SP - Education / Training

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.

1. INTRODUCTION: Older adults, particularly those with multi-morbidity, frailty or cognitive impairment, are under-represented in clinical research studies. To facilitate inclusive research for this population requires empowerment of all members of the multi-disciplinary team to promote and advocate for this underserved population. However, understanding of the personal and organisational barriers to staff engagement with research within Elderly Care remains limited.

2. METHOD: Using an amended version of the research capacity and culture tool an anonymous online survey open all staff members of an Elderly Care Department (n=351) in a District General Hospital was undertaken. The survey results were used to inform the departmental 5-year research strategy and launch a multifaceted educational and engagement programme.

3. RESULTS: 107 responses to the survey were received with a wide multi-disciplinary contribution. Despite 89% of respondents stating research was not part of their job, 96% were willing to be more involved in research. Motivators to staff engagement in research included: dedicated time for research (74%), research skills training (73%), mentors (67%), research relevant to elderly care (62%), hearing from researchers within the department (54%) and local promotion of research studies (49%). Barriers to research included: lack of time (78%), unsure of opportunities (65%) and lack of skills (47%). As a result of the survey numerous departmental interventions have been staged: a multi-disciplinary research half day, research opportunity display boards, monthly departmental presentations, promotion of the associate Principal Investigator scheme, Q&A webinars and a section in quarterly newsletter.

4. CONCLUSION(S): Multi-disciplinary staff working within Elderly Care can be motivated to advocate and engage with research opportunities for older adults. Supporting their engagement through the provision of dedicated time, research skills training and promotion of opportunities is key.

Introduction

Iron deficiency anaemia (IDA) is common in older people, but traditional ferritin cutoffs may not be applicable in older people and iron studies are increasingly being used to diagnose iron deficiency anaemia. We wish to update guidance for diagnosing IDA, but first wished to survey current knowledge.

Methods

Clinical staff working with older people were asked to filled in a survey. They answered questions relating to confidence in interpreting ferritin and iron studies. Their knowledge of interpreting iron studies was assessed with two multiple choice questions illustrating common scenarios.

Results

When asked on a scale of 1-5 how confident the 135 participants were at interpreting ferritin, the mean was 3.7. For iron studies, it was 3.2. Amongst consultants, the mean confidence in interpreting ferritin was 4.18, in doctors of other grades (excluding GPs) this was 3.5, and for other medical professionals (PAs, ACPs and pharmacists) 2.8. Regarding iron studies, the mean confidence in consultants was 3.7, 2.9 in doctors of other grades (excluding GPs), and 2.7 in other medical professions. 88% of consultants, 73% doctors of other grades (excluding GPs), and 65% of other healthcare professionals correctly answered the case on a patient with anaemia of chronic disease. 94% consultants, 88% doctors of other grades (excluding GPs), and 70% of other healthcare professionals correctly answered the case on a patient with IDA. 

Conclusions

The data suggests that clinicians of all grades felt less confident in interpreting iron studies than ferritin. A significant proportion of medical professionals did not correctly interpret iron studies. We have consulted with our colleagues in haematology and gastroenterology and drafted a revised guideline to help interpretation, and suggest that IDA guidance should have advice on iron study interpretation. We will also examine IV iron prescription use and provide clear guidance on indications, tracking related costs.

Introduction: Hospital at home (HAH) is growing apace in the United Kingdom, offering hospital-delivered treatments at home. In parallel, increasingly structured alternative training pathways are being created to enable doctors to train outside of formal specialty training programmes. With a need to train doctors to work in community settings, a HAH rotation within a locally developed internal medicine training (IMT) programme at one large NHS Foundation Trust was evaluated.

Method:

A questionnaire was designed to review the alignment of HAH rotation experience with the IMT curriculum and its acceptability as a clinical rotation within an IMT stage 1 equivalent programme. The questionnaire was distributed to all doctors who had previously undertaken a HAH rotation at junior clinical fellow level in the previous five years. Free-text responses were analysed with thematic analysis.

Results:

23/27 responded (85%). 74% had pursued IMT following their non-traditional training year. 78% agreed that HAH would be a suitable placement for a 4-month IMT rotation, with 74% interested in a HAH role following completion of training. HAH offers core content in internal and geriatric medicine. Curriculum coverage within a HAH rotation included improved confidence in clinical decision making, leadership, risk management, multidisciplinary team working and increased exposure to advanced care planning and palliative medicine. Being part of contextual, personalised medicine with shared decision making central was also cited as beneficial over traditional hospital rotations. Disadvantages were a lack of exposure to core IMT procedural skills, resuscitation and fewer opportunities to attend outpatient clinic.

Conclusion:

Whilst limited to one geographical service, results indicate that HAH is a prime learning environment for internal medicine training as part of a carefully balanced programme ensuring access to all curriculum competencies. Where sufficiently developed, HAH rotations can be included in IMT programmes delivering much needed generalist skills. 

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.

Introduction: Inpatient falls are a common problem, and it is important that newly qualified doctors feel confident in conducting competent assessments of patients after they fall. This project seeks to assess the confidence levels of final year Manchester Medical School (MMS) students surrounding the topic of inpatient falls assessments, as well as to determine whether another resource from MMS regarding this topic would be beneficial.

Method: A survey was conducted and disseminated amongst final year students at MMS through email and social media, with questions designed to address the objectives set, as well as gain an understanding of students’ prior experience and knowledge of inpatient falls assessments.

Results: A total of 70 out of 545 students answered the survey, equivalent to a 13% response rate. The results demonstrated that 70% had observed and 27.1% of students had performed an inpatient post-fall assessment. The results showed students generally were not confident in conducting inpatient falls assessments, with 17% and 39% of students self-assessing as ‘Extremely not confident’ and ‘Somewhat not confident’ respectively. 100% of students believed an additional resource on the topic would be a beneficial addition to the MMS curriculum; with the majority (60%) opting for a simulation session as an appropriate option, followed by an informative summary document (21%), an interactive online case (9%), and a lecture (6%).

Conclusions: Despite certain limitations of the project, it can be said that students generally lack confidence and experience when performing inpatient falls assessments and believe that an additional resource from MMS would be beneficial.

Introduction:

As we strive to generate more geriatricians we must understand the journey of the training programme. Whilst information is available from the RCP census and BGS workforce survey this study will compliment that data and obtain a broader picture. A similar survey was last undertaken by the BGS in 2019 and since that time much has changed, from a pandemic to the first published NHS Long term workforce plan.

Method:

TPDs were contacted directly by the BGS VP for workforce at the geriatric medicine specialty advisory committee and invited to complete an electronic survey. The survey had been designed by the BGS workforce committee in line with the BGS strategic plan to strengthen the workforce for older people. The survey was open for 6 weeks.

Results:

Surveys were returned from 14 out of 19 deaneries, some were incomplete. National training numbers have increased since the 2019 survey, in total and with less vacancies. Six trainees had left the training programme in 2023 before obtaining CCT for various reasons. The percentage of trainees working less than full time has doubled from 21.9% in 2019 to 44.8%, the majority for parenting responsibilities. Most deaneries reported at least one trainee spending time out of programme, the majority pursuing additional experience directly related to the curriculum such as stroke. Qualitative data suggested solutions to increasing national training numbers and encouraging doctors to consider the specialty early in their career.

Conclusions:

This study was limited by incomplete data, a mixture of non and partial responses. What this study adds is an insight into the paths to becoming a geriatrician and solutions TPDs have found to supporting individual needs. These solutions can now be shared to help our members tend to the workforce crisis by successfully recruiting, training and retaining the geriatricians of the future.