Results of a CME-certified activity completed by a total of 986 cardiologists and 783 haematologists-oncologists (haem-oncs) from around the world were examined to determine whether virtual patient simulation could improve decision-making and performance within the simulation related to patient evaluation, tailoring anticoagulant therapy, and patient management to improve adherence using patient-centred care strategies. Results showed a significant overall impact of education from pre-to post-clinical guidance (CG) on correct decisions made in both cases for cardiologists, with a relative improvement of 22% for Case 1 (45% pre-to 55% post-CG, n = 475, t(474) = 14.12, P<.001, Cohen's d =.46) and 19% for Case 2 (62% pre-to 74% post-CG, n = 245, t(244) = 11.95, P<.001, Cohen's d =.59). Impact also was seen for haem-oncs, with a relative improvement of 27% for Case 1 (45% pre-to 57% post-CG, n = 280, t(279) = 11.91, P <.001, Cohen's d =.60) and 19% for Case 2 (63% pre-to 75% post-CG, n = 147, t(146) = 9.52, P <.001, Cohen's d =.58). Virtual patient simulation improved cardiologists' and haem-oncs management of patients with pulmonary embolism in a simulated environment.

This study was conducted to determine if online, virtual patient simulation (VPS)-based continuing medical education (CME) intervention that engages clinicians in a practical learning experience could improve performance of diabetologists/endocrinologists (D/Es) and primary care physicians (PCPs) in the management of T2D and sleep problems. The CME VPS intervention comprised one patient presenting at 2 different points. The VPS platform allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Learners’ choices were analyzed using a sophisticated decision engine. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision. Learners were given the opportunity to modify their decisions after receiving CG. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a 2-tailed paired t-test to determine P values. Through November 2017, significant improvements were documented among participating learners after clinical guidance (D/Es n=19; PCPs n=391): Diagnosis of uncontrolled T2D: 40% absolute improvement among PCPs (3% pre-CG vs. 43% post-CG; P&lt;.001) and 26% improvement among D/Es (0% pre-CG vs. 26% post-CG; P=.004)Diagnosis of insomnia: 31% absolute improvement among PCPs (28% pre-CG vs. 58% post-CG; P&lt;.001) and 537 improvement among D/Es (11% pre-CG vs. 47% post-CG; P=.003)Insomnia treatment: 56% absolute improvement among PCPs (10% pre-CG vs. 66% post-CG; P&lt;.001) and 42% improvement among D/Es (11% pre-CG vs. 53% post-CG; P&lt;.001)Intensification of T2D treatment: 36% absolute improvement among PCPs (28% pre-CG vs. 64% post-CG; P&lt;.001) and 35% improvement among D/Es (29% pre-CG vs. 65% post-CG; P=.013) This study demonstrates that VPS that immerses and engages the clinical learners in an authentic and practical learning experience can improve evidence-based clinical decisions related to the management of T2D. Disclosure A. Larkin: None. K.L. Hanley: None. M. Warters: None. G.S. Littman: None.

ObjectivesThe goal of this study was to determine physician performance in diagnosis and management of postpartum depression (PPD) and to provide needed education in the consequence free environment of a virtual patient simulation (VPS).Methods∙ A continuing medical education activity was delivered via an online VPS learning platform that offers a lifelike clinical care experience with complete freedom of choice in clinical decision-making and expert personalized feedback to address learner’s practice gaps∙ Physicians including psychiatrists, primary care physicians (PCPs), and obstetricians/gynecologists (ob/gyns) were presented with two cases of PPD designed to model the experience of actual practice by including use of electronic health records∙ Following virtual interactions with patients, physicians were asked to make decisions regarding assessments, diagnoses, and pharmacologic therapies. The clinical decisions were analyzed using a sophisticated decision engine, and clinical guidance (CG) based on current evidence-based recommendations was provided in response to learners’ clinical decisions∙ Impact of the education was measured by comparing participant decisions pre- and post-CG using a 2-tailed, paired t-test; P <.05 was considered statistically significant∙ The activity launched on Medscape Education on April 26, 2018, and data were collected through to June 17,2018.Results∙ From pre- to post-CG in the simulation, physicians were more likely to make evidence-based clinical decisions related to:∙ Ordering appropriate baseline tests including tools/scales to screen for PPD: in case 1, psychiatrists (n=624) improved from 34% to 42% on average (P<.05); PCPs (n=197) improved from 38% to 48% on average (P<.05); and, ob/gyns (n=216) improved from 30% to 38% on average (P<.05)∙ Diagnosing moderate-to-severe PPD: in case 2, psychiatrists (n=531) improved from 46% to 62% (P<.05); PCPs (n=154) improved from 43% to 55% (P<.05); and, ob/gyns (n=137) improved from 55% to 73% (P<.05)∙ Ordering appropriate treatments for moderate-to-severe PPD such as selective serotonin-reuptake inhibitors: in case 2, psychiatrists (n=531) improved from 47% CG to 75% (P<.05); PCPs (n=154) improved from 55% to 74% (P<.05); and, ob/gyns (n=137) improved from 51% to 78% (P<.05)∙ Interestingly, a small percentage of physicians (average of 5%) chose investigational agents for PPD which were in clinical trials pre-CG, and this increased to an average of 9% post-CGConclusionsPhysicians who participated in VPS-based education significantly improved their clinical decision-making in PPD, particularly in selection of validated screening tools/scales, diagnosis, and pharmacologic treatments based on severity. Given that VPS immerses physicians in an authentic, practical learning experience matching the scope of clinical practice, this type of intervention can be used to determine clinical practice gaps and translate knowledge into practice.Funding Acknowledgements: The educational activity and outcomes measurement were funded through an independent educational grant from Sage Therapeutics, Inc.

We sought to determine if online, virtual patient simulation (VPS)-based continuing medical education (CME) intervention could improve performance of primary care physicians (PCPs) and diabetologists/endocrinologists (D/Es) in evidence-based use of basal insulin for T2D. The intervention comprised two patients presenting in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity to modify to their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a 2-tailed paired t-test to determine P values. Significant improvements were observed after CG: Case 1 (n=417 PCPs; n=100 D/Es):Appropriate basal insulin initiation: 44% absolute improvement among PCPs (24% pre-CG vs. 68% post-CG; P&lt;.001), 50% improvement among D/Es (30% pre-CG vs. 80% post-CG; P&lt;.001) Order diabetes self-management education (DSME) in newly diagnosed patient: 19% absolute improvement among PCPs (50% pre-CG vs. 69% post-CG; P&lt;.001), 14% improvement among D/Es (59% pre-CG vs. 73% post-CG; P=.017) Titration plan: 27% improvement among PCPs (28% pre-CG vs. 55% post-CG; P&lt;.001), 26% absolute improvement among D/Es (29% pre-CG vs. 55% post-CG; P&lt;.001). Case 2 (n= 537 PCPs, n=132 D/Es): Selection of longer-acting basal insulin in T2D patient complaining of hypoglycemia: 34% absolute improvement among PCPs (31% pre-CG vs. 65% post-CG; P&lt;.001), 39% improvement among D/Es (39% pre-CG vs. 75% post-CG; P&lt;.001) Titration plan: 22% improvement among PCPs (29% pre-CG vs. 51% post-CG; P&lt;.001), 21% absolute improvement among D/Es (34% pre-CG vs. 55% post-CG; P&lt;.001) VPS that immerses and engages specialists in an authentic and practical learning experience can improve evidence-based clinical decisions related to use of basal insulin in T2D. Disclosure A. Larkin: None. M. LaCouture: None. M. Warters: None. G.S. Littman: None.

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