faculty-led, CME-accredited, web-based educational activities on the management of patients with T2D and demonstrated that HCPs expressed high levels of satisfaction and improvements in their knowledge and competence, as well as self-reported performance in T2D management. By the 6- to 7-month postlaunch time point, each activity had been viewed by a global audience of approximately 6000 participants, of which most were specialist physicians. Learners’ satisfaction levels with the educational activities were high, and they considered them to be relevant to clinical practice, meet the stated learning objectives, and impact their future management strategies.
In the touchIN CONVERSATION activity, learners successfully improved their knowledge, competence, and performance, and the benefits of setting individualized glycemic targets were identified as key future educational needs. In addition, most learners confirmed that they would change their practice in response to participation, highlighting the clinical value of the activity. Although an improvement in self-reported performance after participating in the touchMDT activity was reported, no significant increase in knowledge and competence was observed, and fewer learners indicated an intention to change practice compared with the touchIN CONVERSATION activity. This may reflect the relatively high baseline knowledge and competence levels observed in this cohort. However, competence in advising patients on the clinical benefits of SGLT2i therapy was relatively low, with little improvement observed after the activity. This may suggest a requirement for further education or may reflect a bias based on clinical experience with this treatment class. The high baseline scores and subsequent lack of significant increases in knowledge and competence following the touchMDT may also indicate that the activity successfully consolidated the knowledge and competence gained from the earlier touchIN CONVERSATION, which addressed, in part, similar topics. Thus, it is possible that the respondents of the level 3 and level 4 questionnaires for the touchMDT partially overlapped with the learners from the touchIN CONVERSATION, as the target audience and geographies were identical, and participants were reached through the same channels. This interpretation is consistent with the concept of spaced learning, according to which, re-exposing learners to information over time using temporal intervals results in more effective retention of information than if it was all provided at once [
Improvements in knowledge and competence were similar across countries and years of experience, indicating that education was beneficial for the entire range of HCPs. Some numerical differences were observed between countries for the level 3 and level 4 questionnaires, with improvements in knowledge and competence seen for learners in the United States, but not in France, Germany, Italy, or Spain following the touchMDT activity. When the impact of education on learners’ performance was assessed, there was a statistically significant difference in performance improvement across different countries, although learners from France and Germany showed no increase in the mean number of the best clinical options selected. Interestingly, although the lack of increase in performance in learners from Germany could be attributed to the high mean of the best clinical options selected at baseline, leaving little room for further increase, learners from France did not show any increase in performance despite showing the lowest score at baseline. Because of the small size of the subgroups, we cannot speculate on the potential reasons for this; further studies with larger groups of participants from these countries are required to obtain meaningful insights. Significant differences were also noted between specialties for the level 3, level 4, and level 5 questionnaires, with the largest improvements observed for primary care specialists. Overall, the HCPs in primary care demonstrated the lowest levels of knowledge, competence, and performance before both activities. This highlights the importance of ongoing education to ensure that primary care teams remain up to date with the rapidly evolving treatment and management landscape of T2D. The high participation numbers and satisfaction scores, combined with improvements in knowledge, competence, and performance observed following one or both activities, support the educational approach of (1) precanvassing prospective learners and using specific patient cases to ensure that the activity is immediately relevant to HCPs’ daily practice and (2) using multidisciplinary faculty and real-life patients to deliver the educational activity.
Most learners indicated that they would implement changes in clinical practice because of their educational activities. Nonetheless, a notable proportion of HCPs who participated in the activities stated that they would not change their practices at the current time. Although patient-centered care is increasingly becoming the focus of health care improvement, several barriers still exist that may prevent its application in daily clinical practice and on a larger scale across health care organizations [
The results of this study indicated that several educational needs remain. As indicated by the questions that were frequently answered incorrectly after the activity, there appears to be a need for more education on setting individualized glycemic targets, particularly in younger patients, and a need to further understand the potential benefits of SGLT2i therapies. In addition, learners self-selected several educational needs, including the use of time-in-range metrics for continuous glucose monitoring, strategies to avoid hypoglycemia, how to achieve sustained weight loss, understanding data from cardiorenal outcome trials, efficacy data for emerging therapies, and managing the side effects of antihyperglycemic medications.
The strengths of this study were, first, the involvement of prospective learners in the development of the touchIN CONVERSATION and the provision of a multidisciplinary program, the touchMDT, delivered by and for an interdisciplinary team of HCPs. Both aimed to maximize HCP participation, engagement, and satisfaction with the program. Second, the activities were accredited; thus, physicians, physician assistants, and nurses could obtain CME credit through participation in education. Third, there were no barriers to accessing education, with both activities made freely available on the touchENDOCRINOLOGY website. Fourth, the outcome questionnaire data were collected using an independent sample model, and the questionnaire was fielded to a statistically representative sample. All data collection was carried out by an independent third-party vendor.
This study had several limitations. First, self-selection bias must be considered when assessing the impact of educational activities; thus, HCPs who consider their knowledge to be lacking in these topics are more likely to participate than those who consider their knowledge to be up to date. This bias generally affects medical education, irrespective of the format or delivery method used. To mitigate self-selection bias, we used a combination of different channels to reach the HCP target audience for the activities described here: not limited to clinicians actively seeking medical education, but extended to a heterogeneous population of HCPs, including social media subscribers and members of professional societies. Second, the long-term benefits of educational activities remain unknown. In the future, measuring the impact of education over a longer time frame (eg, at 12 and 24 months) may be beneficial, although the treatment paradigm for T2D is relatively fast-moving, and measuring the impact beyond 24 months may not prove insightful owing to changes in clinical practice. Rather, providing updates to the education based on feedback from learners and the results of the outcomes analysis would be more practical and would ensure that HCPs are kept up to date with information that is useful and relevant. Third, aggregated rather than matched data were used for the level 3 and level 4 questionnaires; however, a previous study of CME outcomes indicated that aggregated data are comparable with matched data and are therefore likely to be sufficiently accurate for many program evaluation purposes [
CME accreditors are placing increasing importance on the measurement of higher-level outcomes following participation in educational activities; however, data on outcomes from web-based CME activities in T2D are limited [
Despite the limitations outlined earlier, the overall objectives of this analysis were met: the study demonstrated significant improvements in the knowledge, competence, and performance of HCPs in the management of T2D and obesity following participation in one or both activities; key outstanding educational gaps were identified; and areas for the improvement of educational outcomes assessment were highlighted, which, alongside the knowledge gained on key educational needs, may help to inform future activities that maximize HCP performance and ultimately patient outcomes.
This study demonstrated that short, case-based, patient-focused, and multidisciplinary team–led CME activities that HCPs can fit into their clinical schedules achieved high levels of satisfaction and improvements in HCP knowledge and competence, along with self-reported performance in T2D management. Ongoing educational needs identified included setting individualized glycemic targets, particularly in younger patients, and the potential benefits of SGLT2i therapies. These educational needs can be used to inform future educational activities in the diabetes HCP community. The activities described in this study reduce barriers to participation in CME activities, as they are convenient and easily accessible to learners and are free to access.
Images of the touchIN CONVERSATION and touch MultiDisciplinary Team activities.
For the touchIN CONVERSATION and touch MultiDisciplinary Team activities: Tables showing educational gaps and learning objectives, and questions included in the level 3, level 4 and level 5 outcome questionnaires; and figures showing a summary of responses to the questionnaires.
Accreditation Council for Continuing Medical Education
continuing medical education
glucagon-like peptide-1 receptor agonist
glycated hemoglobin
health care professional
primary care physician
sodium-glucose cotransporter-2 inhibitor
type 2 diabetes
touch Independent Medical Education
touch MultiDisciplinary Team
The authors would like to thank the faculty members Professor Dr med Michael Nauck (St. Josef Hospital [Ruhr-Universität Bochum], Bochum, Germany) and Dr Vincent Woo (University of Manitoba, Winnipeg, Manitoba, Canada) for contributing to the educational content of the touchIN CONVERSATION and touch MultiDisciplinary Team activities, as well as the touch Independent Medical Education (touchIME) audience outreach team (Joel Turner and Hannah Morton-Fishwick) for the collection and analysis of the level 1 data. Medical writing support was provided by Steph Carter, and editorial support was provided by Joanna MacDiarmid, both of touchIME, Stockport, Cheshire, United Kingdom. Educational activities were jointly provided by the University of South Florida Health and touchIME. Eli Lilly provided an independent medical education grant to fund educational activities and medical writing and editorial support but did not contribute directly to manuscript development, the decision to submit, or the submission process.
Data will be shared with bona fide researchers submitting a research proposal to touch Independent Medical Education Ltd. Access requests should be submitted to ADN (Alex.Noble@touchime.org). Data will be made available from the study publication date. Any individual participant data will be shared in data sets in a deidentified and anonymized format.
All authors contributed to study design and manuscript writing. ADN performed statistical analyses.
SBH reports advisory board or panel fees from Abbott, AstraZeneca, Bayer Inc, Eli Lilly, Janssen, Novo Nordisk, and Sanofi; consultancy fees from Abbott, AstraZeneca, Bayer Inc, Eli Lilly, Janssen, Novo Nordisk, and Sanofi; grants and research support from Abbott, AstraZeneca, Eli Lilly, Janssen, Novo Nordisk, and Sanofi; and salary and contractual services from Abbott, AstraZeneca, Bayer Inc, Eli Lilly, Janssen, Novo Nordisk, and Sanofi. AB, SQN, ADN, and HES are employees of touch Independent Medical Education Ltd. JV reports grants and research support from Eli Lilly, Eliem Therapeutics, Lexicon, Novo Nordisk, Pfizer, and Sanofi.