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Moll-Jongerius A, Langeveld K, Tong W, Masud T, Kramer AWM, Achterberg WP. Professional identity formation of medical students in relation to the care of older persons: a review of the literature. GERONTOLOGY & GERIATRICS EDUCATION 2024; 45:424-437. [PMID: 37170948 DOI: 10.1080/02701960.2023.2210559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
With the growing population of older persons, medical students have to be well prepared for older persons' health care during medical school. Becoming a doctor is an interplay of building competencies and developing a professional identity. Professional identity formation of medical students is a relatively new educational concept in geriatric medical education. This review aims to explore the concept of professional identity formation of undergraduate medical students in relation to the care of older persons. Twenty-three peer-reviewed studies were included and summarized narratively. Patient-centeredness, caring and compassion, collaboration and holistic care are characteristics of the doctor's professional identity in relation to the care of older persons. Participating in the context of older persons' health care contributes to the becoming of a doctor in general. In this context, the building of relationships with older persons, participating in their lives and role models are important influencers of professional identity formation. Furthermore, the perceptions and expectations medical students have of future doctoring influence their feelings about the care of older persons. To prepare medical students for older persons' health care, professional identity formation seems to be a relevant educational concept.
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Affiliation(s)
- Annemarie Moll-Jongerius
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Kirsten Langeveld
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Wing Tong
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Tahir Masud
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Teodorczuk A, Abdool PS, Yap CX, Fisher JM. New horizons in undergraduate geriatric medicine education. Age Ageing 2024; 53:afae050. [PMID: 38688484 DOI: 10.1093/ageing/afae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Indexed: 05/02/2024] Open
Abstract
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 10 years 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.
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Affiliation(s)
- Andrew Teodorczuk
- Northside Clinical Unit, The Medical School, The University of Queensland, Brisbane, Qld, Australia
- The Prince Charles Hospital, Metro North Mental Health, Brisbane, Qld, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Qld, Australia
- School of Nursing, QUT, Brisbane, Qld, Australia
| | - Petal S Abdool
- Geriatric Mental Health Service, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Chloe X Yap
- The Prince Charles Hospital, Metro North Mental Health, Brisbane, Qld, Australia
- Mater Research Institute, The University of Queensland, Brisbane, Qld, Australia
| | - James M Fisher
- Department of Geriatric Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
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Moll-Jongerius A, Langeveld K, Helmich E, Masud T, Kramer AWM, Achterberg WP. Becoming a physician for older patients: exploring the professional identity formation of medical students during a nursing home clerkship. A qualitative study. BMC MEDICAL EDUCATION 2023; 23:845. [PMID: 37936183 PMCID: PMC10631180 DOI: 10.1186/s12909-023-04835-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 11/01/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND To prepare medical students for the growing population of older patients, an appropriate professional identity formation is desirable. The community of practice of medical school is primarily hospital-based and disease-oriented which will lead to the development of a physician who is mainly focused on cure. This focus alone however is not always appropriate for older persons' health care. The aim of this study is to explore the influence of participating in a nursing home community of practice on the professional identity formation of medical students. METHODS A qualitative study based on a constructivist research paradigm was conducted, using individual semi-structured, in-depth interviews and a visual narrative method (drawing) as a prompt. Thematic analysis was applied to structure and interpret the data. The study population consisted of fifth-year medical students participating in a six-week nursing home clerkship. Thirteen participants were purposefully sampled. The clerkship took place in nursing homes in the South-West of the Netherlands. RESULTS The medical students described the nursing home as the living environment of the patients. Actively participating in the patients' care and experiencing the daily life of the patients was meaningful for the physician the students want to become in five ways: (1) a physician with a complete picture; (2) a physician who is close; (3) a physician who is in dialogue; (4) a physician who is able to let go and (5) a physican who collaborates. CONCLUSIONS Caring for older patients in the nursing home influences the professional identity formation of medical students. Patient-centeredness, personal, holistic and tailored care, approachability and collaboration are important characteristics in becoming a physician for older persons' health care. The context of this care provides relevant learning experiences for this development and the becoming of a physician in general.
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Affiliation(s)
- Annemarie Moll-Jongerius
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands.
| | - Kirsten Langeveld
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands
| | - Esther Helmich
- Amsta Health Care Organization, Amsterdam, The Netherlands
| | - Tahir Masud
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands
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Spatoula V, Panagopoulou E. Biases towards different patients groups. How do they differ during medical education? PATIENT EDUCATION AND COUNSELING 2023; 112:107747. [PMID: 37084669 DOI: 10.1016/j.pec.2023.107747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE This cross-sectional study was a first to attempt to assess how biases towards age, gender and sexual orientation differ during the years of undergraduate medical education. METHODS 600 medical students from the first, third and sixth year of study participated in the study. Three questionnaires were used: The Ambivalent Sexism Inventory scale (ASI), the Fraboni Scale of Ageism (FSA) and the Homophobia scale (HSc). RESULTS Results showed statistical significant differences between the three groups in the total scores of ageism and homophobia. Students in the last year of studies reported more ageist and more homophobic biases than students in the first year of their studies. CONCLUSIONS Our results demonstrate a need for education to reduce/address/mitigate bias in medical students. Τhe finding that biases increase in students who are farther along in their education needs further investigation. This warrants particular attention to determine if this is a change due to the medical education process itself. PRACTICE IMPLICATIONS Medical education should teach students about diversity and acceptability with updated curriculums and designed interventions.
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Pearson GME, Winter R, Blundell A, Masud T, Gough J, Gordon AL, Henderson EJ, Christopher G, Hart D, Sanders J, Jennings J, Watson A, Miller-Molloy F, Miles E, Mohammed B, Wilkinson I, Al-Jawad M, Vassallo M, Henderson EJ. Updating the British Geriatrics Society recommended undergraduate curriculum in geriatric medicine: a curriculum mapping and nominal group technique study. Age Ageing 2023; 52:7028004. [PMID: 36746388 PMCID: PMC9902152 DOI: 10.1093/ageing/afac325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND medical education must adapt to meet the challenges and demands of an ageing population, ensuring that graduates are equipped to look after older patients with complex health and social care needs. Recommended curricula in geriatric medicine in the United Kingdom and Europe offer guidance for optimal undergraduate education in ageing. The UK version, written by the British Geriatrics Society (BGS), requires updating to take account of innovations in the specialty, changing guidance from the General Medical Council (GMC), and the need to support medical schools preparing for the introduction of the national Medical Licensing Assessment (MLA). METHODS the BGS recommended curriculum was mapped to the most recent European curriculum (2014) and the MLA content map, to compare and contrast between current recommendations and nationally mandated guidance. These maps were used to guide discussion through a virtual Nominal Group Technique (NGT), including 21 expert stakeholders, to agree consensus on the updated BGS curriculum. RESULTS the curriculum has been re-structured into seven sections, each with 1-2 overarching learning outcomes (LOs) that are expanded in multiple sub-LOs. Crucially, the curriculum now reflects the updated GMC/MLA requirements, having incorporated items flagged as missing in the mapping stages. CONCLUSION the combined mapping exercise and NGT have enabled appropriate alignment and benchmarking of the UK national curriculum. These recommendations will help to standardise and enhance teaching and learning around the care of older persons with complexity.
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Affiliation(s)
| | - Rebecca Winter
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Adrian Blundell
- Department of Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK,School of Medicine, University of Nottingham, Nottingham, UK
| | - Tahir Masud
- Department of Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Joanna Gough
- British Geriatrics Society, Marjory Warren House, London, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK,British Geriatrics Society, Marjory Warren House, London, UK,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | | | - Emily J Henderson
- Ageing and Movement Research Group, Bristol Medical School, University of Bristol, Bristol, UK,Older People’s Unit, Royal United Hospitals NHS Foundation Trust, Bath, UK,British Geriatrics Society, Marjory Warren House, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | - Emily J Henderson
- Ageing and Movement Research Group, Bristol Medical School, University of Bristol , Bristol , UK
- Older People’s Unit, Royal United Hospitals NHS Foundation Trust , Bath , UK
- British Geriatrics Society, Marjory Warren House , London , UK
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von Streng Paats T, Masud T, Huwendiek S, Blundell A, Vassallo M, Stuck AE. Geriatric medicine learning objectives and entrustable professional activities in undergraduate medical curricula: a scoping review. Age Ageing 2022; 51:6583201. [PMID: 35536879 PMCID: PMC9089827 DOI: 10.1093/ageing/afac100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background entrustable professional activities (EPAs) have become an important component of competency-based medical education. The aim of this study is to evaluate how geriatric medicine learning objectives are addressed by undergraduate medical curricula including EPAs. Methods we performed a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines to identify undergraduate medical curricula that include EPAs. A content analysis was conducted to examine how these curricula address the care of older individuals. In addition, we mapped the curricula to 19 geriatric medicine learning objectives identified from the European curriculum of undergraduate medical education. Results we found nine curricula, each containing between 4 and 16 core EPAs. In the sections describing the EPAs, three of the nine curricula specify that all core EPAs apply to all age groups including older patients, whereas the remaining six curricula either only refer to older patients in selected EPAs or not at all. Mapping revealed that some geriatric medicine learning objectives are covered by most curricula (e.g. medication use, multidisciplinary team work), whereas others are lacking in the majority (e.g. normal ageing, geriatric assessment, cognitive assessment, nutrition assessment, decision-making capacity assessment, long-term care). Three curricula cover most geriatric learning objectives by using a matrix aligning EPAs with geriatric competencies. Conclusions geriatric learning objectives continue to be missing from undergraduate medical curricula, also from those adopting the novel approach of EPAs. However, this review also identified some curricula that might serve as models for how geriatric learning objectives can be successfully covered within future EPA frameworks.
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Affiliation(s)
- Tasslem von Streng Paats
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tahir Masud
- Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Medical Research Council and Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Nottingham, UK
- National Institute for Health Research Nottingham Biomedical Research Centre: Musculoskeletal Disease theme, Nottingham, UK
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Adrian Blundell
- Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michael Vassallo
- University Hospitals Dorset, Bournemouth, UK
- Clinical Research Unit (BUCRU) Faculty of Health and Social Sciences, Bournemouth, Dorset, UK
| | - Andreas E Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Schlögl M, Roller-Wirnsberger RE, Hernes SS, Perkisas S, Bakken MS, Miot S, Balci C, Dani M, Pajulammi H, Piaggi P, Drenth-van Maanen C, Singler K. Teaching geriatric medicine through gamification: a tool for enhancing postgraduate education in geriatric medicine. Aging Clin Exp Res 2022; 34:455-463. [PMID: 34275114 PMCID: PMC8847288 DOI: 10.1007/s40520-021-01933-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/04/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Polypharmacy is becoming increasingly common and all doctors must be prepared to manage it competently. AIMS The 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. METHODS Electronic 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. RESULTS Most 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 CONCLUSION The 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.
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Affiliation(s)
- Mathias Schlögl
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland
- University Clinic for Acute Geriatric Care, City Hospital Waid Zurich, Zurich, Switzerland
| | | | - Susanne Sørensen Hernes
- Department of Geriatric and Internal Medicine, Sorlandet Hospital Arendal, Sykehusveien 1, 4809, Arendal, Norway
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Stany Perkisas
- University Center for Geriatrics, University Hospital of Antwerp, Edegem, Belgium
| | - Marit Stordal Bakken
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Stéphanie Miot
- Department of Geriatrics, Montpellier University Hospital, Montpellier University, Montpellier, France
- CESP, INSERM U1178, Centre de recherche en Epidemiologie et Santé des Populations, Paris, France
| | - Cafer Balci
- Division of Geriatric Medicine, Eskişehir City Hospital, Eskisehir, Turkey
| | - Melanie Dani
- Cutrale Perioperative and Ageing Group, Uren Biomedical Engineering Research Hub, Imperial College London, London, W12 0BZ, UK
| | - Hanna Pajulammi
- Department of Geriatric Medicine, Central Hospital of Central Finland, Central Finland Health Care District, Jyväskylä , Finland
| | - Paolo Piaggi
- Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Clara Drenth-van Maanen
- Department of Geriatric Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584, Utrecht, The Netherlands
- Expertise Centre Pharmacotherapy in Old Persons (Ephor)
| | - Katrin Singler
- Department of Geriatric Medicine, Klinikum Nürnberg, Paracelsus Private Medical University, Prof. Ernst-Nathan-Str. 1, 90419, Nuremberg, Germany
- Institute for Biomedicine of Ageing, Friedrich-Alexander University Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Germany
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Crosignani S, Fantinati J, Cesari M. Frailty and Geriatric Medicine During the Pandemic. Front Med (Lausanne) 2021; 8:673814. [PMID: 34164415 PMCID: PMC8215135 DOI: 10.3389/fmed.2021.673814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
The term frailty in the era of coronavirus disease 2019 (COVID-19) has a manifold implication. The vast majority of the countries worldwide being hit by the pandemic have shown the frailty of their health and social care systems. Although the surprise factor could somehow justify the unpreparedness experienced during the first wave, the second wave still led to significant difficulties almost everywhere. Looking at Italy's situation, it is evident how the stress test applied by COVID-19 on the system has threatened its stability, getting it closer to collapsing many times. It is true that Italy, in particular the Northern regions, has been the epicenter of COVID-19 in Europe in a time when information about the severe acute respiratory syndrome coronavirus 2 was still lacking and confusing. Nevertheless, what happened has demonstrated significant issues in the structure, priorities, and organization of the system. It has exemplified the obsolete approach adopted in clinical practice, particularly when applied to frail older persons. The COVID-19 pandemic has made emerging the need for a substantial reshaping of our healthcare system. The hospital-centered model has dramatically failed. To adequately face the new challenges brought by the increasing complexity of our aging society, it is critical to move the barycenter of action toward the community/primary care, promoting the integration of services and centralization of clinical/administrative data. It is vital to train healthcare professionals in the identification and basic principles of geriatric conditions, clarifying the role that geriatricians play. In the present article, some cornerstone concepts of geriatric medicine (i.e., definition of geriatrics, multidisciplinarity, integrated care, and development of clinical databases for filling the evidence-based medicine gaps) are presented, explaining the challenges they have faced during the COVID-19 pandemic and possible solutions for implementing improvements in the future.
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Affiliation(s)
- Silvia Crosignani
- Fellowship in Geriatrics and Gerontology, University of Milan, Milan, Italy
| | - Jacopo Fantinati
- Fellowship in Geriatrics and Gerontology, University of Milan, Milan, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Istituti di Ricovero e Cura a Carattere Scientifico Istituti Clinici Scientifici Maugeri, University of Milan, Milan, Italy
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Montano AR. A concept analysis of interprofessional collaborative practice for community-dwelling older adults. Nurs Forum 2021; 56:413-420. [PMID: 33533058 DOI: 10.1111/nuf.12553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
Models of interprofessional collaborative practice have demonstrated improved outcomes for community-dwelling older adults. However, the concept of interprofessional collaborative practice for community-dwelling older adults needs clarification and a clear definition. A concept analysis based on the method posited by Walker and Avant was conducted to formulate an operational definition of this concept. Defining attributes, antecedents, consequences and empirical referents were identified from a review of the literature. A model case and contrary case were selected to further clarify the concept of interprofessional collaborative practice for community-dwelling older adults. Nurses are ideal leaders of interprofessional teams caring for older adults and can utilize this concept in practice, education and research.
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Affiliation(s)
- Anna-Rae Montano
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
- The Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
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McCarthy F, Winter R, Levett T. An exploration of medical student attitudes towards older persons and frailty during undergraduate training. Eur Geriatr Med 2020; 12:347-353. [PMID: 33245506 DOI: 10.1007/s41999-020-00430-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/09/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Older persons and patients with frailty constitute an ever increasing proportion of hospital patients. Improving student attitudes towards both groups is important in preparing future doctors for this demographic shift. We aimed to investigate medical student attitudes towards older persons and frailty over an entire medical school cohort. METHODS All current Brighton and Sussex Medical School students were invited to complete an online questionnaire consisting: (i) the Australian Ageing Semantic Differential (AASD), (ii) the Medical Condition Regard Scale (MCRS) with regards to frailty, (iii) a qualitative question asking participants to record three words regarding both a person over 70 years and frailty. RESULTS 187 students participated (66% female, 25.2% response rate). Participants reported positive attitudes with mean scores of 73.45/114 on the AASD and 52.4/66 on the MCRS. The most positive attitudes towards both older persons and frailty were held by year 1 students, and most negative by year 3 and year 4 students for older persons and frailty, respectively. Examining AASD subgroups, students held negative attitudes towards the instrumentality (function) of older persons (mean score: 17.6/36) with significant variation across year groups (p < 0.05), with the most negative attitudes expressed in year 3. Word clouds of qualitative responses showed that medical students consider the two concepts differently with frailty attracting more negative associations. CONCLUSION Generally medical student attitudes were positive towards older persons and frailty. However, these declined when focusing on the functionality, with word cloud analysis of attitudes revealing a dichotomy between the quantitative and qualitative data surrounding frailty.
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Affiliation(s)
- Fergus McCarthy
- Brighton and Sussex Medical School, University of Sussex, C/O BSMS Teaching Building, Brighton, BN1 9PX, East Sussex, UK.
| | - Rebecca Winter
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Tom Levett
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
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Vieweg J, Schaefer S. How an Age Simulation Suit affects Motor and Cognitive Performance and Self-perception in Younger Adults. Exp Aging Res 2020; 46:273-290. [PMID: 32449473 DOI: 10.1080/0361073x.2020.1766299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND/STUDY CONTEXT We assessed the influence of wearing an Age Simulation Suit (GERT) on gross motor, fine motor and cognitive performance in healthy young adults. METHODS In a within-subjects design, we tested 20 young adults (M age = 22.3 years) with and without the Age Simulation Suit. We assessed gross motor (Functional Fitness test) and fine motor (Purdue Pegboard test) functioning, cognitive performance (Digit Symbol Substitution test), and questionnaires on perceived physical state and mood. Gross and fine motor tests provided norms for large samples of older adults. RESULTS Wearing the Age Simulation Suit leads to significant performance reductions in all task dimensions, with large effect sizes. Depending on the subtest, participants' performances were reduced to the level of mid-50- to 85-years-olds for almost all tests of gross and fine motor performance. Mood and perceived physical state also declined while wearing the suit. CONCLUSION We argue that the GERT suit offers an attractive possibility to experimentally simulate the effects of aging-related sensory and motor losses and propose future studies with this paradigm, in the context of cognitive-motor dual-tasking or motor learning.
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Affiliation(s)
- Janine Vieweg
- Department of Sport Psychology, Saarland University , Saarbrücken, Germany
| | - Sabine Schaefer
- Department of Sport Psychology, Saarland University , Saarbrücken, Germany
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Hebditch M, Daley S, Wright J, Sherlock G, Scott J, Banerjee S. Preferences of nursing and medical students for working with older adults and people with dementia: a systematic review. BMC MEDICAL EDUCATION 2020; 20:92. [PMID: 32228571 PMCID: PMC7106576 DOI: 10.1186/s12909-020-02000-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/11/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND A current issue in workforce planning is ensuring healthcare professionals are both competent and willing to work with older adults with complex needs. This includes dementia care, which is widely recognised as a priority. Yet research suggests that working with older people is unattractive to undergraduate healthcare students. METHODS The aim of this systematic review and narrative synthesis is to explore the factors related to healthcare (medical and nursing) student preferences' for working with older people and people with dementia. Searches were conducted in five databases: MEDLINE, PsycINFO, CINHAL, BNI, ERIC. Screening, data extraction and quality appraisal were conducted by two independent reviewers. A narrative, data-based convergent synthesis was conducted. RESULTS One thousand twenty-four papers were screened (139 full texts) and 62 papers were included for a narrative synthesis. Factors were grouped into seven categories; student characteristics, experiences of students, course characteristics, career characteristics, patient characteristics, work characteristics and the theory of planned behaviour. CONCLUSION Health educators should review their role in cultivating student interest in working with older adults, with consideration of student preparation and the perceived value of this work. There is a lack of evidence about the career preferences of students in relation to dementia, and this warrants further research.
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Affiliation(s)
- Molly Hebditch
- Centre for Dementia Studies, Brighton & Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK.
| | - Stephanie Daley
- Centre for Dementia Studies, Brighton & Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK
| | - Juliet Wright
- Department of Medical Education, Brighton and Sussex Medical School, Falmer, BN1 9RY, UK
| | - Gina Sherlock
- Centre for Dementia Studies, Brighton & Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK
| | - James Scott
- Department of Medical Education, Brighton and Sussex Medical School, Falmer, BN1 9RY, UK
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton & Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK
- Faculty of Health, University of Plymouth, Devon, PL4 8AA, UK
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Jaafari F, Delavari S, Bazrafkan L. Evaluation of the geriatric curriculum implemented at Shiraz University of Medical Sciences, Iran, since 2017: A qualitative study. F1000Res 2019. [DOI: 10.12688/f1000research.16040.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Recently, there has been an increase in life expectancy due to improvements in nutrition, health, and sanitation. The aim of this study was to evaluate the geriatric curriculum in the field of general medicine at Shiraz University of Medical Sciences (SUMS), Iran to improve the quality of services provided to this population in the community. Methods: This was a qualitative study. Six educational hospitals and ambulatory centers of Shiraz University of Medical Sciences participated in this study. Within these centers, 15 medical education faculty members and educational experts, 6 medical students, 6 elderly patients and 6 nurses working in the university related to the geriatric field were selected using purposive sampling. Data were gathered through semi-structured interviews, focus group discussion and field observations in the teaching hospital and ambulatory setting of SUMS from June 2017 to May 2018. Based on the qualitative research, the data underwent conventional content analysis and the main themes were developed from this. Results: Three main themes were extracted from the data: effective clinical education, geriatrics curriculum challenges and promotion strategies for geriatric medicine. Subcategories that emerged were a competent curriculum teacher, a challenging program, management of resources, promotion of the program, and the revision required in the curriculum, which were related to other concepts and described in the real-world situation of the geriatric curriculum in the university, as observed in field observations. Conclusions: This study identified three concepts as main themes that can be used to explain how to implement a geriatric curriculum in a medical university. The main contributing factor to different views of the participants was identified as the revision required to the curriculum for integrative care in a geriatric patient. This should be taken into consideration while planning any programs and decisions aimed at education of medical students on this topic.
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Goldberg GR, Weiner J, Fornari A, Pearlman RE, Farina GA. Incorporation of an Interprofessional Palliative Care-Ethics Experience Into a Required Critical Care Acting Internship. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10760. [PMID: 30800960 PMCID: PMC6346344 DOI: 10.15766/mep_2374-8265.10760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/22/2018] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The literature documents inadequate palliative medicine training in undergraduate and graduate medical education. As the population lives longer, many people will experience multiple chronic illnesses and the associated symptom burden. All physicians involved in clinical care of patients need to be equipped with the knowledge, attitudes, and skills necessary to provide palliative care, yet most physicians do not feel adequately prepared. We designed a curriculum to provide a meaningful palliative care-ethics (PCE) clinical experience to prepare senior medical students for future practice regardless of specialty choice. METHODS The Zucker School of Medicine at Hofstra/Northwell integrated a PCE experience into the required 4-week acting internship in critical care (AICC). Students met weekly with an interprofessional faculty member and presented clinical cases focusing on communication and/or bioethical challenges. Faculty facilitators ensured that the presentations integrated discussion of communication skills. During the final session, students shared written reflections. Students were invited to complete a satisfaction survey postrotation and 1 year after graduation. RESULTS The curriculum was evaluated positively by the graduating classes of 2015 (n = 28) and 2016 (n = 56) at the end of the course and 1 year postgraduation. Qualitative analysis of the class of 2018 fourth-year students' reflective writing demonstrated themes of role modeling, suffering, family, and goals of care. DISCUSSION It is feasible to incorporate an interprofessional PCE experience into a required AICC. Students indicated a better understanding of palliative care and, at 1 year postgraduation, reported feeling comfortable caring for patients with serious illness.
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Affiliation(s)
- Gabrielle R Goldberg
- Assistant Professor, Department of Science Education, the Zucker School of Medicine at Hofstra/Northwell
| | - Joseph Weiner
- Associate Professor, Department of Psychiatry, the Zucker School of Medicine at Hofstra/Northwell
- Associate Professor, Department of Medicine, the Zucker School of Medicine at Hofstra/Northwell
| | - Alice Fornari
- Professor, Department of Science Education, the Zucker School of Medicine at Hofstra/Northwell
- Professor, Department of Occupational Medicine, Epidemiology and Prevention, the Zucker School of Medicine at Hofstra/Northwell
- Professor, Department of Family Medicine, the Zucker School of Medicine at Hofstra/Northwell
| | - R. Ellen Pearlman
- Assistant Professor, Department of Medicine, the Zucker School of Medicine at Hofstra/Northwell
| | - Gino A. Farina
- Professor, Department of Science Education, the Zucker School of Medicine at Hofstra/Northwell
- Professor, Department of Emergency Medicine, the Zucker School of Medicine at Hofstra/Northwell
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Garside MJ, Fisher JM, Blundell AG, Gordon AL. The development and evaluation of mini-GEMs - short, focused, online e-learning videos in geriatric medicine. GERONTOLOGY & GERIATRICS EDUCATION 2018; 39:132-143. [PMID: 27050439 DOI: 10.1080/02701960.2016.1165217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Mini Geriatric E-Learning Modules (Mini-GEMs) are short, focused, e-learning videos on geriatric medicine topics, hosted on YouTube, which are targeted at junior doctors working with older people. This study aimed to explore how these resources are accessed and used. The authors analyzed the viewing data from 22 videos published over the first 18 months of the Mini-GEM project. We conducted a focus group of U.K. junior doctors considering their experiences with Mini-GEMS. The Mini-GEMs were viewed 10,291 times over 18 months, equating to 38,435 minutes of total viewing time. The average viewing time for each video was 3.85 minutes. Learners valued the brevity and focused nature of the Mini-GEMs and reported that they watched them in a variety of settings to supplement clinical experiences and consolidate learning. Watching the videos led to an increase in self-reported confidence in managing older patients. Mini-GEMs can effectively disseminate clinical teaching material to a wide audience. The videos are valued by junior doctors due to their accessibility and ease of use.
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Affiliation(s)
- Mark J Garside
- a Specialist Registrar in Geriatric and General Internal Medicine , Northumbria Healthcare NHS Foundation Trust , Northumberland , UK
| | - James M Fisher
- a Specialist Registrar in Geriatric and General Internal Medicine , Northumbria Healthcare NHS Foundation Trust , Northumberland , UK
| | - Adrian G Blundell
- b Medicine of Older People, Department of Health Care of Older People , Nottingham University Hospitals NHS Trust , Nottingham , UK
| | - Adam L Gordon
- c Medicine of Older People, Division of Medical Sciences and Graduate Entry Medicine , University of Nottingham , Nottingham , UK
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Samra R, Cox T, Gordon AL, Conroy SP, Lucassen MFG, Griffiths A. Factors related to medical students' and doctors' attitudes towards older patients: a systematic review. Age Ageing 2017; 46:911-919. [PMID: 28472444 PMCID: PMC5860378 DOI: 10.1093/ageing/afx058] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/06/2017] [Indexed: 11/25/2022] Open
Abstract
Background studies have sought to identify the possible determinants of medical students’ and doctors’ attitudes towards older patients by examining relationships with a variety of factors: demographic, educational/training, exposure to older people, personality/cognitive and job/career factors. This review collates and synthesises these findings. Methods an electronic search of 10 databases was performed (ABI/Inform, ASSIA, British Nursing Index, CINAHL, Informa Health, Medline, PsycINFO, Science Direct, Scopus, and Web of Science) through to 7 February 2017. Results the main search identified 2,332 articles; 37 studies met the eligibility criteria set. All included studies analysed self-reported attitudes based on correlational analyses or difference testing, therefore causation could not be determined. However, self-reported positive attitudes towards older patients were related to: (i) intrinsic motivation for studying medicine, (ii) increased preference for working with older patients and (iii) good previous relationships with older people. Additionally, more positive attitudes were also reported in those with higher knowledge scores but these may relate to the use of a knowledge assessment which is an indirect measure of attitudes (i.e. Palmore's Facts on Aging Quizzes). Four out of the five high quality studies included in this review reported more positive attitudes in females compared to males. Conclusion this article identifies factors associated with medical students’ and doctors’ positive attitudes towards older patients. Future research could bring greater clarity to the relationship between knowledge and attitudes by using a knowledge measure which is distinct from attitudes and also measures knowledge that is relevant to clinical care.
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Affiliation(s)
- Rajvinder Samra
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, United Kingdom of Great Britain and Northern Ireland
| | - Tom Cox
- Centre for Sustainable Working Life, School of Business, Economics and Informatics, Birkbeck University of London , London, United Kingdom of Great Britain and Northern Ireland
| | - Adam Lee Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham , Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Simon Paul Conroy
- Department of Health Sciences, University of Leicester , Leicester, Leicestershire, United Kingdom of Great Britain and Northern Ireland
| | - Mathijs F G Lucassen
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, United Kingdom of Great Britain and Northern Ireland
- Department of Psychological Medicine, University of Auckland , Auckland, New Zealand
| | - Amanda Griffiths
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham , Nottingham, United Kingdom of Great Britain and Northern Ireland
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17
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Educator Readiness to Improve Gerontological Curricula in Health and Social Service Education. Can J Aging 2017; 36:501-513. [PMID: 28914223 DOI: 10.1017/s0714980817000381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study investigated the state of gerontology content in health and social service education programs in Ontario, and readiness indicators for change among administrators and faculty. We conducted a survey of teaching faculty (n = 100) and deans or directors (n = 56) of 89 education programs, which revealed mixed evidence on readiness for change. Most respondents thought their programs were adequate but needed enhancement. However, they were unaware of published gerontological competencies with which to evaluate their curricula. Beliefs about capacity for change varied, with half the participants indicating that their programs had sufficient faculty expertise in gerontology and geriatrics. Factors influencing readiness for change include lack of gerontological expertise; need for institutional and management support; need for additional teaching resources; and recognizing the need for change. There is an opportunity, by committing resources and time, to capitalize on the faculty and administrators who thought their programs should improve.
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Seferoğlu M, Yıldız D, Pekel NB, Güneş A, Yıldız A, Tufan F. Attitudes of neurology specialists toward older adults. Aging Clin Exp Res 2017; 29:787-792. [PMID: 27456680 DOI: 10.1007/s40520-016-0606-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Attitude of healthcare providers toward older people is very important in the aging world. Neurologists contact older adults very frequently. We aimed to investigate the attitudes of neurologists toward older adults. MEASUREMENTS We recorded participants age; sex; duration of clinical practice in neurology; existence of older adult relatives; and history of geriatrics education, nursing home visits, older adult patient density in their clinical practice, and participation in voluntary public activities. UCLA Geriatrics Attitude Scale was used to evaluate participants' attitudes. RESULTS A total of 100 neurologists participated in this study. Seventy-seven percent had positive, 3 % had neutral, and 20 % had negative attitudes. Twenty-seven percent of the participants had history of geriatrics education, and these participants tended to have a higher rate of positive attitudes. Neurologists with positive attitudes tended to be older than those with negative attitudes. Participants with history of living with older adult relatives had lower rates of positive attitudes. The most common diagnoses of the patients the participants encountered were stroke and dementia. Independent factors associated with positive attitudes were history of geriatrics education and older age. History of living with older relatives tended to have a negative effect. Most of the negative items of the attitude scale were associated with the natural course and behavior of the common diseases in neurology practice. CONCLUSIONS Generalization of geriatrics education may translate into a better understanding and improved care for older patients. Development of instruments and implementation of qualitative studies to assess attitudes of neurologists toward older adults are needed.
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Singler K, Gordon AL, Robertson G, Roller RE. The development of a geriatric postgraduate education assessment instrument using a modified Delphi procedure. Age Ageing 2016; 45:718-22. [PMID: 27189727 DOI: 10.1093/ageing/afw086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/02/2016] [Indexed: 11/13/2022] Open
Abstract
There is currently wide variation in the structure and content of higher medical training in geriatric medicine across Europe and no common framework within which existing efforts can be compared. We set out to develop an audit tool to compare training between countries. An initial review of indexed and grey literature was used to develop an audit tool which was used as the basis of an Internet-based modified Delphi process incorporating the views of 14 expert geriatricians from across Europe. Items in the audit tool were included or excluded when supported by ≥75% or <50% of respondents, respectively. Items supported by 50-74% of respondents were carried forward with additional suggestions and modifications included following Round 1. Thirteen experts representing 12 countries responded to both rounds. 40/45 items were supported at Round 1. Five items were carried forward. A further 13 elements were introduced for consideration at Round 2. Consensus was gained after the second round. The final tool describes 52 items across four domains: general considerations, topics referring to knowledge in patient care, different roles that should be considered in medical training and topics regarding assessment. The resulting tool can be used as a basis for comparing higher medical training programmes in geriatric medicine between countries. Individual countries can use this to audit current practice. At an European Union level, the insights gained through such audit will form the basis of future work to develop an agreed postgraduate curriculum in the specialty.
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Affiliation(s)
- Katrin Singler
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany Department of Geriatrics, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg, Germany
| | - Adam Lee Gordon
- Division of Medical Sciences and Graduate Entry Medicine, Medical School, Royal Derby Hospital, University of Nottingham, Derby DE22 3DT, UK
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20
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Dickinson GE. A 40-Year History of End-of-Life Offerings in US Medical Schools: 1975-2015. Am J Hosp Palliat Care 2016; 34:559-565. [DOI: 10.1177/1049909116638071] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this longitudinal study of US medical schools over a 40-year period was to ascertain their offerings on end-of-life (EOL) issues. At 5-year intervals, beginning in 1975, US medical schools were surveyed via a questionnaire to determine their EOL offerings. Data were reported with frequency distributions. The Institute of Medicine has encouraged more emphasis on EOL issues over the past 2 decades. Findings revealed that undergraduate medical students in the United States are now exposed to death and dying, palliative care, and geriatric medicine. The inclusion of EOL topics has definitely expanded over the 40-year period as findings reveal that US undergraduate medical students are currently exposed in over 90% of programs to death and dying, palliative care, and geriatric medicine, with the emphasis on these topics varying with the medical programs. Such inclusion should produce future favorable outcomes for undergraduate medical students, patients, and their families.
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Affiliation(s)
- George E. Dickinson
- Department of Sociology and Anthropology, College of Charleston, Charleston, SC, USA
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21
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Gordon AL, Blundell AG, Gladman JRF, Masud T. Better teaching in basic gerontology should be seen as both a goal and an opportunity for those shaping undergraduate curricula. Age Ageing 2016; 45:188-9. [PMID: 26941352 DOI: 10.1093/ageing/afw010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK Derby Teaching Hospitals NHS Foundation Trust, Derby, UK City University, London, UK
| | - Adrian G Blundell
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - John R F Gladman
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Tahir Masud
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK Nottingham University Hospitals NHS Trust, Nottingham, UK
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22
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Annear MJ, Lea E, Lo A, Tierney L, Robinson A. Encountering aged care: a mixed methods investigation of medical students' clinical placement experiences. BMC Geriatr 2016; 16:38. [PMID: 26846779 PMCID: PMC4743178 DOI: 10.1186/s12877-016-0211-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/28/2016] [Indexed: 12/30/2022] Open
Abstract
Background Residential aged care is an increasingly important health setting due to population ageing and the increase in age-related conditions, such as dementia. However, medical education has limited engagement with this fast-growing sector and undergraduate training remains primarily focussed on acute presentations in hospital settings. Additionally, concerns have been raised about the adequacy of dementia-related content in undergraduate medical curricula, while research has found mixed attitudes among students towards the care of older people. This study explores how medical students engage with the learning experiences accessible in clinical placements in residential aged care facilities (RACFs), particularly exposure to multiple comorbidity, cognitive impairment, and palliative care. Methods Fifth-year medical students (N = 61) completed five-day clinical placements at two Australian aged care facilities in 2013 and 2014. The placements were supported by an iterative yet structured program and academic teaching staff to ensure appropriate educational experiences and oversight. Mixed methods data were collected before and after the clinical placement. Quantitative data included surveys of dementia knowledge and questions about attitudes to the aged care sector and working with older adults. Qualitative data were collected from focus group discussions concerning medical student expectations, learning opportunities, and challenges to engagement. Results Pre-placement surveys identified good dementia knowledge, but poor attitudes towards aged care and older adults. Negative placement experiences were associated with a struggle to discern case complexity and a perception of an aged care placement as an opportunity cost associated with reduced hospital training time. Irrespective of negative sentiment, post-placement survey data showed significant improvements in attitudes to working with older people and dementia knowledge. Positive student experiences were explained by in-depth engagement with clinically challenging cases and opportunities to practice independent clinical decision making and contribute to resident care. Conclusions Aged care placements can improve medical student attitudes to working with older people and dementia knowledge. Clinical placements in RACFs challenge students to become more resourceful and independent in their clinical assessment and decision-making with vulnerable older adults. This suggests that aged care facilities offer considerable opportunity to enhance undergraduate medical education. However, more work is required to engender cultural change across medical curricula to embed issues around ageing, multiple comorbidity, and dementia.
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Affiliation(s)
- Michael J Annear
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia.
| | - Emma Lea
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia.
| | - Amanda Lo
- School of Medicine, Faculty of Health, University of Tasmania, Private Bag 34, Hobart, TAS, 7001, Australia.
| | - Laura Tierney
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia.
| | - Andrew Robinson
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia. .,School of Health Sciences, Faculty of Health, University of Tasmania, Private Bag 135, Hobart, TAS, 7001, Australia.
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Zeng A, Song X, Dong J, Mitnitski A, Liu J, Guo Z, Rockwood K. Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit. J Gerontol A Biol Sci Med Sci 2015; 70:1586-94. [PMID: 26400736 PMCID: PMC4631107 DOI: 10.1093/gerona/glv084] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 05/18/2015] [Indexed: 02/06/2023] Open
Abstract
Background. In older adults admitted to intensive care units (ICUs), frailty influences prognosis. We examined the relationship between the frailty index (FI) based on deficit accumulation and early and late survival. Methods. Older patients (≥65 years) admitted to a specialized geriatric ICU at the Liuhuaqiao Hospital, Guangzhou, China between July–December 2011 (n = 155; age 82.7±7.1 y; 87.1% men) were followed for 300 days. The FI was calculated as the proportion present of 52 health deficits. FI performance was compared with that of several prognostic scores. Results. The 90-day death rate was 38.7% (n = 60; 27 died within 30 days). The FI score was correlated with the Glasgow Coma Scale, Karnofsky Scale, Palliative Performance Scale, Acute Physiology Score—APACHE II and APACHE IV (r2 = 0.52 to 0.72, p < 0.001). Patients who died within 30 days had higher mean FI scores (0.41±0.11) than those who survived to 300 days (0.22±0.11; F = 38.91, p < 0.001). Each 1% increase in the FI from the previous level was associated with an 11% increase in the 30-day mortality risk (95% CI: 7%–15%) adjusting for age, sex, and the prognostic scores. The FI discriminated patients who died in 30 days from those who survived with moderately high accuracy (AUC = 0.89±0.03). No one with an FI score >0.46 survived past 90 days. Conclusion. ICU survival was strongly associated with the level of frailty at admission. An FI based on health deficit accumulation may help improve critical care outcome prediction in older adults.
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Affiliation(s)
- An Zeng
- School of Computers, Guangdong University of Technology, Guangzhou, China
| | - Xiaowei Song
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Centre for Healthcare of the Elderly, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Jiahui Dong
- Department of Medical Intensive Care Unit, General Hospital of Guangzhou Military Command; Guangdong Provincial Key Laboratory of Geriatric Infection and Organ Function Support and Guangzhou Key Laboratory of Geriatric Infection and Organ Function Support, Guangzhou, China
| | - Arnold Mitnitski
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Departments of Mathematics and Statistics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jian Liu
- Department of Medical Intensive Care Unit, General Hospital of Guangzhou Military Command; Guangdong Provincial Key Laboratory of Geriatric Infection and Organ Function Support and Guangzhou Key Laboratory of Geriatric Infection and Organ Function Support, Guangzhou, China
| | - Zhenhui Guo
- Department of Medical Intensive Care Unit, General Hospital of Guangzhou Military Command; Guangdong Provincial Key Laboratory of Geriatric Infection and Organ Function Support and Guangzhou Key Laboratory of Geriatric Infection and Organ Function Support, Guangzhou, China. Department of Medicine, Southern Medical University, Guangzhou, China.
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Centre for Healthcare of the Elderly, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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Braude P, Reedy G, Dasgupta D, Dimmock V, Jaye P, Birns J. Evaluation of a simulation training programme for geriatric medicine. Age Ageing 2015; 44:677-82. [PMID: 25953500 DOI: 10.1093/ageing/afv049] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/14/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND geriatrics encompasses diverse medical, social and ethical challenges requiring a multidimensional, interdisciplinary approach. Recent reports have highlighted failings in the care of older people. It is therefore vital that trainees in geriatrics are afforded opportunities to develop skills in managing this complex population. Simulation has been adopted as a teaching tool in medicine; however, evidence for its use in geriatrics has been limited to small, single-site studies primarily involving role-play or discrete clinical skills training. METHODS a standardised, two centre, multimodal, interprofessional, geriatrics simulation training programme was developed using curriculum-mapped scenarios in which the patient perspective was central. Simulation techniques used included high-fidelity patient manikins, actors with integrated clinical skills using part-task trainers and role-play exercises. A mixed-methods evaluation was used to analyse data from participants before and after training. RESULTS eighty-nine candidates attended 12 similar courses over 2 years. Thematic analysis of candidate feedback was supportive of simulation as a useful tool, with benefits for both technical and non-technical skills. Candidates commented that simulation was a valuable training modality addressing curriculum areas rarely taught formally including continence assessment, end-of-life decisions and multidisciplinary situations. Quantitative analysis of pre- and post-course questionnaires revealed a significant improvement of self-reported confidence in managing geriatric scenarios (mean improvement 11.5%; P < 0.001). DISCUSSION this study demonstrated the feasibility of a standardised simulation training programme across two sites in geriatrics. Simulation training affords situational learning without compromising patient safety and is an exciting and novel method of delivering teaching for geriatrics that could be integrated into national training curricula.
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Affiliation(s)
- Philip Braude
- Department of Ageing and Health, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Gabriel Reedy
- Simulation and Interactive Learning Centre, Guy's and St Thomas' Hospital, London, UK
| | - Deblina Dasgupta
- Department of Elderly Care Medicine, Homerton University Hospital, London, UK
| | - Valerie Dimmock
- Homerton Simulation Centre, Homerton University Hospital, London, UK
| | - Peter Jaye
- Simulation and Interactive Learning Centre, Guy's and St Thomas' Hospital, London, UK
| | - Jonathan Birns
- Department of Ageing and Health, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, UK
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Minogue V. “Let me back into the world” – compassionate care in practice: a carer and patient’s view. QUALITY IN AGEING AND OLDER ADULTS 2015. [DOI: 10.1108/qaoa-10-2014-0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– “Let me back into the world” was the heart rending response by an older relative to a question about his wellbeing following a difficult period of illness and hospitalisation. As his main carer, the author of the paper was struck, when visiting the hospital, by a small poster, on a notice board near to the entrance to the hospital ward, outlining the staff’s commitment to Compassion in Practice. Compassion in Practice was enshrined in the Compassion in Practice vision and strategy (Department of Health, NHS Commissioning Board, 2012) for building a culture of compassionate care across health and social care. A key element of the strategy was to make the values of care, compassion, courage, communication, competence and commitment, real and visible to patients and the public. The purpose of this paper is to seek to compare the values being stated with the care experience.
Design/methodology/approach
– This paper records a personal perspective from a patient and their family carers of compassionate care in practice. This experience is one case study and does not seek to represent the experience of other patients and their families.
Findings
– This highlights the importance of communication and demonstrates that care and compassion are human emotions and values that have to be lived in practice and are part of the interaction between patient, clinician and family. Simply believing in those core nursing values does not make them real for the patient in practice.
Originality/value
– Both patient and the family carers had extensive experience of working in health and social care including the NHS. This account demonstrates the challenges of turning strategy into actions that can ultimately improve the patient experience of care.
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Geriatrics education is associated with positive attitudes toward older people in internal medicine residents: A multicenter study. Arch Gerontol Geriatr 2015; 60:307-10. [DOI: 10.1016/j.archger.2014.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/25/2014] [Accepted: 12/03/2014] [Indexed: 11/18/2022]
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Oliver D. The future of general medicine. Clin Med (Lond) 2014; 14:693-4. [PMID: 25468869 PMCID: PMC4954156 DOI: 10.7861/clinmedicine.14-6-693a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David Oliver
- Royal Berkshire NHS Foundation Trust, Reading, UK, and British Geriatrics Society, London, UK
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Gordon A. Equipping tomorrow's doctors for the patients of today. Br J Hosp Med (Lond) 2014; 75:366-7. [DOI: 10.12968/hmed.2014.75.7.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Adam Gordon
- Consultant and Honorary Associate Professor in Medicine of Older People Department of Health Care of Older People Nottingham University Hospitals NHS Trust Queens Medical Centre Nottingham NG7 2UH
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