Improving medical care of persons with Alzheimer disease through clinical teaching: the IMPACT program

Geriatric Educational Interventions for Physicians Training in Non-Geriatric Specialties: A Scoping Review

BACKGROUND

Physicians require the expertise to care for an increasingly aging population. A robust understanding of geriatric educational interventions is needed to improve geriatric training for physicians.

OBJECTIVE

To map the breadth of geriatric educational interventions for residents (in non-geriatric specialties).

METHODS

We used a scoping review methodology. We searched MEDLINE, Embase, EMCare, CENTRAL, ERIC, and Scopus from 2004 to September 2019 for search terms related to "educational approaches" AND "geriatric" AND "residents." Two authors independently selected eligible studies, extracted data (categorized by educational approaches and Kirkpatrick level outcomes), and critically appraised studies using the Mixed Methods Appraisal Tool.

RESULTS

There were 63 included studies, with a total of 6976 participants. Twelve studies had comparators, including 5 randomized controlled trials. Fifty-three studies (84%) described multicomponent interventions, incorporating combinations of didactic or self-directed approaches with interactive, simulation, experiential, and/or group-based learning. Use of curricular process was explicitly reported in 34 studies (59%). Most studies met at least 4 of 5 Mixed Methods Appraisal Tool criteria. Studies commonly measured outcomes at Kirkpatrick levels 1 and 2 (reaction and learning), with 15 studies measuring performance outcomes (Kirkpatrick levels 3 and 4b). All included studies had at least one positive result.

CONCLUSIONS

All educational interventions had positive outcomes; however, curriculum-informed multicomponent interventions were the most common. This scoping review demonstrates that robust methodology with comparators, longer-term designs, and use of higher-level Kirkpatrick outcome measures is possible but not commonly used. Clear direction for future research is provided.

What should we be teaching medical students about dementia?

BACKGROUND

Doctors working in the majority of medical subspecialties provide care for patients with dementia, but there is current international concern that many do not have adequate knowledge or skills to deliver appropriate care for these patients in hospital or community settings. The aim of this review is to draw together recommendations for medical education on dementia and empirical research on teaching interventions concerning dementia in order to assess the current provision of training using the UK model as an example.

METHODS

Database and manual searches were undertaken to identify relevant articles for a narrative review.

RESULTS

UK national guidelines recommend that dementia-specific education should be available to trainees in the undergraduate and postgraduate environment. A sample of undergraduate curricula shows considerable variation in the delivery of teaching about dementia. "Non-specialist" postgraduate curricula make reference to care of patients with confusion, but do not always include learning outcomes specific to cognitive impairment or dementia. Teaching interventions trialed in the postgraduate environment provide encouraging qualitative feedback from participants, but do not consistently demonstrate improvement in participants' knowledge, skills or attitudes.

CONCLUSIONS

There is a pressing need to improve undergraduate medical education on dementia in order to help future doctors obtain the ability to provide competent care for patients. There is scope for ongoing research to refine existing curricula covering dementia and to build an evidence-base for successful dementia-specific teaching interventions.

The effect of continuing professional education on health care outcomes: lessons for dementia care

BACKGROUND

This review presents an overview of the published literature on the effectiveness of continuing professional education (CPE), which includes continuing medical education (CME) of different health care professionals in healthcare settings, for improving patient management and patient outcomes. This review summarizes key articles published on the subject, including those relating to dementia care.

METHODS

A literature search was carried out using the National Library of Medicine's PubMed database, Cochrane database and Eric databases.

RESULTS

Studies on CPE generally provide conflicting evidence on their effectiveness in bringing about a change in professional practices and healthcare outcomes. However interactive, multifaceted interventions, and interventions with repeated inputs appear more effective in bringing about positive changes than traditional non-interactive techniques. There are relatively few studies specifically concerning CPE and dementia care.

CONCLUSION

This review shows that CPE in dementia care needs to be targeted carefully. Much can be learnt from examining education approaches in the wider professional and medical education literature.