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The goals of Type 2 diabetes (T2DM) management include achievement of glycemic, blood pressure (BP), and lipid control. All three variables must be addressed adequately in order to prevent diabetic complications. Aim: Using a proprietary smartphone-based application (APP) developed by Edocate Ltd, that simulates virtual visits, we assessed how well healthcare providers (HCPs) manage T2DM. Materials & Methods: A total of 461 HCPs (247 MD, MD/PhD, or DO and 214 NPs) downloaded and used the APP to treat their virtual patients over multiple visits. All patients presented with poorly controlled T2DM, hypertension (HTN) and hyperlipidemia. HCPs chose the first, second and third lines of medications, made diagnostic adjustments, initiated appropriate referrals to specialists, and ordered laboratory tests of their choice. Based on their selections, the APP simulated the course of diabetes and its complications, requiring diverse management decisions on the subsequent virtual visits. Results: In the Edocate virtual clinic, only 53% of HCPs achieved good glycemic control (A1c < 7%), 41% achieved BP control (<130/80 mmHg), and 66% prescribed high-intensity statins. NPs performed slightly but not significantly better than the physician cohort. Only 48% of HCPs checked microalbuminuria, 54% ordered creatinine and 55% ordered LDL. Interestingly, 79% of HCPs either kept or started Metformin as the first line medication. The most commonly ordered second line of medications for glycemic control was either GLP-1 receptor agonists (39%) or SGLT2 inhibitors (36%), while 23% of HCPs kept their patients on or added sulfonylurea or basal insulin (11%). Conclusions: Despite a worldwide effort in diabetes education, the knowledge of T2DM management remains suboptimal (as assessed by the simulation APP) and underscores the need for better professional education. Innovative patient simulation-based learning applications can dramatically improve the level of competency in HCPs. Disclosure B. Draznin: None. I. Iancu: None.

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Atrial fibrillation (AF) is the most common type of cardiac arrhythmia that contributes to over 150,000 deaths each year. Hypertension, ischemic heart disease, and smoking are among the leading risk factors for AF. Historically, it is well-accepted that AF is treated by cardiologists and frequently by specialists of heart electrophysiology. However, an overwhelming majority of patients with AF initially present to their primary care physicians (PCP). Yet, the assessment of PCP skills in the management of AF has not been well studied. We used the Edocate® virtual patient simulation platform and smartphone application to test the skills of physicians in a “virtual” clinic where their decisions in selecting diagnostic and management steps over several encounters were used for analysis of their knowledge and as a learning tool. We applied this application to assess the level of knowledge in managing AF in 25 PCP. The virtual patient was a 68-year-old man (an active smoker) with hypertension, hyperlipidemia, myocardial infarction 5 years ago, presenting with a 30-day history of palpitations and shortness of breath. On presentation, his blood pressure was 145/93 mmHg, ECG showed AF with a ventricular rate of 132 bpm. He was on atorvastatin 40 mg/d, aspirin 100 mg/d, and ramipril 5 mg/d. Total cholesterol was 155 mg/dl and LDL 85 mg/dl. Comprehensive analysis of the PCP choices via the Edocate platform revealed that only 62% of the participants elected to refer this patient to cardiology. While 65% addressed smoking cessation, only 38% achieved LDL levels of <75 mg/dl and none achieved better control of hypertension. Eighteen percent started anti-arrhythmic drugs within 3 weeks, (89% amiodarone, while 1 PCP started propafenone and 1 sotalol) and 82% started novel oral anticoagulants (dabigatran, rivaroxaban or apixaban - in approximately equal numbers). These results, albeit in a small sample size, clearly show a superb utility of the Edocate patient simulation application to reveal the level of competency of participating physicians. In the case of AF and stroke prevention, the data demonstrated a significant gap in the guideline-based knowledge in participating PCP and indicated that educational effort must be increased substantially among this group of providers.

Introduction: A high level of medical knowledge of Advanced Practice Providers is extremely important to secure their role in the contemporary healthcare environment. Continuing Medical Education is the key element in improving their skills and level of competency. Hypothesis: We hypothesized that a mobile and desktop VPS application that provides a self-propelled simulation of disease progression and the effects of treatments, would allow precise assessment of providers’ medical knowledge. Methods: We used the Edocate® virtual patient simulation (VPS) platform to compare the level of competency in treating patients with type 2 diabetes and cardiovascular problems in two groups of nurse practitioners: diabetes-trained (DNP) and family medicine-trained (FNP). All participants completed the same VPS case before being asked to address a second case with similar problems, thus enabling us to assess improvement in their knowledge as well. For each case, the NPs received personalized and detailed feedback on their actions. Results: DNP were significantly more likely to achieve good glycemic control (78.6% vs. 46.8% in the FNP cohort), control of hyperlipidemia (57.1% vs. 40.0%), control of blood pressure (78.5% vs. 46.6%), and were more likely to use SGLT2i or GLP1 RA in patients with cardiovascular problems (78.4% vs. 66.7%). Both groups improved their performance markedly while working with their second patient, reaching levels of competency in key clinical areas between 83 and 100% in both groups. Conclusion: Working with the VPS, DNP demonstrated a higher level of medical knowledge in diabetes and cardiovascular disease management than FNP. However, training with the VPS platform significantly improved the levels of competency in both groups supporting the notion that virtual simulation provides excellent tools for enhancing providers’ knowledge, critical for their real practice skills. Disclosure I.Iancu: None. R.Shental: None. L.Zehavi: None. B.Draznin: None.