Virtual Case Simulations May Improve Foot Care in Diabetes

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Virtual case-based simulations may reinforce the importance of foot care for health care providers managing patients with diabetes.

NASHVILLE, Tenn. — Simulation education may be able fill a significant gap in education concerning foot examinations in diabetes care, according to new data presented at the American Association of Clinical Endocrinologists (AACE) 24th Annual Scientific & Clinical Congress. 

In the study, researchers from the University of Arkansas reported simulation education can be a useful tool in training health care teams, noting that new evidence indicates that clinical skills acquired in simulation sessions could translate into improved patient care practices and outcomes.

“The reason why this new method of learning is important is that improving examination skills in health care professionals can help make patient care more comprehensive. We feel that it is necessary for the residents, advanced practice nurses (APNS) and attending physicians to be familiar and comfortable with such examination protocol so that they can triage their patients towards appropriate additional care if needed, such as podiatrist, orthopedics, wound care nurses, etc.,” said study investigator Bayan Mesmar, MD, of the University of Arkansas for Medical Sciences in Little Rock.

Mesmar, who presented the study findings at the meeting, said clinical simulation is a hands-on experience that mimics some aspects of a real-life clinical situation. It uses standardized patients, who are trained to present a medical history and mimic physical signs in a standardized manner.

Mesmar and her team utilized standardized patients to teach health care providers the best practices for conducting foot care examinations on patients with diabetes. The current American Diabetes Association (ADA) guidelines call for all patients with diabetes to have comprehensive foot examinations annually to identify the risk factors predictive of ulcers.

A workshop was conducted that identified strategies for preventing foot problems in patients with diabetes and recognizing appropriate diagnoses. It also addressed how best to recommend suitable treatment in problems of the feet.

Fifty people attended the workshop, with more than 90% reporting that they gained knowledge to help with their clinical practice, according to the data. In addition, 94% reported that their competencies in foot examination improved.

“The use of live simulation in continuing education is an area that is very promising, but not frequently studied. Though there is a robust set of research that demonstrates efficacy for teaching procedural skills through simulation, it is not frequently utilized in continuing education for health care professions,” Mesmar told Endocrinology Advisor.

Mesmar said virtual simulated diabetes education interventions studies have been shown to improve diabetes management skills. She said adding a new dimension of using standardized patients to reinforce the importance of foot care could provide an even added benefit. 

The researchers noted that the risk of a patient with diabetes developing a foot ulcer may be as high as 25%, and so a comprehensive foot exam can be paramount.


  1. Mesmar B et al. Abstract #220. Presented at: American Association of Clinical Endocrinologists (AACE) 24th Annual Scientific & Clinical Congress; May 13-17, 2015; Nashville, Tenn.