Delivering standardised, easily accessible training at scale to healthcare professionals, people living with Type 1 diabetes and their families/carers is challenging, especially during COVID-19. High quality, structured training, with auditable outcomes, can empower people to make the best use of diabetes technology. The answer was to deliver competency-based training, improving competency, confidence and troubleshooting ability, using a digital, blended learning approach for a wide range of CamAPS FX hybrid closed loop users. CamDiab commercially launched the CamAPS FX system in the UK in March 2020, after years of research at the University of Cambridge to develop the advanced closed-loop algorithm.
CamAPS FX closed-loop insulin delivery is the world’s first closed-loop app which works with continuous glucose monitoring (CGM) and an insulin pump to adjust insulin delivery and manage glucose levels 24 hours a day. It has been developed over 15 years and research studies prove its efficacy, safety and outcomes (reduced HbA1C, increased time in range, reduced time spent in hypos and improved quality of life). It is the only commercially-available system CE marked for children 1-6 years of age and during pregnancy, although it is suitable for all PWD. A novel training solution was needed to help healthcare staff, PWD and the wider care network learn about this cutting-edge diabetes technology. E-learning modules were created to refi ne skills prior to, and after, starting CamAPS FX: Carbohydrate counting refresher; Dana insulin pump refresher; CamAPS FX training; Poststart optimisation and Dexcom refresher training (in development). Each module includes multiple-choice assessment questions. Use of images and videos with written text supports people to engage on multiple levels. An 80% pass mark was set to ensure competency. Modules are designed to complete in ‘bite-sized chunks’, accessible via a computer, smartphone or tablet, to fi t into people’s busy lives. A module takes approximately 45 minutes to complete. Completing a module generates a certificate and reflection document. CDEP rewards entice people to undertake the training. The points accumulated unlock free or discounted resources, like Carbs & Cals diabetes posters, books and (coming soon) their new app. HCPs and PWD must complete the essential CamAPS FX training to obtain a unique training code that unlocks the CamAPS FX app. This ensures that users are optimally trained before starting the closed-loop system.
Equality, Diversity and Variation
CDEP is a well-established online training platform utilised by over 30,000 healthcare staff in the UK to promote optimal standards of diabetes care and reduce variations in care. It is embedded in 40% of the CCGs in England and throughout Wales. The CamAPS FX training portal uses CDEP’s extensive e-learning IT functionality, which is underpinned by high quality, academically sound assessment techniques endorsed by the Cambridge University Health Partners. Online training offers users access when convenient to them, and allows them to revisit the training to refresh skills. A blended learning approach supports individual learning styles. The platform offers a good user experience from tablet, smartphone or computer, allowing wide access for all. Its ‘access on the go’ helps people complete training conveniently. When users register, they select a learning zone relevant to their role. Further resources can be downloaded as guides or templates. Automated reminder mechanisms invite users to return and complete the training. This reminder mechanism, certificate and rewards ensure that a high proportion (74%) of people who register complete at least one module.
Large-scale support for a wide range of people to improve their closed-loop skills, confidence and troubleshooting ability is possible. The platform’s flexibility means it is often a preferred approach. CDEP’s HCP diabetes training site has extensive outcome reporting metrics which demonstrate the efficacy of the e-learning functionality and sets a benchmark against which to measure the new CamAPS FX training. The overall impact of CDEP training is assessed on a 5-point scale (1 = significantly worse, 2 = worse, 3 = no change, 4 = improved and 5 = significantly improved) across three domains (n=54,070). Average score: competency: 4.26; confidence: 4.23; guideline familiarity: 4.24. The CamAPS FX training is assessed on the same scale across three domains (n=808). Average score: competency: 4.39; confidence : 4.22; troubleshooting ability: 4.21. The respective training outcomes are similar, suggesting that the CamAPS FX training is of the same quality as CDEP’s. In addition, qualitative feedback is captured in the mandatory evaluation process and confirms that online training is well received. The training is free, allowing anyone access to the training. Research has shown that PWD with the best clinical outcomes utilising closed-loop therapy have the highest time spent in closed-loop, meaning the system is being used efficiently.
Dissemination and Sustainability
The training platform was developed and tested by the CamDiab clinical team, external expert diabetes HCPs and the target user group prior to making it public in January 2020. The CamAPS FX system has been commercially available in the UK since March 2020. To date, 1,058 users have registered on the site.
User numbers are growing at the rate of 75-106 new users each month and 808 modules have been completed. The platform also offers access to 11 themed webinars. The training offers an auditable, standardised and scalable approach which includes inbuilt safety mechanisms preventing use of the technology without adequate training. It meets the needs of a variety of users in a timely manner, no matter how quickly demand grows, compared to delivering traditional face-to-face training.
When users complete a module, they are required to complete evaluation to generate the certificate, reflection document and CDEP rewards. Feedback is obtained via structured questions and free-text entry.
All feedback is reviewed and acted upon to continually develop the learning experience. A qualitative feedback example from a diabetes HCP: “A user-friendly, well-written resource with a clear framework to help understand the CamAPS FX system.” User feedback is also obtained via email and online chat support. Email and online chat is used to troubleshoot and support users. The online training platform and content were reviewed by Diabetes UK and the JDRF and both have given endorsement.
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