Despite evidence that residents have a high degree of confidence
in their ability to manage diabetes (16), a perplexing question raised
by our study and similar ones (10,11) is why so few patients receive
documented eye and foot examinations. It is possible that this is
simply a failure to document the process of care, and electronic
medical record prompts could improve recording that these quality
indicators were performed. How to increase the quality of diabetes
care is also a concern because this study and others (10,11,13)
repeatedly demonstrate limited time with patients, and competing
comorbid conditions may contribute to not meeting quality
indicators. As Lynn et al (13) argue, additional research is needed to
determine what type of training is best and offers the possibility that
team-based clinics hold promise for improving care.