Table 1.

Lecture outline.

Step	Aim	Timing (min)	Activity
1	Gain attention	5	Tutor explains the rationale of the session
			Start the lesson with a thought-provoking fact: “Why do trainees think that it is so difficult to get the insulin prescription right when a diabetic patient undergoes surgery?”
			Use a multimedia visual stimulus: PowerPoint presentation of a case-scenario of a diabetic patient scheduled for surgery.
			Distribute a note-taking guide with the crucial points and guidelines, and with space for written notes.
2	Inform the trainees of the objectives	3	Present the slide with the learning outcomes
			1. Classify different anti-diabetic drugs and describe their main uses.
			2. Differentiate between recent guidelines for perioperative management of diabetic patients, and compare them with the departmental protocol. Appreciate the commonalities and differences between these different guidelines.
			3. Summarise the main preoperative approaches available according to given anti-diabetic drugs. Follow with a small group discussion, so that trainees can reflect on these learning outcomes. Give input and suggest changes when needed. Ask about topics that are not mentioned and need to be included in the list.
3	Stimulate recall of prior learning	10	Have the trainees review the preoperative approach to diabetic patients as case discussion in ‘buzz groups’.
			Divide the group into three, and have each subgroup discuss a different case of a patient with the specific therapeutic management of diabetes: Case 1: Diabetic managed through their diet. Case 2: Diabetic taking oral antidiabetic drugs Case 3: Diabetic under insulin therapy.
			Review the use and classification of the common anti-diabetic drugs (Objective 1).
			Ask the trainees about any previous experiences and difficulties that they have encountered in prescribing oral antidiabetic drugs and insulin regimes.
4	Present the stimulus	8	Give trainees a thorough insight into the most recent guidelines on preoperative management of diabetic patients.
			Stop twice during this presentation to ask the trainees actively to pinpoint new knowledge, and to compare this with previously learned approaches.
5	Provide learning guidance	10	Go back to cases #2 and #3 of section 3. Review the examples and show the trainees the optimal way to write the pre-operative prescriptions according to both the local hospital protocols and the international guidelines (these should not be mutually exclusive).
			Include in the presentation a simulation of the filling in of the relevant hospital forms, and a flowchart (if existent) of all of the steps to be taken.
6	Elicit performance	10	Use a role-playing exercise to rehearse the practice of writing correct prescriptions.
			Sort the audience into pairs and give out cards with a case vignette to the trainees playing the patient. The goal is to simulate an anaesthesia appointment with different types of diabetic patients (i.e., insulin therapy, oral antidiabetics, injectable non-insulin agents) for different types of surgery (i.e., ambulatory vs. in-hospital admission), and to advise on the correct prescriptions for these drugs, accordingly.
7	Provide feedback	5	Observe each pair of trainees as they perform the role-playing and (preferably) take notes for your feedback. For larger groups, consider more facilitators to help with feedback delivery.
			Offer individual and immediate feedback during the performances where corrections might be needed.
			Deliver feedback in a safe, non-judgemental learning environment.
			Invite the other trainees to provide constructive feedback.
8	Assess performance	5	Ask the trainees to turn to their note-taking guide and to now individually answer the final multiple-choice questions in the booklet.
			After that, the answers are discussed in the group, and the correct ones are given. Check for how many questions each trainee got right.
9	Enhance retention and transfer	5	To enhance retention, insist that trainees practice what they have learned with real patients during their pre-anesthesia appointments.
			Distribute a decision flowchart similar to the one shown in step 5 for trainees to carry with them.
			Inform trainees to contact their teaching supervisors through the usual channels (beeper, e-mail) when questions arise.
			Close the session by asking for the last open questions and answer these. Review the key points as a final statement, and asking for feedback from the trainees using a questionnaire.