Confidence Of Primary Care Physicians Research Articles

Assessment of knowledge, attitude, and practice of primary healthcare physicians in Qatar towards hypertension management: An online cross-sectional study.

Primary health care is integral to diagnosing and managing hypertension. This study aimed to assess the knowledge, attitude, practice, priority, and confidence of primary care physicians in Qatar toward hypertension diagnosis and management, and to measure the determinants of good knowledge, desirable attitudes, and desirable practices. We conducted a cross-sectional web-based survey using a modified version of the World Hypertension League Questionnaire during the period from August 30th to October 23rd, 2020. All primary care physicians working in any of Qatar's 27 publicly run primary healthcare centers were invited to participate in the survey. Out of the 450 primary care physicians working at that time, 197 completed the study questionnaire with a response rate of 43.8%. Most respondents stated that they followed local or international treatment guidelines for hypertension management (96.4%). Primary care physicians were highly confident and prioritized hypertension management. The overall desirable practice score was 73.8%, with the highest score (95.4%) for assessing adherence to antihypertensive medications, whereas the lowest desirable practice score was 33.5% for counseling on home blood pressure monitoring. Fifty-one-point eight percentage and 62.4% correctly identified 140 mm Hg and 90 mm Hg as the systolic and diastolic blood pressure threshold for diagnosing hypertension in most patients. The lowest knowledge scores were for hypertension epidemiology in Qatar and recommended dietary modification for hypertensive patients. Respondents had positive attitudes toward task sharing with nonphysician healthcare workers for most items (58.9%-78.2%), except for drug prescriptions (30.5%). Primary care physicians in Qatar had positive attitudes, with high overall confidence and conviction (priority) scores toward hypertension. However, their knowledge scores and certain practices were suboptimal. Healthcare policymakers in Qatar should raise primary care physicians awareness of the current burden of untreated hypertension in the country by organizing targeted educational programs and emphasizing the importance of following national clinical practice guidelines in the diagnosis and management of hypertension.

Diabetes care and education training audit for primary care physicians across 47 counties of Kenya: A pre-post intervention study

IntroductionThe purpose of the study was to evaluate the effectiveness of an online continuous medical education programme for Primary Care Physicians (PCPs) in improving diabetes management in Kenya. MethodsA pretest-post-test design was used to assess the change in knowledge across multiple modules and the overall change in the confidence level of the PCPs in managing people living with diabetes. The study was non-randomised. Course participants were nominated by local scientific associations. ResultsOut of a total of 1750 nominated participants, 1286 completed the training. A statistically significant (p=<0.001) change in knowledge and overall confidence was observed for each of the 8 modules of the training programme. Cohen’s D effect size was calculated as 2.20 and 1.40 for change in knowledge and confidence levels, respectively. DiscussionWeb-based training is an effective way to improve the knowledge and self-reported confidence of PCPs involved in the management of diabetes. This web-based model can support the training needs of PCPs at a pace and time to suit their situation. Similar evidence-based programmes should be considered and field-tested for other healthcare professionals working in the management of diabetes.

Primary care physicians' knowledge and confidence in providing cancer survivorship care: a systematic review.

To systematically review existing literature on knowledge and confidence of primary care physicians (PCPs) in cancer survivorship care. PubMed, Ovid MEDLINE, CINAHL, Embase, and PsycINFO were searched from inception to July 2022 for quantitative and qualitative studies. Two reviewers independently assessed studies for eligibility and quality. Outcomes were characterized by domains of quality cancer survivorship care. Thirty-three papers were included, representing 28 unique studies; 22 cross-sectional surveys, 8 qualitative, and 3 mixed-methods studies. Most studies were conducted in North America (n = 23) and Europe (n = 8). For surveys, sample sizes ranged between 29 and1124 PCPs. Knowledge and confidence in management of physical (n = 19) and psychosocial effects (n = 12), and surveillance for recurrences (n = 14) were described most often. Generally, a greater proportion of PCPs reported confidence in managing psychosocial effects (24-47% of PCPs, n= 5 studies) than physical effects (10-37%, n = 8). PCPs generally thought they had the necessary knowledge to detect recurrences (62-78%, n = 5), but reported limited confidence to do so (6-40%, n = 5). There was a commonly perceived need for education on long-term and late physical effects (n = 6), and cancer surveillance guidelines (n = 9). PCPs' knowledge and confidence in cancer survivorship care varies across care domains. Suboptimal outcomes were identified in managing physical effects and recurrences after cancer. These results provide insights into the potential role of PCPs in cancer survivorship care, medical education, and development of targeted interventions.

ODP566 Success of CME at Improving Knowledge, Competence and Confidence Related to Guideline-Based Diagnosis and Management of Acromegaly

Abstract Introduction We sought to determine if a series of online continuing medical education (CME) activities could improve knowledge, competence and confidence of primary care physicians (PCPs) and endocrinologists (endos) related to guideline-based diagnosis and management of patients with acromegaly. Methods The effect of two (2) separate online, 30-minute, CME-certified roundtable discussions among 3 faculty were analyzed to determine efficacy. The activities posted December 16, 2020, and May 19, 2021, and data were collected for 3 months for each activity. Results Overall, 42% and 30% of PCP learners and 20% and 43% of endo learners improved their knowledge/competence. Conclusions This study demonstrates the success of 2 online, 30-minute roundtable discussions on improving knowledge, competence, and confidence of both PCPs, and endocrinologists regarding guideline-based diagnosis and management of acromegaly, with gaps identified for future education. Presentation: No date and time listed

ODP603 Impact of CME at Improving Knowledge, Competence and Confidence Related to Management of Cushing Disease

Abstract Introduction We sought to determine if an online continuing medical education (CME) activity could improve knowledge, competence and confidence of primary care physicians (PCPs) and endocrinologists (endos) related to management of patients with Cushing disease (CD). Methods Educational design included a "test, then teach" approach to elicit cognitive dissonance, with evidence-based feedback provided following each learner response. A repeated pairs pre-/post-assessment study design was used and McNemar's test (5% significance level, P .8 large). The activity posted June 22, 2021, and data were collected through August 27, 2021. Results Overall, 74% of PCP learners (N=468, Cohen's d=.96) and 75% of endo learners (N=81, Cohen's d=1.14) improved their knowledge/competence(both P Presentation: No date and time listed

ODP567 Success of CME at Improving Knowledge and Confidence Related to Hyperglycemia Associated with Cushing Disease and Acromegaly

Abstract Introduction We sought to determine if an online continuing medical education (CME) activity could improve knowledge and confidence of primary care physicians (PCPs) and endocrinologists (endos) related to hyperglycemia associated with cushing disease (CD) and acromegaly. Methods The effect of an online, 30-minute, CME-certified roundtable discussion among 3 faculty was analyzed to determine efficacy. The activity posted April 29, 2021, and data were collected through July 7, 2021. Results Overall, 51% of PCP learners and 55% of endo learners improved their knowledge. Conclusions This study demonstrates the success of an online, 30-minute roundtable discussion on improving knowledge and confidence regarding hyperglycemia associated with CD or acromegaly, with gaps identified for future education. Presentation: No date and time listed

Online Education Improves Knowledge and Confidence Related to CGM and the AGP

We sought to determine if online continuing medical education (CME) could improve the knowledge and confidence of primary care physicians (PCPs) and diabetologists/endocrinologists (D/Es) related to CGM and AGP. The CME activity was a 30-minute online video panel discussion with synchronized slides. A repeated pairs pre-/post-assessment study design and chi-square test (P <.05 is considered significant) assessed educational effect. The activity launched March 23, 2020 and data were collected through May 19, 2020. In total, 338 PCPs and 189 D/Es were included in the analysis. Overall, there were knowledge and confidence improvements seen among all groups from pre- to post-assessment: • 14% of PCPs (P=.NS) 14% of D/Es (P<.05) improved at identifying benefits of an AGP report • 20% of PCPs (P<.01) 11% of D/Es (P=.NS) improved at recognizing importance of time in range in diabetes management • 13% of PCPs (P<.05) 3% of D/Es (P=.NS) improved at recognizing target blood glucose levels for time in range • 43% of PCPs and 36% of D/Es had a measurable increase in confidence in ability to explain results from an AGP to patients Continued educational gaps: • 60% of PCPs and 47% of D/Es failed to identify benefits of an AGP report • 35% of PCPs and 12% of D/Es failed to recognize importance of time in range in diabetes management This study demonstrates the success of online 30-minute video panel discussion CME on improving knowledge and confidence of PCPs and D/Es related to CGM and the AGP. Continued gaps were identified for future educational targets.

2340-PUB: Success of Online CME at Improving the Clinical Knowledge and Confidence in Using SGLT1/SGLT2 Inhibitors in T1D Management

Introduction: New data continue to emerge related to safety and efficacy of emerging SGLT1 and 2 inhibitors. We sought to assess the effect of online education designed to improve the knowledge and confidence of primary care physicians (PCPs), diabetologists and endocrinologists (D/Es), and nurses/nurse practitioners (NPs) in emerging therapies for diabetes management. Methods: The education consisted of a 30-minute continuing medical education (CME)-certified roundtable discussion among 3 expert faculty. A 3-question knowledge and 1-question confidence linked pre-/post-assessment study design with McNemar’s chi-squared test (5% significance level, P &amp;lt;.05) assessed educational effect. The activity launched September 26, 2018 and data collected through October 5, 2018. Results: Improvements were demonstrated by all specialties (PCP N=324, D/E N=104, nurse/NP N=1519): 24% more PCPs (P&amp;lt;.0001), 20% more D/Es (P=.0032), and 4% more nurses/NPs (P=.0251) correctly identified the mechanism of action of dual SGLT1/SGLT2 inhibitors. 38% of PCPs, 27% of D/Es, and 28% of NPs reported increased confidence in the treatment of type 1 diabetes with non-insulin therapies, specifically SGLT type 1 and SGLT type 2 inhibition. Continued knowledge gaps were identified for all specialties: 72% of PCPs, 65% of D/Es, and 66% of nurses/NPs failed to recognize safety and efficacy data for an emerging dual SGLT1/SGLT2 inhibitors. 40% of PCPs, 17% of D/Es, and 55% of nurses/NPs incorrectly identified a candidate for dual SGLT1/SGLT2 therapy 45% of PCPs, 32% of D/Es, and 69% of nurses/NPs failed to recognize the mechanism of action of dual SGLT1/SGLT2 inhibitors. Conclusion: This study demonstrates the success of an online CME-certified roundtable discussion on improving clinical knowledge and confidence of PCPs, D/Es, and nurses/NPs related to dual SGLT1/SGLT2 inhibitors when treating patients with T1D. Continued knowledge gaps were identified for future education. Disclosure A. Larkin: None. M. LaCouture: None. A. Le: None. Funding Sanofi U.S.; Lexicon Pharmaceuticals

2258-PUB: Online CME Improves Clinical Knowledge and Confidence Related to Use of GLP-1 Receptor Agonists in Combination with Basal Insulin

Introduction: We sought to assess baseline knowledge related to GLP-1 receptor agonist (GLP-1RA) use in combination with basal insulin and determine if an online, video-based, continuing medical education (CME) activity could improve the clinical knowledge of primary care physicians (PCPs) and diabetologists/endocrinologists (D/Es). Methods: A 3-question knowledge and 1-question confidence linked pre-/post-assessment study design with McNemar’s chi-squared test (5% significance level, P &amp;lt;.05) and Cramer’s V (&amp;lt;0.05 no effect; 0.06-0.15 noticeable effect; 0.16-0.30 considerable effect; &amp;gt;0.30 significant effect) assessed educational impact. The activity launched August 23, 2018, and data collected through September 19, 2018. Results: Overall improvements were seen after participation in the CME activity for both PCPs (n = 254, P&amp;lt;.0001, noticeable effect of V= 0.115) and D/Es (n = 95, P=.0284, noticeable effect of V= 0.091). Improvements include: 11% more PCPs (P=.013) and 5% more D/Es (P=.3597) accurately identified the profound effect of combining a GLP-1RA with basal insulin; 9% more of PCPs (P=.0327) and 14% more D/Es (P=.0311) correctly identified the effect of adding exenatide once weekly to insulin glargine in patients with T2D failing basal insulin; 14% more of PCPs (P=0.0016) and 3% more of D/Es (P=.545) accurately identified which combination of therapy resulted in significantly greater reductions in HbA1c, blood glucose (fasting and postprandial), weight, and systolic blood pressure; 28% of D/Es and 41% of PCPs reported increased confidence in recommending a GLP-1RA or SGLT2 inhibitor for a patient failing basal insulin. Conclusion: This study demonstrates the success of online, video-based CME on improving clinical knowledge and confidence of PCPs and D/Es related to using GLP-1RA in combination with basal insulin. Disclosure A. Larkin: None. M. LaCouture: None. A. Le: None. Funding AstraZeneca

Improving Appropriate Basal Insulin Use in Clinical Practice—Impact of Physician Education on T2D Clinical Management

Although insulin is among the most effective antihyperglycemic agents, initiation is often delayed. We studied whether online continuing medical education (CME) could improve the clinical performance and confidence of primary care physicians (PCPs) and endocrinologists (endos) regarding use of basal insulin. The CME activity consisted of an online, 30-minute, video-based roundtable panel discussion. Educational effects were assessed using 3 case-based and 1 self-efficacy repeated pair pre-/post-assessment questions and McNemar’s chi-squared test. The activity launched online August 16, 2016, and data were collected through December 20, 2016. Overall improvements were seen for PCPs (n = 197; P &amp;lt;.001) and endos (n = 27; P =0.014). Relative percent changes from pre- to post-assessment were between 15% and 126% for PCPs and -4% to 40% for endos. While only 7% of PCPs and 19% of endos answered all 4 questions correctly on the pre-assessment, 28% of PCPs and 41% of endos answered all correctly on the post-assessment. The greatest improvements were seen in dosing strategies for preventing hypoglycemia (44% improvement in PCP, P &amp;lt;.001, and 18% in endos, P = 0.025), individualizing therapy in a patient with high glucose variation (23% improvement in PCP, P &amp;lt;.001, and 7% in endos, P = 0.4), and insulin initiation (8% improvement in PCP, P = 0.039, and 22% in endos, P = 0.058). PCPs reported a confidence level of 2.86 on the pre-assessment and 3.45 on the post -assessment, for a total confidence shift of 20.6%. Endos reported a confidence level of 4.04 on the pre-assessment and 4.44 on the post -assessment for a confidence shift of 10.1%. This study demonstrates the success of an online, roundtable activity in improving performance of PCPs and endos regarding use of newer basal insulins. Studies have shown that case questions are an effective way to measure clinical performance in practice; therefore this activity is expected to translate into improved T2D management in clinical care. Disclosure A. Larkin: None. M. LaCouture: None. A. Le: None.

Maternal mental health: a shared care approach.

Maternal mental health problems affect up to 20% of women, with potentially deleterious effects to the mother and family. To address this serious problem, a Maternal Mental Health Program (MMHP) using a shared care approach was developed. A shared care approach can promote an efficient use of limited specialized maternal mental health services, strengthen collaboration between the maternal mental health care team and primary care physicians, increase access to maternal mental health care services, and promote primary care provider competence in treating maternal mental health problems. The purpose of this research was to evaluate the impact of a MMHP using a shared care approach on maternal anxiety and depression symptoms of participants, the satisfaction of women and referring physicians, and whether the program met the intents of shared care approach (such as quick consultation, increased knowledge, and confidence of primary care physicians). We used a pre and post cross-sectional study design to evaluate women's depression and anxiety symptoms and the satisfaction of women and their primary care health provider with the program. Findings Depression and anxiety symptoms significantly improved with involvement with the program. Women and physicians reported high levels of satisfaction with the program. Physician knowledge and confidence treating maternal mental health problems improved. Shared care can be an effective and efficient way to provide maternal mental health care in primary health care settings where resources are limited.

Use of Survivorship Care Plans in the United States: Associations With Survivorship Care

Survivorship care plans (SCPs), including a treatment summary and follow-up plan, intend to promote coordination of posttreatment cancer care; yet, little is known about the provision of these documents by oncologists to primary care physicians (PCPs). This study compared self-reported oncologist provision and PCP receipt of treatment summaries and follow-up plans, characterized oncologists who reported consistent provision of these documents to PCPs, and examined associations between PCP receipt of these documents and survivorship care. A nationally representative sample of medical oncologists (n = 1130) and PCPs (n = 1020) were surveyed regarding follow-up care for breast and colon cancer survivors. All statistical tests were two-sided. Multivariable regression models identified factors associated with oncologist provision of treatment summaries and SCPs to PCPs (always/almost always vs less frequent). Nearly half of oncologists reported always/almost always providing treatment summaries, whereas 20.2% reported always/almost always providing SCPs (treatment summary + follow-up plan). Approximately one-third of PCPs indicated always/almost always receiving treatment summaries; 13.4% reported always/almost always receiving SCPs. Oncologists who reported training in late- and long-term effects of cancer and use of electronic medical records were more likely to report SCP provision (P < .05). PCP receipt of SCPs was associated with better PCP-reported care coordination, physician-physician communication, and confidence in survivorship care knowledge compared to receipt of neither treatment summaries nor SCPs (P < .05). Providing SCPs to PCPs may enhance survivorship care coordination, physician-physician communication, and PCP confidence. However, considerable progress will be necessary to achieve implementation of sharing SCPs among oncologists and PCPs.

Gaps in survivorship care plan delivery and potential benefits to survivorship care.

9594 Background: Survivorship care plans (SCPs), consisting of a treatment summary and follow-up plan, are intended to promote coordination of post-treatment cancer care. Yet, little is known about the provision of these documents by oncologists to primary care physicians (PCPs). This study compared self-reported oncologist provision and PCP receipt of treatment summaries and follow-up plans, characterized oncologists who reported consistent provision of these documents to PCPs, and examined associations between PCP receipt of these documents and survivorship care. Methods: A nationally representative sample of medical oncologists (N=1130) and primary care physicians (PCPs; N=1020) were surveyed regarding follow-up care for breast and colon cancer survivors using the cross-sectional Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) in 2009. Results: Nearly half of oncologists reported always/almost always providing treatment summaries, while 20.2% reported always/almost always providing SCPs (treatment summary + follow-up plan). Approximately one-third of PCPs indicated always/almost always receiving treatment summaries, while 13.4% reported always/almost always receiving SCPs. Oncologists who reported training in late and long-term effects of cancer and use of electronic medical records were more likely to report SCP provision (p&lt;0.05). PCP receipt of SCPs was associated with better PCP-reported care coordination, physician-physician communication, and confidence in survivorship care knowledge compared to receipt of neither treatment summaries nor SCPs (p&lt;0.05). Conclusions: Providing SCPs to PCPs may enhance survivorship care coordination, physician-physician communication, and PCP confidence in caring for survivors. However, a minority of oncologists report routinely delivering SCPs to PCPs. Considerable progress will be necessary to achieve sharing of SCPs among oncologists and PCPs.

Caring for Survivors of Breast Cancer: Perspective of the Primary Care Physician

Increasing numbers of women are surviving breast cancer, and survivorship care is becoming more complex. Primary care physicians provide care for most survivors of breast cancer in the Canadian province of British Columbia. The present study offers insight into the confidence of primary care physicians in their abilities to provide such care. It also explores potential ways to assist those providers in enhancing this aspect of their practice. A questionnaire was mailed to 1000 primary care physicians caring for survivors of breast cancer. The questionnaire explored the perspectives of the responding physicians on their ability to manage various aspects of survivorship care for breast cancer patients, identified preferences for the content and format of communication from oncologists at the time of transition from active oncology treatment to survivorship, and determined the means most commonly used to obtain knowledge about breast cancer. This 1-page, 31-item checkbox and open-answer questionnaire assessed the perceptions of primary care physicians about the care of breast cancer survivors after completion of active treatment and their personal preferences for resources providing information about breast cancer. The questionnaire response rate was 59%. Primary care physicians reported being most confident in screening for recurrence and managing patient anxiety; they were least confident in managing lymphedema and providing psychosocial counselling. Compared with physicians following fewer survivors of breast cancer, those who followed more breast cancer survivors had higher confidence in managing the biomedical aspects of follow-up and in providing counselling about nutrition and exercise. Most physicians found discharge letters from oncologists to be useful. Point-form discharge information was preferred by 43%; detailed description, by 19%; and both formats, by 38%. The most useful information items identified for inclusion in a discharge letter were a diagnosis and treatment summary and the recommended surveillance and endocrine therapy. Continuing medical education events and online resources were the means most commonly used to obtain knowledge about breast cancer. Primary care physicians who provide follow-up for survivors of breast cancer report that they are confident in managing care and satisfied with discharge letters containing a diagnosis and treatment summary, and recommendations for surveillance and endocrine treatment. At the time of patient discharge, additional information about common medical and psychosocial issues in this patient population would be useful to primary care physicians. Preferred means to access current breast cancer information include continuing medical education events and online resources.

Confidence of primary care physicians in their ability to carry out basic medical genetic tasks—a European survey in five countries—Part 1

Western health care systems are facing today increasing movement of genetic knowledge from research labs into clinical practice. This paper reports the results of a survey that addressed the confidence of primary care physicians in their ability to carry out basic medical genetic tasks. The survey was conducted in five countries (France, Germany, The Netherlands, Sweden and the UK). Stratified random samples were drawn from primary care physicians in the five countries representing a sampling frame of 139,579 physicians. Stepwise binary logistic regression procedures were performed to identify the predictor variables for self-reported confidence. Three thousand six hundred eighty-six physicians participated and filled out a self-administered questionnaire. The margin of error for accurate representation of each group of European general practitioners and specialists in the total sample is 2.9% for GP, 2.8% for obstetricians/gynaecologists (OB/GYN) and for paediatricians (PAED) 2.6% (95% confidence level). Confidence in their ability to carry out basic medical genetic tasks is low among participating primary care physicians: 44.2% are not confident, 36.5% somewhat confident, confident or very confident are 19.3%. In each country, those confident/very confident represent less than 33% of the participating physicians. Primary care physicians who report the lowest levels of confidence prove to be those least exposed to medical genetics information and training. Although there are significant differences in the way in which professional education is organised and practice is regulated across European countries, there is a need for a coordinated European effort to improve primary care physicians' background in medical genetics.

Primary Care Physicians and Oncologists Are Players on the Same Team

Primary Care Physicians and Oncologists Are Players on the Same Team

Autoevaluación de fortalezas, debilidades y confianza de los médicos de atención primaria en el abordaje de enfermedades reumatológicas

Rheumatologic diseases are common and frequently managed by primary care physicians. To assess strengths, weaknesses and self confidence of primary care physicians in the management of rheumatic diseases. A self assessment and anonymous questionnaire was mailed to primary care physicians of two Chilean regions. Using a 10 points Likert scale, they were asked about personal interest, undergraduate training, continuous medical education, availability of medical literature, complementary laboratory tests and consultation with a rheumatologist. Medical skills, knowledge, therapeutic approach and performance of rheumatologic procedures were evaluated under the item confidence. Three hundred forty seven out of 763 physicians (45%) answered the questionnaire. Their age range extended from 25 to 75 years, 59% were male, 58% were Chilean and 74% worked in the Metropolitan region. The worst evaluated parameters were availability of literature with a score of 2.2+/-2, access to consultation with a rheumatologist (3.8+/-2.2) and to continuous medical education (4.3+/-2.7). Physicians had a better confidence in their knowledge (6.7+/-1.5) and in their therapeutic approach (6.1+/-1.5). The worst confidence score was for shoulder injection therapy (3.4+/-2.6). Continuous medical education correlated with knowledge but not with clinical skills. Primary care physicians perform a bad assessment of their skills in rheumatology. They have a low level of confidence in their clinical skills to perform rheumatologic procedures. Continuous medical education improves confidence in knowledge but not in skills.

Confidence of primary care physicians in assessing the suicidality of geriatric patients.

This study examined the confidence levels of physicians in assessing the risk of suicide among older adults in clinical settings. Of the 300 physicians who were selected from a population of 4980 family practice, internal medicine, and geriatric physicians in Illinois, 63% responded to the mail survey. Several categorical items inquired about specific assessment and treatment approaches, referral resources used, barriers to meeting the mental health needs of older patients, and sources of training in suicide risk assessment. All the training items (suicide assessment in medical school, residency, and CME courses; rating of medical school training; and insufficient training in geriatric mental health) were significantly (p < 0.01) associated with confidence in assessing suicidality. The overall model consisting of six variables explained 57% of the variation in confidence scores [F (6, 130) = 28.48, p < 0.001]. Three variables accounted for 50% of the explained variance: confidence in diagnosing depression, residency training in the assessment of suicide risk, and assessment of the intentional misuse of medication. Confidence in diagnosing depression (beta = 0.38, p < 0.001) was the strongest predictor. More effective mental health care will require specific preparation in treating geriatric patients through the full spectrum of medical training, including medical school, residency, and CME courses. Improved prevention of elderly suicide hinges on the enhancement of clinical skills in diagnosing and treating geriatric depression.