Lack of confidence among trainee doctors in the management of diabetes: the Trainees Own Perception of Delivery of Care (TOPDOC) Diabetes Study

QJM. 2011 Sep;104(9):761-6. doi: 10.1093/qjmed/hcr046. Epub 2011 Apr 21.


Background: There is an increased prevalence of diabetes. Doctors in training, irrespective of specialty, will have patients with diabetes under their care.

Aim: To determine levels of confidence of doctors in training in the management of diabetes and establish their training needs in this area of clinical practice.

Design: A national online survey of trainee doctors in the UK using a pre-validated questionnaire.

Methods: A four-point confidence rating scale was used to rate confidence in the management of diabetes and comparators. A six-point scale was used to quantify how often trainees would contribute to the management of patients with diabetes and trainees were asked about their training in managing diabetes.

Results: A total of 2149 doctors completed the survey. The percentage 'fully confident' in diagnosing diabetes was 27%, diagnosing and managing hypoglycaemia 55%, diagnosing and managing diabetic ketoacidosis 43%, managing intravenous (IV) insulin 27%, prescribing IV fluids for patients with diabetes 39% and altering diabetes therapy prior to surgery/other procedure 18%. In comparison, 66% and 65% were 'fully confident' in the management of angina and asthma, respectively (P < 0.05). Forty-one percent would take the initiative to optimize glycaemic control for patients under their care >80% of the time. Respectively, 19% and 35% of respondents reported that their undergraduate and postgraduate training had prepared them adequately to optimize treatment of diabetes. The majority (>70%) wanted further training in managing all aspects of diabetes care.

Conclusions: Trainee doctors in the UK lack confidence in the management of diabetes, are unlikely to take the initiative to optimize glycaemic control and report a need for further training.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel*
  • Clinical Competence*
  • Delivery of Health Care / standards
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / therapy*
  • Disease Management
  • Education, Medical, Graduate / methods
  • Education, Medical, Graduate / standards*
  • Endocrinology / education*
  • Humans
  • Needs Assessment
  • Psychometrics
  • Self Concept
  • Students, Medical / psychology*
  • United Kingdom