# From Guidelines to Practice: Case-Based Teaching Module to Improve MASLD Screening in Diabetes Care for Internal Medicine Residents

## TL;DR

A case-based teaching module improved internal medicine residents' knowledge and practices regarding MASLD screening in diabetes care.

## Contribution

A novel case-based educational module effectively enhanced residents' adherence to updated MASLD screening guidelines.

## Key findings

- Residents' overall knowledge scores increased significantly after the session.
- Epidemiology and practice scores improved, with lasting effects observed at year's end.
- Most residents reported changes in screening and referral practices post-training.

## Abstract

Metabolic dysfunction–associated steatotic liver disease (MASLD) is a prevalent, yet underrecognized condition with serious, but preventable, complications. The American Association for the Study of Liver Diseases, American Association of Clinical Endocrinology (2022), and American Diabetes Association (2025) recommend MASLD screening for patients with type 2 diabetes, including using the Fibrosis-4 (FIB-4) index for noninvasive risk stratification of those needing further evaluation. Primary care physicians are key to early diagnosis but may be unfamiliar with updated guidelines.

A 30-minute case-based educational session on MASLD was delivered to 54 internal medicine residents in small groups during 2023–2024. Sessions integrated retrieval-based learning, brief didactics, and facilitated discussion. Participants completed 3 surveys (presession, immediately postsession, and year's end) assessing MASLD knowledge and perceived clinical impact. Scores (correct answer = 1 point, 12 total) overall and by category (Epidemiology, Practices) were analyzed by ANOVA and paired t tests.

Among 47 survey 1 respondents, 41 survey 2 respondents, and 9 survey 3 respondents, respective mean scores were 6.57, 9.20, and 8.00 overall (p < .001); 1.91, 3.88, and 2.56 for Epidemiology (p < .001); and 4.66, 5.32, and 5.44 for Practices (p = .006). Mean scores increased on survey 2 (overall +2.59; Epidemiology +1.95; Practices +0.63; each p < .001). Survey 3 mean scores increased for Practices (+1.22, p = .01), with 71% reporting screening changes and 76% reporting referral practice changes.

Targeted interventions improved knowledge of guideline-based MASLD screening, FIB-4 interpretation, and indications for hepatology referral.