Geriatric Curriculum Research Articles

Design and Development of Virtual Reality Application Implementing Age-Friendly Care and the 4Ms: A Quality Improvement Project.

With an increase in the aging population, the application of evidence-based practice in geriatric education can strengthen knowledge, skills, and clinical experience for healthcare students caring for older adults. The Age-Friendly Health System (AFHS) is one of the frameworks founded on providing evidence-based and low-risk care centered on what matters most to older adults, their families, and caregivers. Virtual reality (VR) platforms are gaining popularity due to their ability to provide an immersive, hands-on learning experience resembling an actual medical practice or care setting. Immersive learning enhances students' sensory perceptions, promoting an innovative and engaging way of acquiring concepts that are difficult to teach in real life. This study aimed to design, develop, implement, and evaluate a case-based training module highlighting AFHS and educating medical students on the 4Ms approach in geriatric care (What Matters, Medication, Mentation, and Mobility). The project was a feasibility study completed in two phases. Phase one included planning and developing a case-based scenario incorporating the 4Ms of AFHS. Phase two included implementing and evaluating the VR training module into the geriatric curriculum for medical students. The final VR case displays a hospital and post-acute setting where an elderly patient is admitted for a hip fracture. Students learn how to triage and treat patients from admission to discharge while demonstrating their knowledge of AFHSs. Approximately 10% of students completed the evaluation survey, and preliminary results indicate significant knowledge change in pre-post scenario-based training on an AFHS. The VR education platform and embedded scenario promise an innovative adaptation of technology in learning the concepts of the 4Ms of AFHSs. However, future studies should explore VR education with clinical assessment evaluation to ensure competence in providing age-friendly care.

A Fulbright International Exchange to Expand the Physician Assistant/Associate Curriculum in Geriatrics.

The international growth of the physician assistant/associate (PA) profession provides opportunities for global exchange that PA faculty and clinicians should seek out and cultivate. Physician assistant/associate programs can benefit from the experiences and expertise of faculty educators from different backgrounds and countries. The Fulbright International Scholars Program is a well-established and recognized organization dedicated to supporting international exchange in higher education. This study describes the experience of an American PA who received a Fulbright Specialist Program award that provided the opportunity to collaborate with a Dutch PA program on improvement of their geriatric medicine didactic curriculum.

A community-based geriatric interprofessional education experience and its impact on post-graduate collaborative practice

ABSTRACT While a growing body of interprofessional education (IPE) literature demonstrates a positive impact on learner knowledge, there is limited data on its long-term impact on collaborative practice (CP). With the growth of the aging population globally, understanding both the long-term impact on CP and sustainability of community-based geriatric experiential IPE programs are imperative. This study explores the impact of the Interprofessional Geriatric Curriculum (IPGC), a community-based geriatric IPE program, on post-graduate clinical practice among seven health professions. This study utilized a cross-sectional descriptive design, where both qualitative and quantitative data were collected in the same online survey of health professionals’ to measure their perceptions of the impact IPGC has had on their respective clinical practice 1–3 years post-graduation. Forty-six per cent of health profession graduates provided clinical care for people 65 years of age or older; 81% worked in interprofessional teams; 80% reported the IPGC experience significantly impacted their practice (N = 137), and all used validated assessment tools taught in the IPGC program in their practice. Eight themes emerged from the list of what health professionals learned from IPGC that they use regularly in their clinical practice: four themes were interprofessional in nature (i.e. teamwork and team-based care, interprofessional communication, roles/responsibilities, and personal/professional) and four themes related to geriatrics (i.e. aging, screening and assessment, medications, and didactic content). This study is one of the first to describe the sustained influence of a community-based IPE program across multiple health professional disciplines on clinical geriatric practice.

Is geriatric medicine teaching homogeneous? The analysis of geriatric medicine courses at Polish undergraduate medical programmes.

We aimed to analyse the characteristics of geriatric courses offered to undergraduate medical students in higher educational institutions (HEIs) in Poland. We searched the official websites of the HEIs offering the medical degree programmes and directly contacted the dean's offices and HEIs representatives to retrieve the relevant information. The documents were analysed for course content, teaching methods, duration, and recommended texts. We also checked the obtained curricula for the reference to of the learning objectives related to geriatric medicine, selected from the currently endorsed Polish educational standards (ES) provided by the Ministry of Science and Higher Education. Geriatric medicine courses were obligatory at all included HEIs (n = 19), but the courses differed in structure and content. The courses varied in duration from 11 to 60h and were primarily lecture based. Simulation was utilized at only one HEI and e-learning at two institutions. Out of 315 learning objectives, we acknowledged only 9 as geriatric. They were not always found in all curricula. Two HEIs included self-described learning objectives in their curricula. Across all HEIs, a total of 29 recommended texts (published between 1995 and 2021) were identified, including 2 English-language texts. Geriatric medicine was a mandatory subject for medical students of the included HEIs. However, there was a lack of uniformity in the offered courses. This leaves room for the development of a unified undergraduate geriatrics curriculum to effectively address diverse geriatric issues across Europe. The importance of this matter is highlighted by demographic trends and workforce challenges.

Evaluating Movement Disorder Training in Geriatric Curriculum

Evaluating Movement Disorder Training in Geriatric Curriculum

MAKING AN IMPACT: AN INTEGRATED MODEL TO REDUCE AGEISM AND SUPPORT PROFESSIONAL IDENTITIES

Abstract Nearly one-million people in the U.S. are living with Parkinson’s disease (PD) and require skilled care. Despite this, only 20% of educational programs offer a geriatric rotation. Ageism is a major factor in healthcare students’ lack of clinical exposure, decreased self-confidence, and desire to specialize in geriatrics. Research shows positive exposure to older adults improves students’ knowledge, attitudes, and interest in this population. Yet, limited geriatric curriculum exists that integrates specialized knowledge combined with positive contact experiences to shape students’ professional identities as capable providers. This project combined two experience-based learning (ExBL) models to form the Intrinsically-Motivated learning, Professional identity, Awareness, Capacity, and Timing (IMPACT) model—to support specialized knowledge acquisition and positive, repeated contact experiences with older adults. Third-year Doctor of Physical Therapy (DPT) students who completed both didactic training and a 2-week PD Boot Camp were interviewed about their experiences in the program. Nine students participated in the PD Boot Camp and interviews. Qualitative thematic analysis revealed the following: 1) unexpected insights gained about clients’ unique abilities, 2) therapeutic alliances formed and mutually created functional goals, 3) improved decision-making through practice with mentorship, and 4) increased self-confidence to provide care to clients with complex conditions. The IMPACT model provided students specialized knowledge and practical skills to capably care for older adults with PD. This model can serve as a guiding educational framework to reduce ageism among healthcare students across a variety of settings, support students in developing their professional identities, and increase interest in caring for older adults.

DESIGN AND DEVELOPMENT OF VIRTUAL REALITY APPLICATION: AGE-FRIENDLY HEALTH SYSTEM SCENARIO

Abstract With an increase in the aging population, evidence-based practice education can help strengthen knowledge, skills, and clinical practice for healthcare students caring for older adults. Age Friendly Health Systems (AFHS) is one of the frameworks founded on providing evidence-based and low-risk care centered on what matters most to older adults, their families, and caregivers. While didactic education is still the primary force in teaching medical students, innovative methods are being included in the medical curriculum to practice competency. Virtual Reality (VR) platforms are popular due to their ability to provide an immersive hands-on learning experience resembling an actual medical practice. The immersion abilities engage the students’ sensory organs promoting an innovative way of learning concepts that are difficult to teach in real life. The project’s objective was to develop and publish a case highlighting AFHS that can help educate medical students on the 4Ms (Mobility, Mentation, Medication Management, and What Matters). The case was completed in multiple phases 1) using a design document modified through multiple edits and reviews by our interprofessional team; 2) technical development including environment, objects, and interfaces of the application; and 3) publication. The VR case displays four scenarios where an elderly patient is admitted for a hip fracture. Students learned how to triage and treat patients from admission to discharge while demonstrating their knowledge of AFHS. The case is integrated in the geriatric curriculum for medical students, and the education is ongoing. Future studies will evaluate the learning outcomes of medical students.

PROMOTING AFHS FRAMEWORK WITHIN NURSING STAFF TRAINING CURRICULUM: NURSING HOME QUALITY IMPROVEMENT INITIATIVE

Abstract The recent report by the Committee on the Quality of Care in Nursing Homes highlighted the limitations within nursing home facilities including neglect and abuse of their residents, high living costs and poor quality of life, lack of oversight, as well as nursing staff shortages and burnouts. With multiple challenges in sustaining the nursing home workforce, it is imperative to provide support and continued education to nursing home staff and nursing students on recent developments in evidence-based approaches to geriatric care including Age-Friendly Health Systems (AFHS) and dementia-friendly care. NSU SFGWEP conceptualized, designed, and delivered a modified geriatric curriculum to the nursing workforce at three distinct partner sites. The curriculum integrated eight training modules within the framework of AFHS and covers topics on each of the 4Ms: Matters Most, Mobility, Mentation, and Medication. The trainings are currently being delivered to the nursing home staff, nursing students, and to CNA students. The data on increase in education on AFHS and the 4Ms is being collected via a specifically designed survey which is administered electronically through mobile devices or via paper questionnaires. The survey responses are managed through REDCapTM, a secure web application for administering online surveys. An estimated 160 trainees have completed at least one training session and 38 trainees have submitted the feedback survey. Preliminary data on pre/post-training evaluations suggests an improvement in participants’ knowledge of the geriatric topic within AFHS and the 4Ms, proposing a sustainable training program for the nursing workforce to promote age-friendly care for older adults

Medical student curriculum in Geriatrics and "Aging in Place": A comparison of home-based, community, and virtual experiences.

Medical student curriculum in Geriatrics and "Aging in Place": A comparison of home-based, community, and virtual experiences.

Geriatrics emergency medicine: The need of time.

Madam, Since the inception of Emergency Medicine (EM) in Pakistan, it has been an ever-growing field, and one such current need is the development of geriatric emergency care. Older patients have a longer Emergency department (ED) stays and more frequent admissions, with an increased risk of special care and intensive care admissions. These patients have unusual presentations and multiple comorbidities, are more prone to complications, are easily affected by their surroundings and require an understanding of their social needs and thorough counselling, complicating their care. The elderly population also termed the ‘silver tsunami’ shares a significant burden of the ED in Pakistan.1 According to the 2017 national census, nearly 13.7 million people in Pakistan, were over the age of 60, accounting for roughly 7% of the total population,2 which is anticipated to double in the coming years, increasing the burden of geriatric patients. This highlights the urgent need todevelop a specialised system for the elderly in acute care settings. Although several programmes in Pakistan focus on elderly care under Family Medicine, there remains a huge gap in emergency care, which is crucial in providing 24/7 healthcare service delivery. Geriatrics curriculum must be incorporated in emergency medicine residency programmes to facilitate patient outcomes, decrease mortality, and prevent functional decline in that age group. The American College of Emergency Physicians (ACEP) certified hospitals as "Geriatric Emergency Departments" (GEDs) in 2018 based on GED guidelines established in 2014. The purpose was to assist in providing more effective care to the elderly population. 3 According to Kaeley et al., a considerably higher number of older people (2965, 54.9%) were hospitalised from the ED, with approximately 651, or 21.9 % admitted to the intensive care unit.4 Geriatric Emergency Medicine Fellowship training provides EDs with expertise to meet the need of a growing geriatric population. (Figure 1) These programmes can serve as a foundation for clinical innovation, research, and education focusing on the elderly population. Work on this is being done globally., Pakistan must play a role in this aspect of emergency medicine, owing to the rapidly increasing older population and advancement in GEM practice worldwide.3,5 A proper healthcare infrastructure at the government level will help geriatric patients cope with limited health resources, financial burdens, and palliative care. A better understanding of geriatric care will assist us in better allocating and utilising the limited resources we have available to alleviate the financial burden. ---Continue

Geriatric curriculum at faculties of medicine in Indonesia

Aim: In Indonesia, the elderly population is growing rapidly and will comprise 35 million in 2035. The aim of this study was to assess how geriatric training is organised in medical faculties in Indonesia. Methods: In 2017, we asked through questionnaires the vice deans of the faculties of medicine about their perceptions towards health and ageing and how they organized the geriatric training in their respective schools. Overall, we obtained data from 32 out of 71 (45.1%) faculties of medicine. Results: All respondents perceived geriatrics as an important issue for faculties of medicine. Only 12 (37.5%) faculties employ geriatric specialists, 28 (87.5%) teach geriatrics at the undergraduate level, and 12 (40.6%) at postgraduate level, whereas 4 (12.5%) universities teach at specialty level. Conversely, at undergraduate level, only 18 (64.2%) faculties include the ‘geriatric giants’, and 5 (17.8%) include ageism. There are 13 (46.4%) geriatric classes implemented through skill laboratories, 5 (17.8%) through geriatric policlinics, and 4 (14.3%) through geriatric wards. Conclusion: Attention to geriatric training among medical schools in Indonesia has to be improved. At national level, there should be a more specific formulation of geriatric competencies and how they can be operationalised. Geriatric training is recommended to prepare lecturers in medical faculties. Related to the content of aging curriculum, geriatric issues, attitudes towards aging, and ageism should be addressed.

Program evaluation of a new interprofessional geriatrics curriculum for advanced practice nursing and master of social work learners

ABSTRACT The Indiana Geriatrics Workforce Enhancement Program (GWEP) implemented a new longitudinal geriatrics curriculum for advanced practice registered nurse (APRN) and master of social work (MSW) learners to prepare them for interprofessional collaborative practice in the care of older adults. This paper reports program outcomes of a novel longitudinal interprofessional geriatrics curriculum involving immersive learning for these learners. Outcomes are described in terms of learner reaction, modification of attitudes/perceptions, acquisition of knowledge/skills, behavior change, impact on the organization, and impact on the patient or client using the Freeth/Kirkpatrick evaluation model. Program participation influenced graduates’ knowledge of and their perceived ability to participate in team care and job selection in geriatric-focused positions.

Predictors for nursing students’ perception of working with older people

The increasing number of older people around the world has increased the demand for elderly care nursing services. Understanding nursing perceptions can identify willingness to work with older people. This study aims to determine predictors for nursing students’ perception of working with older people. A cross-sectional study was performed on 292 nursing students at the University of Medicine and Pharmacy. Stratified random sampling with an online self-reporting questionnaire was used to collect data from first- to fourth-year nursing students. Data analysis was performed using SPSS 20. Independent t-test, ANOVA and Pearson’s correlation were utilised to determine the correlation of demographic variables, knowledge and attitude with perception. Moreover, multiple linear regression was applied to determine predictors for the perception of working with older people. The mean score of perception of working with older people amongst undergraduate nursing students was 51.79±6.31. Factors related to perception include gender (p=0.004), geriatric nursing choice (p=0.007), knowledge about ageing (p=0.001) and attitude towards older people (p<0.001). Multiple linear regression analysis showed that gender (P=-0.149, p=0.005), geriatric nursing choice (P=0.154, p=0.o03), knowledge about ageing (P=0.122, p=0.021) and attitude towards older people (P=0.367, p<0.001) are predictors for the perception of working with older people. An in-depth understanding of ageing and attitude towards older people in the geriatric curriculum plays a vital role in promoting nursing students’ perception of working with older people.

Is dental education meeting the oral health needs of older adults?

The aim of this article is to highlight the importance of promoting oral health for the geriatric population and implementing change to address their complex oral and systemic health needs. Oral healthcare providers are unequipped to meet the demanding oral health needs of the aging population, resulting in a geriatric oral health crisis that needs immediate attention and action. Despite the advancements in geriatric education over the last two decades, the geriatric curriculum in 2022 is still inadequate, and varies greatly among different US dental schools for both pre- and postdoctoral programs. Predoctoral students are graduating without being sufficiently trained to identify and treat the dental issues of older adults due to lack of a purposely planned curriculum with balanced didactic and clinical exposure. It is critical to have a trained and competent workforce that meets the oral health needs of current and future older adults. To change the present environment, there is a need for curriculum redesign, faculty development, and training. In addition, more research to evaluate pre- and postdoctoral geriatric dentistry curricula, their impact on increasing access to care, and the likelihood of graduating dentists competent to treat functionally dependent and frail older adults is needed. Furthermore, decision-makers in dental education, national dental organizations, and government institutions must support policies that integrate oral health into overall health through robust reimbursement mechanisms, including a dental benefit in Medicare, and recognition of geriatric dentistry as a specialty.

Out of the classroom, into the home: Medical and dental students' lessons learned from a Geriatrics home visit.

Home visits are an important part of Geriatrics education for medical and dental students (MS), and the lessons learned by students from these experiences inform further curriculum development. A mixed methods analysis of students' lessons learned from a single Geriatrics home visit shapes the future focus and impact of similar educational programs to ultimately improve the care of older adults. Over a 3-year period at Harvard Medical School, approximately 495 first year MS participated in an educational Geriatrics home visit to learn about the geriatric assessment. Three hundred and forty-eight students completed voluntary anonymous evaluation forms, rating whether their interest in geriatrics increased after the home visit and describing two lessons learned. We analyzed the student responses and conducted a qualitative content analysis of the lessons learned, identifying major themes within the Geriatrics 5Ms Framework (Mobility, Mind, Medications, Multicomplexity, and Matters Most). Most students (70.7%) reported their interest in Geriatrics somewhat or greatly increased after the home visit. Three hundred and ten students (89% of participants) reported 605 lessons learned; 174 students' lesson learned related to Multicomplexity (56.1%), and 158 students reported a lesson related to Mobility (51%). After a Geriatrics home visit, a majority of students report an increase interest in Geriatrics. The most common lessons learned relate to Mobility and Multicomplexity, essential areas of focus in a Geriatrics curriculum. Educational home visits are an important opportunity to increase student interest in geriatrics and build their skills to improve the care of older adults using the Geriatrics 5Ms Framework.

4Ms for Early Learners: A Skills-Based Geriatrics Curriculum for Second-Year Medical Students.

IntroductionGiven the growing population of older adults, it is of utmost importance for all future physicians to be trained in the core skills of conducting geriatric assessment.MethodsWe designed an interactive, skills-based session introducing core competencies for geriatric assessment for second-year medical students (MS2s). We organized our curriculum for early learners based on the 4Ms framework: mind/memory, medications, mobility, and matters most. The session consisted of brief didactics with integration of real-time skills-based practice. Students completed pre- and postsession surveys to assess their confidence in their knowledge and skills. All students completed a geriatric assessment during a clinical skills encounter as part of a multistation, end-of-course, summative clinical skills examination (CSE). The session was conducted virtually over 2 academic years, and the CSE was conducted virtually in 2020 and in person in 2021.ResultsOne hundred ninety-nine MS2s participated in the session (100 in 2020, 99 in 2021). All students surveyed (33%) reported improved confidence in geriatric knowledge and skills by the end of the session (ps < .001). Students were more likely to use a cognitive screening tool, ask about advance care planning, and assess medication adherence on the CSE in 2021 compared to 2020 (ps < .001).DiscussionWe provide an interactive curriculum for MS2s to develop geriatric assessment skills. The curriculum and assessment tools are versatile, can be easily integrated into any medical school curriculum, and can be effectively delivered in person or on a virtual platform.

Surveying Knowledge Gaps for a Post-Acute Care (PAC) Curriculum Taught by Geriatrics-trained Core Internal Medicine Program Faculty for Internal Medicine and Family Medicine Residents Learners

Preventable errors in care transitions for the elderly are responsible for up to one third of costly hospital readmissions. The 2009 Institute of Medicine sentinel report outlined a critical need to expand geriatrics competencies in residencies caring for the vulnerable elders. While the 2010 published set of core competencies for geriatrics aligns with the Medicare Payment Advisory Commission directives, training in geriatrics competencies during residency is still lacking. We surveyed our IM/FM residents (Internal Medicine/Family Medicine residents) to help formulate a customized geriatrics curriculum with dedicated clinical exposure and emphasis on teaching communication across care transitions, health care systems, discharge destinations, and their level of care for the hospitalized elderly.

Interprofessional geriatric assessment in nursing home (IgAP): a curricular development in geriatrics.

The hallmark of medical action in geriatrics is the interprofessional treatment of the patient by a multi-professional team consisting of doctors, nurses and therapists with the aim of treating the patients primarily in a way that preserves their function and thereby enabling them to live as independently as possible. Therefore, at the beginning of every geriatric treatment, there is a multiprofessional geriatric assessment of functional abilities. With regard to successful medical action, this necessarily requires all health professions involved to understand geriatric patients and their limitations. Under ideal circumstances, their competencies overlap. From the point of view of the related disciplines, this means to teach working together with the other professions – interprofessionally – and learning from one another in order to effectively collaborate. After comparing the existing education in geriatrics within the Medical Curriculum Munich (MeCuM) with the European catalog of learning objectives for geriatricians (UEMS-GMS), a deficit with regard to geriatric assessment was recognized in the field of multi-professional training. Therefore, the existing geriatric curriculum of the Ludwig Maximilians University (LMU) in Munich should be expanded to include an interprofessional course on geriatric assessment. This project report aims to show the development and implementation of this course. For this purpose, the model for curriculum development according to Kern was used by the planners to establish an interprofessional briefing. Due to its innovative character, the course received public recognition and is the basis for the expansion of interprofessionalism in the sense of professional cooperation in geriatrics. Establishing interprofessionalism in other disciplines and locations is welcome.

KNOWLEDGE AND ATTITUDE TOWARDS GERIATRIC HEALTH AND THE ASSOCIATED FACTORS AMONG MEDICAL STUDENTS OF INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA

Comprehensive care towards geriatric health can be sustained by having good knowledge and attitude among the providers. Hence, this research aims to measure the knowledge and attitude of the final year medical students towards geriatric health and determine the associated factors. A cross-sectional study was conducted among the students using structured questionnaires of Geriatric-Attitude-Scale and Palmore-Facts-on-Aging-Quiz was used. Data was analysed using Mann Whitney U test, Chi square test and Spearman correlation coefficient analysis for the association between the score and studied variables. Median score of students’ knowledges is at 14.00 (IQR 13.00) and mean score for attitude is 48.52 (+5.53) respectively. Place of residence (P= 0.01) and presence of grandparents (P= 0.04) were the significant factors that affected knowledge of students towards geriatrics while number of siblings (P= 0.05) influenced attitudes of students towards geriatrics. Improvement of current geriatric curriculum should be done with more refined implementation of gerontology course in the basic medical learning.

Collective Perceptions of Aging and Older Persons Held by Students From Eight Healthcare Professions.

In order to increase the number of students entering the geriatric workforce, an understanding of factors influencing career preference and what may prevent students from pursuing geriatric careers is necessary. Using a convergent parallel mixed methods approach, the aim of this study was to provide insight for geriatric educators regarding the collective perceptions of aging and older persons held by 864 students from eight healthcare professions. Quantitative questions assessed students' attitudes (Geriatric Attitudes Scale). Student responses to four open-ended questions were assessed using conventional content analysis. Results included rich narrative examples of healthcare professions students' perceptions and understanding of the aging process, as well as myths and misconceptions of aging and older persons that can be used to inform geriatric curricula across multiple health professions training and education programs. Geriatric education is a critical avenue to correct misperceptions, quell ageism and address the current shortage in the geriatrician workforce.