Title: Baseline and End line knowledge assessment: A time tested tool to ascertain the impact on knowledge of a pan India diabetes training
Background
In India, several capacity building initiatives on diabetes are in place but the delivery of these programs is often plagued by lack of inbuilt Monitoring and evaluation (M & E) mechanism and quality assurance is often ignored. Certificate Course in Evidence Based Diabetes Management (CCEBDM) is a diabetes training program conceptualized in 2010, which has trained over 8000 trained PCPs in 7 years. The objective of CCEBDM program has been to enhance knowledge, skills and core competencies of primary care physicians (PCPs) in Diabetes. The course has a robust and rigorous mechanism for continuous monitoring and evaluation.
Aim: To evaluate the impact of CCEBDM training on knowledge of PCPs through baseline and end line knowledge assessment.
Methods
A questionnaire consisting 25 questions, in consultation with the academic partner was designed, consisting of multiple choice questions pertaining to basic knowledge on diabetes. The knowledge of the participants was assessed using this questionnaire at the commencement of the cycle (Baseline Survey) as well as at the cycle completion. (End line survey). Baseline & end line questionnaires were uploaded on an online portal (survey monkey), and participants were sent the link to fill in their responses. Printed copies of the baseline and end line questionnaires were also sent to the enrolled participants to ensure maximum participation in the survey. The questionnaire constituted 25 questions and 19 out of the 25 questions were analyzed.

Results
A total of 977 baseline and 867 end line responses were received out of which 82 % were online responses and 18% printed responses. The cumulative results demonstrate a 3 unit increase in knowledge in the end line scores as compared to the baseline. The results also depicted that before the training 290 participants received less than 50% correct overall baseline score (<10) while after the training, only 27 participants had a low score. Before the training, only 101 participants had scores in the highest range (15-19) while after the training the number increased to 314.These results were  statistically significant (p value = < 0.0001. Participant performance in all subthemes (basic concepts, diagnosis, complications and management of diabetes) improved in all after the training. The number of participants with nil scores decreased from 99 to 7 in basic concepts, from 8 to 1 in diagnosis, from 36 to 15 in complications and from 10 to 1 in management of diabetes. Number of participants who got all the correct responses in management of diabetes showed a 3 fold increase from baseline to end line evaluation (Baseline n =97; end line n=271).

Conclusion 
Simple tools such as baseline and end line knowledge assessments have proven to be effective measures to assess the progress and impact on knowledge of the CCEBDM trainees.

Baseline and end line knowledge assessment: A tool to ascertain the impact on knowledge of a pan India diabetes training