SP - Education / Training

Introduction: There is growing awareness of the harms caused by racial abuse and discrimination from patients towards healthcare professionals, including anecdotal reports of patients ‘requesting a white doctor’ (Kline, BMJ Opinion, 2020); yet there is limited understanding of the impact in Geriatric settings. We conducted a survey in an inpatient Older Persons Service (OPS) on the prevalence, impact and actions taken in response to patient racism towards staff.

Methods: A cross-sectional survey (Total N=47; Black and Minority Ethnic (BME) staff: N=32; White staff: N=15) of staff experiences of racist behaviour from patients and carers (July 2021) in a tertiary level inpatient OPS in an ethnically diverse London borough, both in terms of patients and staff, in the United Kingdom. The survey was developed in collaboration with OPS staff and the BME network. The anonymous survey was offered to all nurses, doctors, allied healthcare professionals and non-clinical staff on two 26-bed wards.

Results: Sixty-nine percent (22/32) of BME staff had personally experienced racist behaviour from older patients, while witnessing racism towards colleagues was reported by 62% (18/29) of BME staff and 80% (12/15) of White Staff. Sixty-seven percent (30/45) of respondents had witnessed a patient request a different ethnicity of healthcare professional. The majority of racist incidents went unchallenged and unreported with only 39.1% challenging the patient or carer, 21.7% reporting to a senior and 8.7% reporting via the electronic incident reporting system. The impact of such incidents on staff well-being included self-reported depression (56%, n=11/21), anxiety about work (28%, n=6/21) and insomnia (14%, n= 3/21).

Conclusion: With an ageing population, staff recruitment and retention in Geriatrics is critical. Comprehensive policies that have a zero-tolerance approach to racism, support staff and encourage reporting are crucial. Future research that considers the impact of mental capacity and cognitive impairment would be beneficial.

 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.

Introduction

Geriatric syndromes are traditionally taught through didactic teaching and bed side tutorials. However, these do not consider the science of learning and the strategies needed for a novice learner. It is prudent to manage cognitive load, create associations through testing and enforce deliberate practice for a novice as opposed to an advanced learner. Case- Based discussions (CBD) serve as an apt tool to deliver knowledge covering geriatric syndromes; aimed at testing learner's understanding through its application to a simulated patient profile.

This pilot aimed to test the applicability of CBD to teach geriatric syndromes to novice learners.

Method 

A scoping review was completed by medical officers starting on their geriatric medicine rotation in a Singapore tertiary hospital to determine syndromes which they request dedicated teaching for within curriculum. Learners ranked Incontinence and Falls with Osteoporosis management as the top 2 geriatric syndromes of interest. Focus group discussion using Rogers’s theory of diffusion principle was undertaken to understand both the advantages and challenges of CBD. Clinical scenarios were curated specific to the 2 topics with learner's completing a pre session quiz beforehand to determine their baseline knowledge. The topic specific CBD was done via zoom platform with questions applied in a graded fashion; components include that of diagnosis, evaluation, and management of select syndrome. Learners completed a post session quiz 1 week after the CBD to determine retention of knowledge.

Results

Quantitative Feedback received from the learners highlighted that more than 90% would want CBD to be implemented for other geriatric syndromes. There was an improvement in the average score obtained in post session quiz for Osteoporosis from 6.09 to 6.75. However, there was notably poor participation in the post session quiz.

Conclusion

This pilot highlights that CBD should be utilized to enhance teaching of clinical concepts in geriatric medicine.

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:

COVID-19 disease can cause a wide variety of long-term health problems, such as impaired lung function, reduced exercise performance, and decreased quality of life. Our study aimed to investigate the efficacy, feasibility, and safety of pulmonary rehabilitation in patients with COVID-19 and to compare the results between patients with a mild/moderate and severe/critical course of the disease.

Materials and Methods:

Patients in the post-acute phase of a mild to critical course of COVID-19 admitted to a comprehensive pulmonary rehabilitation program were included in this prospective, observational cohort study. Various measures of exercise performance, 6-minute walk distance, lung function (forced vital capacity (FVC)), and quality of life (36-question short-form health survey (SF-36)) were assessed before and after.

Results:

43 patients were included in the study (20 with mild/moderate COVID and 23 with severe/critical COVID-19).

Results:

At admission, patients had reduced walking distance (mild: median 401 m, interquartile range (IQR) 335-467 m; severe: 108 m, 84-132 m), impaired FVC (mild: 72%, severe: 35%,) and a low SF-36 mental health score (mild: 52 points, severe: 32 points. Patients received sessions adjusted to their physical abilities, patients in both subgroups improved on the walking test of 6 min (mild/moderate: +54m, severe/critical: +117m, both p < 0.002), FVC (mild/moderate: +8.9%, p=0.004; severe/critical: +12.4% , p <.003) and mental component sf-36 (mild /> moderate: +6.8 points, p = 0.062; severe / critical: +16.7 points, -p <.005). conclusions: an exercise program well structured results in a benefit the spheres of aerobic capacity, lung volumes and quality life, this sense it is recommended to expand population samples be able apply our protocol other centers charge n rehabilitation covid 19 patients. 

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 and Aims

            Many medical specialty trainees report a lack of confidence in hyperacute stroke management, contributing to inefficient patient care. We identified a lack of knowledge of our pathways, as well as difficulty managing human factors, particularly communication and teamwork. We hypothesised that the implementation of a simulation-based education programme could address these issues amongst medical specialty trainees and lead to improvements in our door-to-needle (DNT) times.

Methods

            We organised a scenario-based simulation education session for our trainees led by a multi-disciplinary faculty. We addressed the management of acute ischaemic stroke, intracerebral haemorrhage, and basilar artery occlusion, as well as thrombolysis complications. Learners were surveyed before and after each session to gauge improvements in knowledge and confidence using a Likert scale. Free text feedback was sought from both learners and faculty to identify areas for improvement. We measured the mean DNT 3 months before and after our session.

Results

            We improved both the knowledge and confidence of trainees in managing hyperacute stroke presentations and the human factors involved in a stroke pathway. We received feedback regarding the staffing of our on-call team and improving communication, including the use of lanyard cards and single point of contact devices. We also noted an improvement in our mean DNT amongst trainees who attended our training from 62mins to 34mins. Our resources were trialled in two other healthcare trusts to refine them further, before expanding the programme locally and regionally to improve training across all healthcare trusts.

Conclusions

            Simulation education is beneficial in improving knowledge and confidence in the management of hyperacute stroke and can contribute to reduced DNT.

Background: The MDTea is a free open access medical education podcast designed for all healthcare professionals caring for older adults. To date there are 120 episodes.

Introduction/Method: The MDTea Podcast has CPD survey logs on its website where listeners who access the website can record their learning and receive a CPD certificate, Listeners provide their professional roles. Listener numbers for episodes were much higher than those recorded in the CPD log, so alternative measures were sought to understand who listens to the podcast. Series 11 was released in January to July 2022 and was themed around ‘A Day in the Life’ of health professionals working with older adults in the hospital environment. The MDTea Podcast Twitter account had 6333 followers before series 11 release and has good discussion and engagement with followers, and is regularly tagged in other geriatrics care from discussion by professionals. Measuring the followership and social network of the account may be useful to understand the MDTea’s place in the social network of UK care of older adults healthcare. Therefore with each episode release the new follower numbers and if available self identified professional roles of each were recorded and counted.

Results: Over the course of the 11th series, the MDTea Podcast twitter account gained 432 new followers, from 22 different self defined professional groups who engaged with our social media.121 followers did not identify their title. In contrast 12 self identified professions were recorded in our series 11 CPD log results from 30 responses.

Conclusion: This work has demonstrated the wide range of professionals that engage with FOAMed resources produced by the MDTea. Given the breadth of professionals working in elderly care roles in both primary and secondary settings, having an understanding content users can enable authors to design content that is appropriate for their audience.

Introduction

From our observations and personal experience Parkinson’s Disease (PD) patients have complex medical needs and are often mismanaged during acute admissions.Medications are wrongly prescribed, particularly out of hours, leading to increased mortality and morbidity.¹

The aim of this project was to assess junior doctors’ understanding of managing the acutely unwell PD patient, with a particular focus on common prescribing errors. We addressed gaps in knowledge by providing teaching sessions and reassessing learning.

Methods

We designed a 9-point questionnaire which assessed confidence and prescribing knowledge. This was given to 14 participants in 2 different settings; informally on the wards and at an FY1 teaching session.  Following this, education was delivered either in the form of 5-minute tutorials on the wards which we named ‘educational soundbites’ (ES) or as a 30-minute interactive case study (ICS) delivered in a lecture hall. Participants were then asked to repeat the same questionnaire and results were compared.

Results

Pre-education, clear gaps in knowledge were identified. None of the participants were aware of the use of Madopar as a rescue drug. There was little awareness of Parkinsonism-Hyperpyrexia Syndrome and of the consequences of missed medications. Knowledge of alternative routes of administration in nil-by-mouth PD patients was poor, as was awareness of contra-indicated drugs.

Of the 14 participants, 7 were given the ES session and 7 the ICS. Following both of these interventions there was an overall increase in confidence levels and understanding of safe prescribing in PD.

Conclusion

PD is one of the most common neurodegenerative disorders in the world and its prevalence is rising.²  It is therefore essential that junior doctors are proficient at managing these patients in the acute setting. This quality improvement project highlights that there are concerning gaps in knowledge surrounding this, particularly in regards to prescribing. Knock-on effects can lead to increased patient morbidity and mortality. This project has demonstrated that educational interventions are simple and effective at addressing this issue.  We would therefore propose that teaching surrounding this subject should be a mandatory component of medical training programmes across the UK.

References

1. Medication Management Performance in Parkinson's Disease: Examination of Process Errors - PubMed (nih.gov)
2. Change in the incidence of Parkinson’s disease in a large UK primary care database | npj Parkinson's Disease (nature.com)

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form is widely adopted to document advanced care plans, including Do Not Attempt Resuscitation (DNACPR) decisions. Communication between clinicians and patients, or next of kin is required for completion. It is widely documented UK medical students have little exposure to these experiences, including being asked to leave whilst they are occurring. During the COVID19 pandemic, Foundation Year 1 (FY1) doctors led discussions with increased frequency and autonomy, with no documented concurrent training. We present a novel learning experience designed to aid these discussions. Students were timetabled to a 1.5 hour workshop, facilitated by a clinical teaching fellow. They were invited to complete a ReSPECT form for a celebrity to familiarise themselves with the layout. They then considered a patient admission scenario in 3 different groups from the perspective of the patient, family and medical team, and used this to contemplate potential, future, emergency treatments. Subsequently a discussion surrounding CPR effectiveness, ways of communicating this, and legal advanced decision documents occurred. The session concludes with scrutinising example ReSPECT forms provided by the Resuscitation Council UK.

Method: Students' confidence levels were measured pre and post session using a Likhert scale questionnaire.

Results: 90 students attended workshops across 6 rotations. 80% students completed post - session questionnaires, of which 100% reported an increase in confidence with having a DNACPR/advanced care planning discussion compared to before the session.

Conclusion: DNACPR conversations can incite anxiety in any seniority of health care professionals. Medical educators need to adequately prepare medical students during their training in advanced care planning and DNACPR discussions. This can be done with simulated workshop experiences, reinforced with opportunistic or organised observational experience. Adequate preparation will lead to increased confidence in discussions, ultimately leading to better experiences for patients and their families.