Objective. To assess the impact of an elective diabetes course on student pharmacists' skills and attitudes about diabetes management. Design. A 1-credit elective course on diabetes was developed that included a 1-week simulation experience during which students completed daily insulin injections, glucose checks, carbohydrate counts, and kept a daily log. Assessment. A preintervention and postintervention survey was administered to assess students' attitudes toward and confidence in performing and teaching patients various diabetes self-management skills. Students' confidence in performing and teaching diabetes self-management skills significantly improved. Students' reflective writing assignment, diabetes logbook, weekly quizzes, and group presentation were also evaluated. Conclusion. A diabetes elective, which included a 1-week simulation of living as a diabetic patient, was an effective teaching method to increase students' confidence in performing and teaching diabetes self-management skills.

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Nichole Mirocha, DO Tracey Smith, DNP Ann Fam Med 2020;18:83. https://doi.org/10.1370/afm.2467 Several team members often see the patient during a CCC, and some may not need to see the patient at all; therefore, patients see different combinations of the nurse, physicians, pharmacist, resident or student learners, and behavioral health provider, often with the psychiatrist involved in case discussion without entering the room. Team members have received training in, and consistently utilize, patient-centered engagement techniques such as motivational interviewing, trauma informed care, accompaniment, and harm reduction. Approximately 10 patients are seen in each half-day clinic, with any team members who are not in the room during a patient encounter facilitating follow-up and delivery of services for patients as needed.There is an informal debriefing session following clinic.We have been pleased to see that patients who had previously been labeled as "noncompliant" or "difficult" have successfully engaged in primary care services, and "no-show" occurrences are rare. Financial sustainability has been possible through traditional physician and mental health service reimbursement with both the physician and behavioral health providers billing separately, as well as CHW funding though grants; agreements with managed Medicaid for CHW services are now in place to maintain sustainability. LEARNING Replication of this model is possible in other primary care settings but requires careful selection of team members and a high level of enthusiasm. The team and clinical environment must be willing to "relax the rules" to help these patients succeed, and a non-judgmental attitude is paramount. Team members often cross the typical boundaries of their job descriptions, working in true interdisciplinary fashion. The CHWs' role cannot be overemphasized, especially when it comes to continued patient engagement.This team is unique in its composition and fluidity and has learned that it is essential to move beyond what are currently considered progressive and innovative models (such as traditional group visits, sequential provider visit models, and integrated behavioral health care) to meet the needs of patients with highest levels of complexity. We have found that it is not enough to have "on call" interdisciplinary team members; these individuals must all be present during visits and have in-depth conversations about patients together in order to close gaps in care and move quality of treatment to a higher level.For additional information, including supplemental materials, key words, author affiliations, and funding support, see it online at http://www.AnnFamMed.org/content/18/1/83/suppl/DC1/.