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Home Research Research Library Diuretic of Choice in ABFM Hypertension Self-Assessment Module Simulations Diuretic of Choice in ABFM Hypertension Self-Assessment Module Simulations 2012 Author(s) Hagen, Michael D, Sumner, W, and Fu, H Topic(s) Education & Training Keyword(s) Clinical Simulation Volume Journal of the American Board of Family Medicine Source Journal of the American Board of Family Medicine BACKGROUND: Evidence suggests that chlorthalidone has therapeutic advantages over hydrochlorothiazide, perhaps because of a longer antihypertensive effect. Although guidelines such as the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure treat diuretics as a class, some experts believe chlorthalidone is the diuretic of choice in hypertension management. We evaluated diplomates’ use of chlorthalidone and hydrochlorothiazide as first-choice diuretics in virtual patient simulations of hypertension in the American Board of Family Medicine Maintenance of Certification for Family Physicians self-assessment modules. METHODS: We examined action logs for hypertension simulations completed between 2004 and 2011 and identified initial antihypertensive choices made by diplomates. We tabulated uses of any diuretic as initial treatment, distinguishing between chlorthalidone, hydrochlorothiazide, and other diuretic choices. We examined trends in the use of diuretics and chlorthalidone in simulations using linear models. RESULTS: Chlorthalidone use increased 0.7 percentage points per year (test for beta >0, P < .0013), from approximately 1.3% of simulation prescriptions in 2004 to about 4.8% in 2010 and 2011, whereas hydrochlorothiazide prescriptions fell 2 percentage points per year (P = .035), from nearly 57% to 47%. As a fraction of all diuretic use, chlorthalidone increased 1.4 percentage points per year (P = .0006), from 2% to 9%. CONCLUSIONS: Small but growing numbers of diplomates are heeding recommendations in the growing literature to start with chlorthalidone rather than hydrochlorothiazide, at least in the virtual patient environment. Observed choices in virtual patient management strongly imply that this is a valid topic for additional attention in the hypertension self-assessment module. ABFM Research Read all 2020 Family Medicine Clerkship Directors’ Handling of Student Mistreatment: Results From a CERA Survey Go to Family Medicine Clerkship Directors’ Handling of Student Mistreatment: Results From a CERA Survey 2011 Demonstrating the construct stability of a translated exam for family medicine residents. Go to Demonstrating the construct stability of a translated exam for family medicine residents. 2013 Toward Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions Go to Toward Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions 2022 Family Medicine Residencies: How Rural Training Exposure in GME Is Associated With Subsequent Rural Practice Go to Family Medicine Residencies: How Rural Training Exposure in GME Is Associated With Subsequent Rural Practice
Author(s) Hagen, Michael D, Sumner, W, and Fu, H Topic(s) Education & Training Keyword(s) Clinical Simulation Volume Journal of the American Board of Family Medicine Source Journal of the American Board of Family Medicine
ABFM Research Read all 2020 Family Medicine Clerkship Directors’ Handling of Student Mistreatment: Results From a CERA Survey Go to Family Medicine Clerkship Directors’ Handling of Student Mistreatment: Results From a CERA Survey 2011 Demonstrating the construct stability of a translated exam for family medicine residents. Go to Demonstrating the construct stability of a translated exam for family medicine residents. 2013 Toward Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions Go to Toward Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions 2022 Family Medicine Residencies: How Rural Training Exposure in GME Is Associated With Subsequent Rural Practice Go to Family Medicine Residencies: How Rural Training Exposure in GME Is Associated With Subsequent Rural Practice
2020 Family Medicine Clerkship Directors’ Handling of Student Mistreatment: Results From a CERA Survey Go to Family Medicine Clerkship Directors’ Handling of Student Mistreatment: Results From a CERA Survey
2011 Demonstrating the construct stability of a translated exam for family medicine residents. Go to Demonstrating the construct stability of a translated exam for family medicine residents.
2013 Toward Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions Go to Toward Graduate Medical Education (GME) Accountability: Measuring the Outcomes of GME Institutions
2022 Family Medicine Residencies: How Rural Training Exposure in GME Is Associated With Subsequent Rural Practice Go to Family Medicine Residencies: How Rural Training Exposure in GME Is Associated With Subsequent Rural Practice