Education In Geriatric Medicine Research Articles

New horizons in undergraduate geriatric medicine education.

Current projections show that between 2000 and 2050, increasing proportions of older individuals will be cared for by a smaller number of healthcare workers, which will exacerbate the existing challenges faced by those who support this patient demographic. This review of a collection of Age and Ageing papers on the topic in the past 10years explores (1) what best practice geriatrics education is and (2) how careers in geriatrics could be made more appealing to improve recruitment and retention. Based on these deeper understandings, we consider, as clinician educators, how to close the gap both pragmatically and theoretically. We point out paradigm shifting solutions that include innovations at the Undergraduate level, use of simulation, incorporation of learner and patient perspectives, upskilling professionals outside of Geriatrics and integration of practice across disciplines through Interprofessional Learning. We also identify an education research methodological gap. Specifically, there is an abundance of simple descriptive or justification studies but few clarification education studies; the latter are essential to develop fresh insights into how Undergraduate students can learn more effectively to meet the needs of the global ageing challenge. A case of improving understanding in delirium education is presented as an illustrative example of a new approach to exploring at greater depth education and outlines suggested directions for the future.

1826 Development of inter-professional simulation-based education in geriatric medicine

Abstract Background Understanding human factors involved in patient care is a focus of the Geriatric Medicine Training curriculum including the leadership of and communication within an interprofessional team. Geriatric Medicine Specialty Trainees (ST4+) need advanced communication skills and confidence in managing complex situations. Simulation-enhanced Interprofessional Education (Sim-IPE) provides insight into other disciplines roles (1). We hypothesised that the implementation of a Sim-IPE programme dedicated to communication skills could improve confidence. Method We organised a one-day Sim-IPE programme for our Geriatric Medicine ST4+. Faculty consisted of doctors, advanced nurse practitioner, social worker, occupational therapist, physiotherapist and speech and language therapist. Communication scenarios, with faculty as simulated participants, were undertaken including establishing a ceiling of treatment, management of delirium, breaking bad news, ethical feeding dilemmas, complex discharge planning and capacity assessment. Debrief discussions followed each scenario. Mixed-method evaluation was used with questionnaires collected from learners’ pre and post session in a 10-point Likert scale to compare confidence levels. Qualitative feedback was collected from learners and faculty. Results Ten Geriatric Medicine ST4+ attended plus nine faculty including two facilitators. Positive feedback was received from learners and faculty. There was improvement in confidence across all six scenarios (one being “not at all confident” and ten “extremely confident”). Pre-session average confidence was 7.2, post-session 8.7. All trainees would recommend the programme to a colleague. Common learning themes included gaining feedback from debrief discussions and shared learning from our allied-health professionals. Learners and faculty commented on the enjoyment, usefulness and value of learning within a safe team environment. Conclusion Sim-IPE can improve confidence in complex communication scenarios and human factor skills. Feedback highlighted that this programme would be useful for all General Internal Medicine Specialty Trainees.

Opportunities to improve undergraduate Geriatric Medicine education in the post-pandemic era

Opportunities to improve undergraduate Geriatric Medicine education in the post-pandemic era

276 Development of inter-professional simulation-based education in geriatric medicine

Abstract Background Understanding human factors involved in patient care is a focus of the Geriatric Medicine Training curriculum including the leadership of and communication required within an interprofessional team. Geriatric Medicine Specialty Trainees (ST4+) need advanced communication skills and confidence in managing complex situations. Simulation-enhanced Interprofessional Education (Sim-IPE) provides insight into other disciplines roles. We hypothesised that the implementation of a Sim-IPE programme dedicated to communication skills could improve confidence. Methods We organised a one-day Sim-IPE programme for our Geriatric Medicine ST4+. Faculty consisted of doctors, advanced nurse practitioner, social worker, occupational therapist, physiotherapist and speech and language therapist. Communication scenarios, with faculty as simulated participants, were undertaken including establishing a ceiling of treatment, management of delirium, breaking bad news, ethical feeding dilemmas, complex discharge planning and capacity assessment. Debrief discussions followed each scenario. Mixed-method evaluation was used with questionnaires collected from learners’ pre and post session in a 10-point Likert scale to compare confidence levels. Qualitative feedback was collected from learners and faculty. Results Ten Geriatric Medicine ST4+ attended plus nine faculty including two facilitators. Positive feedback was received from learners and faculty. There was improvement in confidence across all six scenarios (one being ‘not at all confident’ and ten ‘extremely confident’). Pre-session average confidence was 7.2, post-session 8.7. All trainees would recommend the programme to a colleague. Common learning themes included gaining feedback from debrief discussions and shared learning from our allied-health professionals. Learners and faculty commented on the enjoyment, usefulness and value of learning within a safe team environment. Conclusion Sim-IPE can improve confidence in complex communication scenarios and human factor skills. Feedback highlighted that this programme would be useful for all General Internal Medicine Specialty Trainees.

Transforming undergraduate education in geriatric medicine: an innovative curriculum at Bristol Medical School

Key summary pointsAimResearch and innovation in undergraduate education in geriatric medicine is essential to effectively equip tomorrow’s doctors with the skills and knowledge required to care for older adults with complex health and social care needs.FindingsTransitioning between two undergraduate medical curricula meant that Bristol Medical School was uniquely positioned to innovate and evaluate undergraduate education in geriatric medicine. The product of this was a new innovative 18-week programme titled ‘Complex Medicine in Older People’, outlined in this article.MessageThis marked shift in mode and duration of teaching affords the opportunity to innovate and evaluate undergraduate education in geriatrics, providing an evidence-based model for future teaching on aging.

743 THE THIRD NATIONAL SURVEY OF UNDERGRADUATE TEACHING IN AGEING AND GERIATRIC MEDICINE AND ITS IMPACT ON STUDENTS’ ATTITUDES

Abstract Introduction The British Geriatrics Society’s (BGS) recommended undergraduate curriculum was conceived in 2008 and mapped to the General Medical Council’s (GMC) standards [1]. Subsequently, two national surveys have described how geriatric medicine is taught in the UK and both identified areas for improvement [2,3]. In 2018, the GMC updated their statutory learning outcomes, therefore it is timely that the BGS remap their curriculum to this new guidance, with repeat surveys of UK institutions and students. Methods We will undertake a three-stage study of undergraduate education in geriatrics. Firstly, we will map the BGS recommended curriculum to the GMC’s ‘Outcomes for Graduates’. Secondly, we will survey UK medical schools on the content, methodology, timing and duration of teaching in geriatrics. Thirdly, we will assess medical students’ attitudes towards older people and a potential career in geriatric medicine. Results Descriptive analysis will be used for quantitative data. ‘White space’ questions will be analysed qualitatively using a framework approach. Medical school data will be compared to the BGS recommended curriculum to identify gaps in the current provision of education in geriatrics. We will test whether teaching exposure to geriatrics is associated with students’ attitudes and career intentions, conditional on student characteristics. Conclusion In order to meet the demands of the ageing population, it is essential that medical schools nurture doctors furnished with the knowledge, skills and values required to look after older adults with complex care needs. This study is an opportune evaluation of current UK teaching provision and student attitudes that will inform future iterations of the BGS recommended undergraduate curriculum and innovations in geriatric medicine education.

The giants of education in geriatric medicine and gerontology.

In 2014, the European undergraduate curriculum in Geriatric Medicine was published to cover the minimum requirements that a medical student should achieve by the end of medical school. In 2019, the European postgraduate curriculum in Geriatric Medicine outlined the minimum recommended training requirements to become a geriatrician at specialist level in the EU. The postgraduate dimension of Geriatric Medicine education is a highly relevant topic for all, since most physicians-independently of their specialty-are inevitably involved in the care of older patients, but for most physicians, geriatrics is not part of their postgraduate generalist or specialty training. A key area for postgraduate education remains the provision of Geriatric Medicine competencies to all specialties outside geriatrics. There is also need for wider educational initiatives to improve the gerontological education of patients and the public. Bernard Isaacs famously coined the expression 'geriatric giants' or the four clinical I's: Intellectual impairment, Incontinence, Immobility, and Instability. However, non-clinical giants exist. In education, we face challenges of Investment, Inspiration, Integration, and Interprofessionality; and in research, we need to attract Interest and Income, and generate Innovation and Impact. Without strengthening the links between all giants, we will not be able to achieve the ambition of age-attuned societies. A key goal for gerontological education is to enhance everyone's understanding of the wide diversity underlying the 'older people' demographic label, which will ultimately promote services and societies that are more responsive and inclusive to the needs of all older adults, irrespective of their health status.

Teaching geriatric medicine through gamification: a tool for enhancing postgraduate education in geriatric medicine

BackgroundPolypharmacy is becoming increasingly common and all doctors must be prepared to manage it competently.AimsThe aim of this project is to evaluate the feasibility and use of a novel gamification-based teaching intervention on polypharmacy among doctors undergoing advanced geriatric training. Among others, one of the learning goals for the students was to be able to describe the adherence to medication.MethodsElectronic questionnaire sent to students of the third session “evidence-based medicine in geriatrics” of advanced postgraduate course in geriatrics of the European Academy for Medicine of Ageing.ResultsMost students reported issues with forgetting doses and remembering sufficiently to establish a medication routine due to busy schedules as well as social influences around medication taking. Reflecting on the challenges of the game, most students reported that their own prescribing practice was likely to change.Discussion and conclusionThe current model of learning appears to be a feasible approach for postgraduate medical education or in other areas of healthcare such as nursing or physiotherapy. Learning through action and reflection promotes deeper thinking and can lead to behavioral change, in this case thus enhancing the attitudes and understanding regarding pharmacological issues associated with ageing. Recommendations for future research in medical education about medication adherence are outlined.

Teaching Tools to Teach Geriatric Medicine to Family Medicine Residents

Objective: To determine if pocket-sized, reference guides are helpful tools for teaching geriatric medicine to family medicine residents. Setting: Loma Linda University Healthcare Education Consortium, a family medicine residency in San Bernardino County, California. Participants: Family medicine residents that successfully completed the required geriatrics rotation between July 2019 and June 2020. Results: From the twelve family medicine residents, 100% believed their geriatric medicine rotation helped them to be successful in residency. The preferred study tool was the pocket guides, mainly the “Geriatric Medicine Pocket Guide” and “2019 AGS Beers Criteria”. For a more comprehensive reading, the study tool most used was search engines such as Up-to-date and Dynamed. Geriatrics at Your Fingertips (Reuben et al., 2016) and the “Guiding Principles for the Care of Older Adults with Multimorbidity Pocket Card” were not as helpful due to the perceived increased efforts to rapidly find clinically relevant information. Conclusion: Pocket guides, especially “Geriatric Medicine Pocket Guide” and “2019 AGS Beers Criteria”, are helpful teaching tools that can be used to augment geriatric medicine education in a family medicine residency.

Start low, go slow, but look far: the case of geriatric medicine in Balkan countries.

To present an insight of the situation of geriatric medicine in Balkan countries, as it was presented in the context of the 2nd pre-congress seminar of the 16th European Geriatric Medicine Society (EuGMS) Congress Athens 2021. Representatives from 8 Balkan countries (Albania, Croatia, Greece, Republic of North Macedonia, Romania, Serbia, Slovenia, Turkey) answered 3 questions to reflect the state of geriatric medicine in their country: education on geriatrics; systems/methods for assessment of functional status and frailty; pre-operative risk assessment. An open discussion followed. Undergraduate education in geriatric medicine seems underestimated in medical faculties of Balkan countries, whereas a high heterogeneity is observed at a post-graduate level. Only a few Balkan countries have geriatric medicine as a recognized medical specialty or subspecialty. Functional status and frailty are only sporadically assessed, and pre-operative risk assessment is very rarely performed with a geriatric focus. Scarcity of expertise and structures relevant to geriatric medicine seems to be common. Developing a training curriculum and geriatrics-related structures are two interconnected aspects. Cooperation among physicians and multidisciplinary teams are essential for the practice of geriatric medicine. A functional geriatric network is eventually necessary and ambulatory geriatric expertise is probably a feasible and clinically relevant starting point. Providing pragmatic solutions to the pressing challenges in variable clinical settings, supplementing and working in harmony with existing components of each health system, is probably the most convincing strategy to gain political support in developing geriatric medicine. Balkan countries share common experiences and challenges in developing geriatrics. Whilst the principles of geriatric medicine are perhaps universal, proposed solutions should be adapted to each country's specific circumstances. Cooperation of the Balkan countries could promote in each the development of geriatric medicine. EuGMS is willing to foster relevant actions.

Interprofessional education in geriatric medicine: towards best practice. A controlled before–after study of medical and nursing students

ObjectivesTo investigate nursing and medical students’ readiness for interprofessional learning before and after implementing geriatric interprofessional education (IPE), based on problem-based learning (PBL) case scenarios. To define the optimal number...

Massive open online courses (MOOCs) for long-distance education in geriatric medicine across Europe

Key summary pointsAimThe aim of the paper is to give insight into MOOCs in general and to specifically describe a MOOC developed in the course of the SCOPE project “Screening for Chronic Kidney Disease (CKD) among older People across Europe”.FindingsThe major target of the MOOC was the improvement of knowledge for a broad audience. The SCOPE MOOCs are freely accessible, structured in three modules, offer additional learning material and guarantee knowledge dissemination about aging and chronic kidney diseases.MessageThe MOOCs represent a contemporary example of how modern technology is supporting a transition to modern training in geriatrics.

Podcast: The State of Geriatric Medicine Education

Podcast: The State of Geriatric Medicine Education

Geriatric medical education for medical undergraduate students in UK and its implications to China

In the United Kingdom, undergraduate education of geriatric medicine focuses on helping students understand or describe relevant contents, with only a few ability requirements. At most medical schools, the teaching of geriatric medicine is integrated with other clinical curriculums, such as mental health and internal medicine. The pedagogy of geriatric medicine that consists of formal and informal ones, tends to become varied and has some innovations in terms of simulation education, interdisciplinary education, and student-centered education. Based on the relevant experience in the UK, it is suggested that China should study and formulate the teaching requirements of geriatrics for undergraduate clinical medicine specialty in order to standardize and promote related work. Medical colleges and universities can better integrate geriatric knowledge into the existing curriculum system, constantly innovate geriatric teaching methods, actively use simulation teaching, student-centered education and other ways to improve the teaching effect. Key words: Undergraduate medical education; Geriatric medical education; UK

Diez recomendaciones para mejorar la enseñanza de la Geriatría en el pregrado

IntroductionPopulation ageing and scientific progress have made specific training in Geriatrics essential for any medical students. There are different international recommendations on the teaching of Geriatric Medicine at undergraduate level, but they are still far from being offered systematically. The aim of this work was to develop a National list of recommendations in order to improve training in Geriatric Medicine at the undergraduate level. Material and methodsA list of 10 recommendations was produced by reflecting on the Geriatric training situation in Spain in 2016/2017 and international recommendations. Consensus was reached among the members of the Spanish Society of Geriatrics and Gerontology (SEGG) working group on «Geriatric training at undergraduate level» through 2meetings and online discussions. ResultsA list of 10 of recommendations on Geriatric training in Spanish Medical Schools is proposed, including areas such as, the status of the discipline in the curriculum, length, contents, practical training, lecturers, teaching methods, and innovation. ConclusionsThese recommendations are intended to improve Geriatrics training. They can be used by different Medical Schools either to adapt their programs or to start training in Geriatric Medicine.

Medical student attitudes and concepts of frailty and delirium.

Frailty and delirium are important conditions in an ageing population, but there is little evidence exploring medical students' conceptualisation of, or attitudes towards these subjects. We investigated how students' concepts of frailty and delirium changed following a new geriatric medicine module at Manchester medical school. Semi-structured interviews were used with students before and after the new teaching week to explore changes in attitude towards frailty and delirium and their conceptualisation. Final year students who had not completed the module were interviewed as a comparison group. Grounded theory and content clouds were employed for data analysis. Ten 4th year and 11 final year students were interviewed. After the teaching week, 4th year students had a richer conceptualisation of frailty and delirium. Students described structured assessments such as comprehensive geriatric assessment and expressed confidence in their use. Their frameworks were more developed than the final year students who had not had such teaching. Attitudes towards older people, frailty, delirium, and the specialty of geriatric medicine improved following the teaching week. This study shows that geriatric medicine teaching improves students' conceptualisation of frailty and delirium and their understanding of the importance of structured assessments and management plans.

New horizons in geriatric medicine education and training: The need for pan-European education and training standards

The ageing population ought to be celebrated as evidence for the efficacy of modern medicine, but the challenge that this demographic shift presents for 21st century healthcare systems, with increasing numbers of people living with multi-morbidity and frailty, cannot be ignored. There is therefore a need to ensure that all healthcare professionals grasp the basic principles of care of older people. In this paper, we make a case for the development of pan-European education and training standards for the field of geriatric medicine. Firstly, the challenges which face the implementation and delivery of geriatric medicine in a systematic way across Europe are described – these include, but are not limited to; variance in geriatric medicine practice across Europe, insecurity of the specialty in some countries and significant heterogeneity in geriatric medicine training programs across Europe. The opportunities for geriatric medicine are then presented and we consider how engendering core geriatric medicine competencies amongst nongeriatricians has potential to bridge existing gaps in service provision across Europe. Finally, we consider how work can proceed to teach sufficient numbers of doctors and health professionals in the core knowledge, skills and attitudes required to do this. To safeguard the future of the specialty across Europe, we contend that there is a need to strive towards harmonisation of post-graduate geriatric medicine training across Europe, through the establishment of pan-European education and training standards in the specialty.

Clinical Simulation Training in Geriatric Medicine: A Review of the Evidence and Lessons for Training in Psychiatry of Old Age.

Clinical simulation encompasses a broad range of methods and techniques that allow clinical skills to be rehearsed and practiced away from the clinic before being applied to real patients. As such, preparation of doctors and other healthcare professionals for safe clinical practice is one of its main aims. The objective of this paper was to review the evidence regarding the use of clinical simulation training in geriatric medicine education and consider how the findings may be translated to education in the closely related field of psychiatry of old age. Original papers and descriptive case studies of clinical simulation training programs for medical professionals were considered for inclusion. Papers were grouped according to the participants' level of training: (1) undergraduate medical education; (2) postgraduate medical education; and (3) multiple levels of medical learners. A diverse range of effective simulation modalities for teaching geriatric medicine was identified across all levels of learning. The evidence suggests that there is much fertile ground for trainees in geriatric medicine and psychiatry of old age to participate in joint simulation training programs, thereby maximising their reach while minimising associated resource requirements and financials costs. Given the prominent position of psychiatry of old age at the interface between psychiatry and medicine, old age psychiatrists potentially have much to offer in advancing the field of clinical simulation while simultaneously improving patient care.

Interprofessional education in geriatric medicine

The majority of older patients present with complex health needs that often require to be addressed by more than one discipline. Hence, the involvement of physicians, nurses, physiotherapists, occupational therapists, pharmacists and other disciplines, adopting a patient-centred interprofessional approach, is an essential component of successful care. A growing phenomenon in education is interprofessional education (IPE), in which various health professionals learn with, from and about another in order to improve collaboration and the quality of care. This article presents a geriatric medicine literature review on IPE, covering several studies that have examined such education, describing different types of intervention and the involvement of various health professionals. There was no clear evidence that could be drawn from the available literature about best practice and intervention, due to the differences in interventions and the lack of replication studies. In this article, we have also reviewed the theories on which IPE is based and its suitability for application to the discipline of geriatric medicine (e.g. regarding curriculum design, clinical practice, and the optimisation of collaboration between team members). Present evidence supports the assumption that IPE-related general principles are applicable to education in geriatric medicine.

Equipping tomorrow's doctors for the patients of today.

As the proportion of older patients with frailty presenting to health services increases, so does the need for doctors to be adequately trained to meet their needs. The presentations seen in such patients, the evidence-based models of care and skillsets required to deliver them are different than for younger patient groups-so specific training is required. Several research programmes have used detailed and explicit methods to establish evidence-based expert-validated curricula outlining learning outcomes for undergraduates in geriatric medicine-there is now broad-consensus on what newly qualified doctors need to know. There are, despite this, shortcomings in the teaching of undergraduates about geriatric medicine. National and international surveys from the UK, EU, USA, Canada, Austria and the Netherlands have all shown shortcomings in the content and amount of undergraduate teaching. Mechanisms to improve this situation, aside from specifying curricula, include developing academic departments and professorships in geriatric medicine, providing grants to develop teaching in geriatric medicine and developing novel teaching interventions to make the best of existing resources. Under the last of these headings, innovations have been shown to improve outcomes by: using technology to ensure the most effective allocation of teaching time and resources; using inter-professional education as a means of improving attitudes towards care of older patients; focusing teaching specifically on attitudes towards older patients and those who work with them; and trying to engage patients in teaching. Research areas going forward include how to incentivise medical schools to deliver specified curricula, how to choose from an ever-expanding array of teaching technologies, how to implement interprofessional education in a sustainable way and how to design teaching interventions using a qualitative understanding of attitudes towards older patients and the teams that care for them.