SP - Education / Training

Introduction

Despite the UK’s increasing life expectancy, and increase in the elderly population, there is an overwhelming lack of Geriatricians in the UK; as of 2022, there is only 1 consultant Geriatrician per 8,031 individuals over the age of 65 (BGS, 2023). To meet the complex care needs of this population, there must be a focus on increasing the interest that doctors have towards Geriatric Medicine, with the overall aim being to recruit more doctors into the speciality.

Method

The aim of this review was to investigate what factors medical students perceive as barriers to pursuing a career in Geriatric Medicine and then, from identifying these, generate a set of comprehensive suggestions as to how to tackle these barriers at a medical school level to increase the interest and ultimately uptake of Geriatric Medicine. The qualitative review contains literature published between 2003 and 2023 accessed using MedLine.

Results

Six themes were identified in answering our question: (a) high emotional burden, (b) caring for patients with complex needs, (c) negative preconceptions of non-clinical factors (prestige, salary, career progression), (d) negative influence of clinical educators, (e) lack of intellectual stimulation and (f) lack of exposure to the speciality and the elderly.

Conclusion

The barriers perceived by medical students when considering Geriatrics as a speciality are complex and multifaceted; these barriers must be tackled promptly in order to secure the next generation of Geriatricians. We suggest that this work can be used as a foundation for further qualitative studies with UK medical students to investigate barriers that are specific to UK students. From this, interventional courses designed to increase Geriatric Medicine uptake could be developed to strengthen the UK Geriatric Medicine workforce.

Introduction :

This study demonstrates how a network of geriatric medicine trainee representatives was established across the UK. The intention of the network was threefold: accurately represent the interests of trainees by gathering national feedback, develop a job description of deanery trainee representatives and create a community of practice between representatives.

Method:

Deanery trainee representatives were identified through TPDs then contacted to participate in an online questionnaire which also consented for whatsapp group invitation.

Results:

Deanery representatives were identified for 12 out of 13 deaneries, the final post was vacant. The survey response rate was 83% and all respondents gave permission to be added to the whatsapp group. We gathered information regarding eligibility, appointment and the role of deanery trainee representatives. Most deaneries (73%) do not require representatives to be a minimum grade whereas 27% required representatives to be ST4 or above. Over half (55%) were appointed following an expression of interest without an election, 27% required an election and 9% were approach and appointed directly either by the TPD or current representative. Once appointed 82% had no fixed term whilst 18% would have a term limited to two years. Once appointed the role entails an invitation to the local higher specialty training committee for 73% of respondents and 73% also reported a role in organising regional training.

Conclusions :

The aim of this project to create a network between deanery representatives has been achieved and produced an engaged network of representatives facilitating accurate representation of trainees at a national level. Further applications include collaboration between trainees to share training practices. In a period of training recovery following the Covid-19 pandemic and a new geriatric medicine curriculum a community of practice between trainee representatives has enormous potential to improve training quality and experiences for geriatric medicine trainees in the UK.

Introduction

Some people living with dementia have difficulties at mealtimes, with significant implications for physical and mental health (Abdelhamid et al., 2016). Care home staff provide direct care at mealtimes (Skills for Care, 2015), but there is a shortage of high-quality dementia care training focusing on mealtimes (Fetherstonhaugh et al., 2019). This study tested the feasibility and acceptability of an evidence-based training programme promoting better mealtime care for people living with dementia (Faraday et al, 2022).

Method

The study comprised a before-and-after design using multiple methods of data collection and analysis. The qualitative arm of the study is reported here. The training programme was delivered in three care homes in the UK, chosen for differences in context, size and ownership. Trainees were recruited from a range of different roles across the homes, including care staff, kitchen staff and management staff. After training, participants attended focus groups to elicit views on their experience of the training and suggestions for improvement. Data from the focus groups were analysed using reflexive thematic analysis (Braun & Clarke, 2022).

Results

Analysis to date has generated five themes: Need a mix of experience in the room; More dementia-specific content; Make the most of group discussions; Scenarios should be nuanced and complex; One-day delivery is easiest; Facilitator experience and skill outweighs profession. These themes will inform modification of the training programme’s content and format, to increase its acceptability and usefulness to care home staff, prior to wider roll-out and evaluation. At the same time, a short animation has been co-produced with experts by experience to convey key messages from the training as accessibly as possible (https://vimeo.com/1009856313).

Conclusion(s)

This study has reduced uncertainty about the training programme’s acceptability, so that it is more likely to become embedded in practice and improve mealtime care for people living with dementia. 

Abstract Content -

 Background/purpose: To prepare future physicians to care for a growing aging population, the Canadian Geriatrics Society (CGS) Education Committee formed a working group in 2019 to update the 2009 Core Competencies in the Care of Older Persons for Canadian Medical Students. The goal is to assist medical educators with developing relevant undergraduate medical curriculum. Methods: The working group chose 5Ms model and canMEDs framework to develop the competencies. A modified Delphi process was used. National participants were recruited and three rounds of Delphi surveys were conducted via survey monkey. A 7 point Likert scale was used for each competency statement.

Results: The first round was conducted in October 2019, n=72, identifying the importance and skill level of the components of the competencies under three headings; knowledge, skills and attitudes. The second round was conducted in September 2020, n=54, with proposed competencies under seven headings; aging, caring for older adults, (5Ms): mind, mobility, medications, multi-complexity and matters the most with > 70 % agreement for all. Based on the strength of the agreement and comments, minor revisions were made and the final survey was conducted in June 2021. The agreement level for competencies varied from 85 - 98 %. Thirty-three core geriatric competencies were developed under 7 headings. The CGS education committee approved the competencies in Dec 2021. 

Conclusion: The 2021 Aging Care 5M Competencies framework integrates new concepts and knowledge that inform current practice in the field of geriatrics. Thirty-three core geriatric competencies for the graduating undergraduate medical student were developed and classified under 7 headings. The framework was distributed to the accreditation and examination bodies and Canadian medical schools and was published in Academic medicine. 2024 Feb 1;99(2):198-207. doi: 10.1097/ACM.0000000000005475. Epub 2023 Nov 19. Currently we are working on implementation of the competencies. 

Introduction

Despite the UK’s increasing life expectancy, and increase in the older population, there is an overwhelming lack of Geriatricians in the UK; as of 2022, there is only 1 consultant Geriatrician per 8,031 individuals over the age of 65 (BGS, 2023). To meet the complex care needs of this population, there must be a focus on increasing the interest that doctors have towards Geriatric Medicine, with the overall aim being to recruit more doctors into the speciality. 

Methodology

The aim of this review was to investigate what factors medical students perceive as barriers to pursuing a career in Geriatric Medicine and then, from identifying these, generate a set of comprehensive suggestions as to how to tackle these barriers at a medical school level to increase the interest and ultimately uptake of Geriatric Medicine. The qualitative review contains literature published between 2003 and 2023 accessed using MedLine.

 Results 

Six themes were identified in answering our question: (a) high emotional burden, (b) caring for patients with complex needs, (c) negative preconceptions of non-clinical factors (prestige, salary, career progression), (d) negative influence of clinical educators, (e) lack of intellectual stimulation and (f) lack of exposure to the speciality and the elderly. 

Conclusion 

The barriers perceived by medical students when considering Geriatrics as a speciality are complex and multifaceted; these barriers must be tackled promptly in order to secure the next generation of Geriatricians. We suggest that this work can be used as a foundation for further qualitative studies with UK medical students to investigate barriers that are specific to UK students. From this, interventional courses designed to increase Geriatric Medicine uptake could be developed to strengthen the UK Geriatric Medicine workforce.

Introduction

Advance care planning (ACP) is about what matters to patients, enabling their wishes to be respected, even when they become unable to engage in decision-making. Evidence shows ACP improves end of life care for patients and reduces relatives' bereavement reactions (Detering KM et al. BMJ. 2010; 340:1345). A simulation course for multidisciplinary healthcare professionals, using actors, was developed to improve understanding of ACP, and confidence in having these conversations. In response to the COVID-19 pandemic, the course was adapted to an online format.

Method

Participants were asked about their ACP confidence and understanding pre- and post-course, using a Likert scale (1-Not at all to 5-Very confident). Data between 2018-2022 was analysed to compare face-to-face and online course responses. Free-text responses to 'How do you feel about attending the course online?' were analysed qualitatively. Ethics approval was not required.

Results

Five face-to-face and five virtual sessions trained 128 and 133 attendees respectively. Confidence in having ACP discussions improved significantly following the course in both cohorts; from a mean Likert rating of 2.77 (95% CI 2.60-2.94, n=132) to 4.11 following face-to-face training (95% CI 3.97-4.25, n=128), and from 2.79 (95% CI 2.66-2.91, n=149) to 4.11 following the online course (95% CI 4.01-4.21, n=133). Additionally, 97% (n=132) of face-to-face attendees and 99.2% (n=133) of virtual attendees said their practice would change because of the course. Following the training, 100% of participants across both cohorts reported that they 'fully understood' what was meant by ACP, from a baseline of 77.3% (n=132) in the face-to-face cohort and 81.9% (n=149) of virtual participants. Free-text analysis highlighted the convenience of attending online (n=22,21%), and only a minority reported technical difficulties (n=8,8%).

Conclusion

This course was successfully adapted to a virtual format, improving participants' ACP confidence and understanding as effectively as in-person training, whilst being more accessible.

Introduction

The British Geriatrics Society “Joining the Dots” blueprint recommends delivery of inter-professional education aligned with the Skills for Health Frailty Core Capabilities Framework as part of a system wide frailty strategy. Our ambition is to educate and train the entire health and care system in frailty awareness through the Guildford & Waverley Frailty Academy (GWFA).

Methods

The GWFA developed a Frailty Awareness course aligned to Tier 1 Core Capabilities and introduced this as part of a system wide programme of education and workforce development in frailty. The course was embedded in e-learning platforms across Acute, Community, Ambulance services and Local Authorities. A blend of virtual and face to face (FTF) workshops were used in undergraduate University programmes, the Voluntary sector and care sector.

Results

Between April 2023 and July 2024, 2,195 people completed Tier 1 training.

• Care sector, voluntary sector, Fire service, trading standards: 147 through 7 virtual workshops

• Undergraduate students at the University of Surrey: 234 (FTF)

• Acute, community, Local Authority, Ambulance service: 1,814 people through e-learning

Feedback showed the following:

• 83% said they had good/significant improvement in knowledge after participating in virtual workshops.

• 79% of paramedic students rated their improvement in knowledge and skills as good/ significant as a result of attending their session.

• 90% of nursing students rated their improvement in knowledge and skills as good/ significant as a result of attending their session.

Qualitative responses showed participants felt more aware of frailty and had a better understanding of how to adapt their practice when encountering older people with frailty.

Conclusions

Tier 1 training is an effective method of raising awareness of frailty across a health and care system when applied as part of a broader system strategy using a variety of mediums for delivery.

Introduction: Simulation training is a valuable resource to teach clinical skills and mimic emergency settings. Human factors (HF) are non-technical skills that are affected by human attitudes and behaviours. Weaknesses in human factors can cause fatal medical errors. We wanted to assess if simulation can be used as a tool to improve these. We conducted two simulation training days for medical higher specialty trainees (HST) focusing on HF.

Methods: 20 HSTs participated in 10 simulated scenarios. Scenarios involved using a high-fidelity manikin and actors. The scenarios were a mixture of long and short cases, including both clinical and non-clinical scenarios with a HF focus. Pre- and post-session questionnaires were used to rate confidence levels in a series of specific HF. A 10-point Likert scale was used.

Results: The majority of participants had a firm understanding of the importance of human factors in healthcare, especially the importance of teamwork, compassion, communication and situational awareness. 70% of participants felt that human factors training may not be adequately considered in current training pathways due to limited formal exposure, limited time, and its importance being underestimated. There was an increase in confidence in: managing disagreements (31%), negative emotions (38%), prioritisation (28%), delegation (23%), teamwork (34%) and leadership skills (30%), dealing with uncertainty (29%), challenging hierarchy (27%), anticipation (31%). 100% felt simulation training helped to develop their attainment of human factor skills.

Conclusion: This form of simulation training was successful in improving confidence and understanding of human factors in healthcare and showcased the value of using high-fidelity training to realistically recreate the clinical environment. Going forward, this type of teaching could be integrated within the specialty training curriculum to formally improve skills in human factors and therefore improve patient outcomes and relationships between team members, thus contributing to a more positive working environment.

Background & Objectives

Research suggests that specialized education for nurses decreases frailty and improves functionality in hospitalized older adults. This study explored the impact of a specialized geriatric education program on  mobilization rates for older adult patients in acute care in 5 hospitals.

Methods

A mixed methods approach with pre- and post- intervention questionnaires (Geriatric In-hospital Nursing Care Questionnaire (Ger-INCQ) and study specific knowledge assessment) was used to explore facilitators and challenges of caring for older adults, the knowledge base and experiences of staff, and the impact of providing specialized education. Acute care nursing staff participated in a 4-hour education intervention focusing on the Geriatric 5Ms (Mind, Mobility, Medications, Multi-complexity and Matters Most) and frailty prevention. Patient level data was collected through mobility audits (I-MOVE) and observation of shift handover communication.  Semi-structured interviews with staff were completed to explore the results of the questionnaires. 

Results

Registered nurses, licensed practical nurses and personal care attendants (N=64, Mean age=36.9, 87% female) who participated in the specialized training did not show significant change in their assessment scores. Patient (N=99, mean age=76.2, 54.5% female ) mobilization did not differ between phases of intervention (p=0.08), nor was there any significant change in reporting mobility at shift handover. Ger-INCQ indicated neutral responsibility for falls incidents and retention of patient mobility, with interviews (n=26) revealing that patients are kept immobilized for safety and workload management.

Conclusion

Staff had positive attitudes toward caring for older adults; however, their understanding and application of geriatric principles were limited and remained unchanged. Interview participants stated their work environment limits their capacity to deliver the best practice care presented in the education sessions. These findings suggest that education alone is unlikely to influence prioritization of mobility for frail older adults in a strained acute care setting.

INTRODUCTION: Medical students may find practical aspects of the transition to FY1 doctor challenging. In recent years medical curriculums have been updated to address this issue by increasing the emphasis on assistantships and practical learning. We explored how prepared final year medical students felt for managing common scenarios in geriatrics, such as a patient with delirium or inpatient falls. This allowed us to develop a tailored teaching programme to be delivered by junior doctors with relevant practical experience.

METHODS:

1) We surveyed assistantship students in geriatrics to identify areas in which knowledge and confidence were lacking. We subsequently developed a tailored teaching programme to address these gaps, focusing on practical tasks and common scenarios.

2) We delivered teaching to 3 sets of assistantship students, each receiving two teaching sessions per week for their 4 week placement.

3) Quantitative & Qualitative (Likert Scale) feedback was sought using a standardised feedback form. We used QI methodology to update and improve our curriculum & delivery to match students’ learning needs.

RESULTS:

• Over the course of the teaching programme, 89 feedback forms were completed.

• 54.8% of students felt “unprepared” or “somewhat unprepared” whilst only 18% felt “prepared” or “somewhat prepared”.

• Following the teaching session, only 2.3 % felt “unprepared” or “somewhat unprepared. Those feeling “prepared” or “somewhat prepared” improved to 92%.

• 91% found the teaching relevant to their learning needs. • 91% rated teaching quality 5/5.

CONCLUSIONS: Students felt ill-equipped to manage many practical aspects of FY1. Junior Doctors are uniquely placed to address the practical knowledge gaps final year medical students may have. Our teaching programme greatly improved the students’ confidence on practical tasks and scenarios commonly encountered while working as an FY1 doctor. It was a valuable supplement to assistantship placements, and will be incorporated for future years.