Education

Introduction: Within our hospital, the Surgical Acute Frailty Team (SAFT) delivers perioperative care to the older emergency surgical population. SAFT focuses on early identification of frailty using the Clinical Frailty Scale and subsequent comprehensive geriatric assessment delivery. The most common referral reason to the team is delirium therefore widespread awareness and timely management is essential. Given the challenging clinical environment, SAFT decided to implement a blended teaching programme to support with delivering frailty education to the surgical multidisciplinary team. The aim of the education programme was to improve confidence in frailty identification, delirium assessment and management.

Methods: Teaching sessions targeting all healthcare professionals were delivered by members of SAFT. Education was delivered in two formats: ‘tea trolley teaching’ and small group classroom-based lectures. ‘Tea trolley teaching’ provides focussed ward-based education with a sweet treat provided as an incentive to attend. Feedback was gathered real-time before and after sessions to identify areas of knowledge improvement.

Results: 53 healthcare professionals attended these face to face teaching sessions. Prior to receiving this education, only 26% of participants felt confident in the identification of frailty. This improved to 91% post education. There was also significant improvement in participants’ confidence with delirium assessment from 23% to 74%. A similar improvement was also recorded in confidence with use of the TIME bundle for delirium management from 13% to 60%.

Conclusions: Delivering our education programme using a blended learning approach has improved participants’ confidence with frailty identification, delirium assessment and management. Future plans include the expansion of the teaching curriculum to include other common frailty-related topics, with the goal of improving the perioperative care of older adults within the emergency surgical setting.

Introduction:

Inpatient falls are the most common adverse patient safety incidents in hospitals in the UK. The assessment and management following an inpatient fall is often the responsibility of the most junior doctor on call, particularly out of hours. Frequently, there are key omissions in the assessment of these patients, leading to missed diagnoses, poor management and avoidable patient harm. This study aimed to improve the knowledge and confidence of foundation doctors in the assessment and management of inpatient falls.

Method:

31 patients were identified who had suffered ‘severe harm’ following an inpatient fall and a retrospective review of their notes was performed. A preliminary survey on self-perceived confidence levels on different areas of the assessment and management of inpatient falls was distributed to all foundation doctors at Ipswich Hospital. The key themes of the simulation scenario were subsequently determined by the areas of weakness identified in both the survey and documentation review. A total of 9 foundation doctors at Ipswich Hospital participated in a high-fidelity inpatient fall simulation with a patient actor. Pre- and post-simulation knowledge and confidence surveys consisting of ten multiple choice questions and Likert scales respectively were distributed using QR codes.

Results:

Post-simulation confidence levels improved in all domains measured (p < 0.05) with an overall increase in average confidence levels from 3.3/5.0 to 4.3/5.0 (p=0.007). Average post-simulation knowledge score increased from 4.6/10 to 7.4/10 (p= 0.01). Domains in which the greatest improvements in knowledge and confidence were seen included: moving & handling, neurological observations, assessment of suspected hip fractures and escalating concerns.

Conclusion:

The use of simulated patients improves the knowledge and confidence of foundation doctors in the assessment and management of inpatient falls. The pilot project is due to be expanded with plans to incorporate this simulation scenario into the local foundation teaching programme.

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.

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.

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.

References 1. Monrouxe LV, Grundy L, Mann M et al. BMJ Open. 2017;7(1). 2. British Geriatrics Society. Protecting the rights of older people to Health and Social Care [Internet] 2023. 3. Fisher JM, Walker RW. Age and Ageing. 2013 Dec 18;43(3):424–8.

Introduction

The prevalence of dementia is increasing and yet healthcare professionals (HCP) do not always have sufficient education and training to deliver optimal care for patients with dementia (PWD). There is an evidence base as to how to deliver effective undergraduate education about dementia but this is infrequently integrated into the medical curriculum.

Methods

We undertook a realist synthesis to review the barriers to integrating effective interventions on dementia into the medical curriculum. A realist synthesis differs from a traditional systematic review in terms of explaining how interventions might succeed (or not) in a particular context, involving iterative cycles of literature review and synthesis to develop and refine a “programme theory” (PT).

Results

We analysed and synthesised twenty relevant studies of undergraduate educational interventions on dementia to identify common themes. We constructed an “initial programme theory” (IPT) to illustrate the contexts where teaching on dementia occurs, and outline four main categories of barriers to curriculum integration: culture, concern for patient welfare, student attitudes, and logistics.

Conclusion

We have identified key barriers to implementation of undergraduate education about dementia, and potential mechanisms to overcome them. The next stage of our realist synthesis is to gather stakeholder feedback on the validity of the IPT before returning to the next cycle of literature review to refine and finalise our PT. This model will serve as a guide for those aiming to successfully integrate effective education about dementia into the medical curriculum.

Introduction: The terminology surrounding manual-handling equipment and discharge planning is rarely taught in medical school. Yet, it is crucial for medical staff, particularly those working on Care of the Elderly (COTE) wards, to comprehend these terms to accurately assess a patient's function and optimise discharge planning.

Methods: A 17-question survey was distributed to establish the baseline knowledge of medical staff in a district general hospital, with the aim of using PDSA (plan, do, study, act) cycles for improvement as needed. Following preliminary data analysis, a lunchtime hospital teaching session was designed to educate individuals on these key terms and equipment. Ten clinicians attended and took part in a mentimeter quiz reassessing knowledge post-teaching.

Results: Seventeen participants, ranging from physician associates and junior doctors to consultants, completed the initial survey anonymously. Knowledge varied widely, with scores ranging from 15% to 91%. All participants accurately identified a Zimmer frame, 15 (88%) correctly labelled a PAT slide and 13 (76%) a hoist. Reassuringly, all knew that the acronym “POC” stood for Package of Care. Poorly recognised equipment included turn discs, standing hoists and hover jacks. Furthermore, the term “reablement” and the healthboard-specific “complex needs booklet” lacked clear definitions. While many participants could define fast track discharge, they could not distinguish between the two types. The average score per question increased from 53% in the pre-teaching survey to 59% post-teaching, however this was not statistically significant (P=0.57).

Conclusions: Although medical staff were familiar with certain equipment, they lacked understanding of more specialist aspects of discharge planning and less commonly used equipment. Unfortunately, these results did not significantly change post-teaching, likely due to low attendance; however, we are hopeful that the survey distribution and teaching will spark discussion throughout the hospital. We have now adapted the teaching content into posters for the next PDSA cycle. 

Introduction:

BGS reports in its 'Case for more Geriatricians' that the number of people age over 85 is set to double by 2045. As well as Geriatric specific policies in the Ageing Well programme of the NHS Longterm Workforce Plan there are plans to expand the number of allied health professionals including Physician Associates (PA). We set out to improve PA students knowledge of and confidence in managing geriatric patients with a bespoke teaching programme culminating in a novel bleep simulation.

Methods:

We identified the students needs with a preliminary survey and then created a teaching programme on medical topics and issues common to geriatric wards with weekly lectures and small group work. The programme culminated in a bleep simulation where students were contacted via bleep to come to different parts of the medical education centre and respond to scenarios which would be common on geriatric wards. These included reviewing unwell patients and issues such as aspiration, constipation and urinary retention. The students were required to amend or create prescriptions and interpret test results with access to the BNF and relevant local guidelines.

Results:

Students were asked how useful the simulation was and how much it had improved their confidence in working on geriatric wards. The average score for both statements was greater than 9/10. The students were asked before and after the simulation how confident they were responding to bleeps and managing clinical scenarios in geriatric patients. Both scores doubled following the simulation to 6.7/10 (from 2.5 and 3.3 respectively).

Conclusion:

The Faculty of Physician Associates curriculum does not necessitate placements in geriatrics and its matrix of core clinical conditions does not include any specific to geriatrics. Through a bespoke teaching programme and a novel bleep simulation we increased PA students confidence in managing geriatric patients.

INTRODUCTION Medical graduates should be capable of providing good quality care for older adults who present with multi-morbidity, frailty and challenging long-term conditions, as recommended by the GMC’s “Outcomes for Graduates” guidance. Simulation-based education (SBE) is a recognised modality for replicating experiences to enhance and consolidate learning in a safe environment. We have developed an undergraduate geriatric medicine themed SBE experience, which aims to consolidate learning for core geriatric medicine concepts. METHODS Three geriatric medicine simulation scenarios have been written for 4th year medical students, which follow a simulated patient’s clinical journey within an acute hospital setting covering an inpatient fall, challenging communication and assessment of delirium. The intended learning outcomes align to the geriatric medicine themes in the University of Glasgow undergraduate curriculum, in addition to addressing salient skills including A to E assessment, handover and other non-technical skills. A questionnaire using Likert scales and free text boxes was sent to candidates and faculty before and after the sessions to gather feedback. Faculty members consisted of consultants, registrars, nurses and clinical fellows, with backgrounds in both general and geriatric medicine. RESULTS Following the sessions, 100% of students and faculty “agreed” or “strongly agreed” that SBE is useful for geriatric medicine themes. Following the sessions, 80% of students felt “fairly confident” in their knowledge of falls and delirium, with 60% feeling the same regarding breaking bad news. Qualitative student feedback recognised it as “relevant”, “helpful” and they enjoyed the “realistic pace” of the scenarios. Faculty acknowledged that this SBE “will help prepare students for foundation years”. CONCLUSIONS Our innovative geriatric medicine themed SBE has been positively received by both students and faculty. Early results show students have subsequently improved confidence around core geriatric medicine topics. We intend to continue expanding our audience and strengthening undergraduate learning for geriatric medicine.