Education In Geriatric Medicine Research Articles

A narrative overview of undergraduate geriatric medicine education worldwide.

There is a mismatch between the healthcare needs of the ageing population worldwide and the amount of education medical students receive in geriatric medicine. In 2014, Mateos-Nozal et al. published a systematic review of all undergraduate education surveys in geriatric medicine-a decade on, it is timely for an up-to-date overview of the state of undergraduate geriatric medicine education globally. In this review, we outline the international evidence in the field, exploring the results of national and multi-national teaching surveys, and discussing the relative strengths and weaknesses of nationally recommended curricula. We set these findings in the context of ageing population demographics, concluding with recommendations for the future of education and educational research in geriatric medicine, that aims to build capacity in the healthcare workforce and improve quality of care for older people.

2224 What are we teaching UK medical students about ageing? Results of the third BGS national curriculum survey

Abstract Introduction The ageing population means all doctors, regardless of specialty, will need knowledge, skills, and attitudes to care for older people with complex health conditions. An essential component of preparing the medical workforce to best care for older people is by including teaching on ageing and geriatric medicine in undergraduate medical curricula. Here we present results of the British Geriatrics Society (BGS) national curriculum survey 2021–22, highlighting progress made in undergraduate teaching in geriatric medicine. Methods All 35 UK GMC-registered medical schools at the time of data collection were invited to participate in an online survey on content, methodology, timing, and duration of teaching in ageing and geriatric medicine. The survey was structured around the 2013 BGS recommended undergraduate curriculum, for consistency with previous surveys. Results 30/35 of UK medical schools responded (83% response rate). Most teaching occurred in the fourth year of study (21/30, 70%). The majority (15/30, 50%) reported a discrete module for geriatric medicine lasting 4–8 weeks, an increase on previous surveys. However, several programmes have reduced the amount of in-person teaching since the COVID-19 pandemic. Notably, three schools reported geriatric medicine exposure lasting >12 weeks. Of these, two were integrated clerkships and one a dedicated geriatric medicine module. There is increasing focus on multidisciplinary education, with emphasis on combining virtual or simulated teaching with other healthcare professions (n = 7). Every school (n = 30) taught at least one topic as small-group or case-based learning. Conclusion There is a trend towards increasing exposure to geriatric medicine compared to previous surveys in 2008 and 2013. However, several of the programmes reporting greater exposure incorporate geriatric medicine in an integrated clerkship rather than as a dedicated module. Programmes demonstrated a move from didactic teaching towards small-group and case-based learning, employing a wider variety of assessment methods than previous.

2241 ‘You learn by doing, and by falling over’: a simulation-based approach to frailty, falls and fractures.

Abstract Background Studies show that newly qualified doctors feel unprepared for clinical practice in several key areas in the care of older people, despite older people occupying two thirds of inpatient beds [1,2]. Grounded in experiential learning theory, simulation has been hugely effective in undergraduate education in geriatric medicine [3]. We aimed to evaluate a novel simulation series exploring practically challenging aspects of geriatric medicine, such as ‘silver trauma’ and using de-escalation strategies in the management of delirium. Methods Using quality improvement methodology, we developed two inpatient simulation scenarios for fourth-year medical students on their geriatric medicine clerkships. The scenarios (managing delirium and post-falls assessment) are commonly encountered during on-call shifts, with learning outcomes aligned to Outcomes for Graduates. Our initial cycle involved eight students piloting the two scenarios and evaluation tool. Using their feedback, we will iteratively improve the methods and evaluation before repeating and obtaining pre- and post-simulation data on students’ ‘preparedness for F1’. Results Following the pilot, 100% of participants agreed that they felt more prepared for clinical work in geriatrics as an F1 doctor. 12.5% felt confident assessing a patient following a fall pre-session, which increased to 100% afterwards. Confidence in using de-escalation techniques in managing delirium improved from 50% (pre-) to 100% (post-session). Common themes in free-text feedback were that the simulation felt realistic and effectively tested prioritisation. Conclusion Our work highlights the merits of using simulation in geriatric medicine to help undergraduates prepare for the complexities and uncertainty involved in caring for the ageing population.

Long-term Outcomes of Geriatric Medicine Teaching Strategies: Comparing no Content, Traditional Lecture, and Flipped Classroom 2 Years Postintervention

Long-term Outcomes of Geriatric Medicine Teaching Strategies: Comparing no Content, Traditional Lecture, and Flipped Classroom 2 Years Postintervention

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.

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.