Improving family medicine resident training in dementia care: An experiential learning opportunity in Primary Care Collaborative Memory Clinics.

Family physicians often find themselves inadequately prepared to manage dementia. This article describes the curriculum for a resident training intervention in Primary Care Collaborative Memory Clinics (PCCMC), outlines its underlying educational principles, and examines its impact on residents' ability to provide dementia care. PCCMCs are family physician-led interprofessional clinic teams that provide evidence-informed comprehensive assessment and management of memory concerns. Within PCCMCs residents learn to apply a structured approach to assessment, diagnosis, and management; training consists of a tutorial covering various topics related to dementia followed by work-based learning within the clinic. Significantly more residents who trained in PCCMCs (sample = 98), as compared to those in usual training programs (sample = 35), reported positive changes in knowledge, ability, and confidence in ability to assess and manage memory problems. The PCCMC training intervention for family medicine residents provides a significant opportunity for residents to learn about best clinical practices and interprofessional care needed for optimal dementia care integrated within primary care practice.

"Booster Days": An educational initiative to develop a community of practice of primary care collaborative memory clinics.

This study explores the value of a Booster Day education initiative for clinicians working in interprofessional Primary Care Collaborative Memory Clinics (PCCMC) to share updates in dementia care, challenging cases, key lessons learned, and best practices, as a mechanism to foster learning and support the PCCMC Community of Practice (CoP). Between 2010 and 2016, 17 annual Booster Days were delivered to health professionals who completed the PCCMC training program. All participants were invited to complete an evaluation survey in which they identified the ways in which the sessions have been helpful; 89% (1361/1530) completed surveys. The Booster Days were valued as opportunities for networking to learn from other clinicians, fostering a sense of community, learning new information, learning to support practice improvements, and team building. An annual Booster Day that incorporates active participant engagement, information sharing, and networking may effectively support CoPs, learning, team building, and practice change within interprofessional teams.

Shared Canadian Curriculum in Family Medicine (SHARC-FM): Creating a national consensus on relevant and practical training for medical students.

PROBLEM ADDRESSED: In 2006, leaders of undergraduate family medicine education programs faced a series of increasing curriculum mandates in the context of limited time and financial resources. Additionally, it became apparent that a hidden curriculum against family medicine as a career choice was active in medical schools. OBJECTIVE OF PROGRAM: The Shared Canadian Curriculum in Family Medicine was developed by the Canadian Undergraduate Family Medicine Education Directors and supported by the College of Family Physicians of Canada as a national collaborative project to support medical student training in family medicine clerkship. Its key objective is to enable education leaders to meet their educational mandates, while at the same time countering the hidden curriculum and providing a route to scholarship. PROGRAM DESCRIPTION: The Shared Canadian Curriculum in Family Medicine is an open-access, shared, national curriculum (www.sharcfm.ca). It contains 23 core clinical topics (determined through a modified Delphi process) with demonstrable objectives for each. It also includes low- and medium-fidelity virtual patient cases, point-of-care learning resources (clinical cards), and assessment tools, all aligned with the core topics. French translation of the resources is ongoing. CONCLUSION: The core topics, objectives, and educational resources have been adopted by medical schools across Canada, according to their needs. The lessons learned from mounting this multi-institutional collaborative project will help others develop their own collaborative curricula.

Structured approach to patients with memory difficulties in family practice.

OBJECTIVE: To provide family physicians with a structured approach to patients presenting with memory difficulties. SOURCES OF INFORMATION: The approach is based on an accredited memory clinic training program developed by the Centre for Family Medicine Memory Clinic in partnership with the Ontario College of Family Physicians. MAIN MESSAGE: Use of a structured clinical reasoning approach can assist physicians in achieving an accurate diagnosis in patients presenting with memory difficulties. Delirium, depression, and reversible causes need to be excluded, followed by differentiation among normal cognitive aging, mild cognitive impairment, and dementia. Obtaining collateral history and accurate functional assessment are critical. Common forms of dementia can be clinically differentiated by the order in which symptoms appear and by how cognitive deficits evolve over time. Typically, early signs of Alzheimer dementia involve impairment in episodic memory, whereas dementia involving predominantly vascular causes might present with early loss of executive function and relatively preserved episodic memory. Frontotemporal dementia and Lewy body spectrum disorders might have early loss of executive function and visuospatial function, as well as characteristic clinical features. CONCLUSION: A clinical reasoning approach can help physicians achieve early, accurate diagnoses that can guide appropriate management and improve care for patients with memory difficulties.

Comparing Virtual to In-Person Delivery of Continuing Medical Education in Dementia Care: Which Is Preferred?

OBJECTIVES: There is limited understanding of learners' perceptions of virtual learning during the COVID-19 pandemic, as well as the use of virtual modalities for interprofessional education (IPE) in primary care. Four of 7 in-person annual "Booster Day" IPE sessions for health professionals working in primary care-based memory clinics in Ontario, Canada, were canceled when the pandemic was declared; these sessions were replaced with 2 sessions delivered via live-streamed videoconferencing. This study compares Booster Day session participants' perceptions of the in-person and virtual sessions and assesses their preferences for in-person or virtual sessions in the future. DESIGN: Survey methodology. SETTING AND PARTICIPANTS: Interprofessional primary care-based memory clinic team members attending 1 of 5 annual IPE events, 3 delivered in-person immediately prior to the COVID-19 pandemic and 2 subsequently delivered virtually via videoconferencing. METHODS: Chi-squared test and analysis of variance was used to identify significant differences in reaction, attitude, and preference ratings between delivery modalities. RESULTS: There were no significant differences in satisfaction, relevance, knowledge acquisition, and intentions to apply new knowledge between delivery modalities. Although attendance via videoconferencing was perceived as useful, enjoyable, engaging, and as more feasible to attend, it was rated as less enjoyable and perceived as having fewer opportunities for networking than in-person sessions. Most participants preferred in-person sessions. CONCLUSIONS AND IMPLICATIONS: Quality engagement and networking, as afforded by in-person IPE, are highly valued by health professionals attending dementia-related education. IPE on complex health issues of the older people requiring interprofessional perspectives may be best suited to in-person formats.

Building capacity for dementia care: training program to develop primary care memory clinics.

PROBLEM BEING ADDRESSED: Currently, dementia care provided by family physicians is suboptimal and access to specialist resources is limited. With the aging population, there is a need for system-wide, programmatic interventions to improve the diagnosis and management of patients with memory difficulties. The development of primary care memory clinics addresses this need. OBJECTIVE: The Memory Clinic Training Program aims to develop highly functioning interprofessional memory clinics that assist family physicians in providing improved care for patients with dementia and other forms of cognitive impairment. PROGRAM DESCRIPTION: The interprofessional training program consists of a 2-day case-based workshop, 1 day of observership and clinical training at the Centre for Family Medicine Memory Clinic, and 2 days of on-site mentorship at each newly formed memory clinic. CONCLUSION: The Memory Clinic Training Program is an accredited, comprehensive program designed to assist family practice groups with developing primary care memory clinics. These clinics aim to transform the current limited practice capability of individual family physicians into a systematic, comprehensive, interprofessional health care service that improves capacity and quality of primary care for patients with cognitive impairment and dementia.

A Decade of Dementia Care Training: Learning Needs of Primary Care Clinicians.

INTRODUCTION: Limited knowledge of dementia among health professionals is a well-documented barrier to optimal care. This study examined the self-perceived challenges with dementia care and learning needs among primary care clinicians and assessed whether these were associated with years of practice and perceived preparedness for dementia care. METHODS: Participants were multi-disciplinary clinicians attending a 5-day team-based dementia education program and physicians attending a similar condensed continuing medical education workshop. Pre-education, they completed an online survey in which they rated (5-point scales): interest in learning about various dementia-related topics, perceived challenges with various dementia-related practice activities and preparedness for dementia care, provided additional dementia-related topics of interest, number of years in clinical practice, and discipline. RESULTS: Thirteen hundred surveys were completed across both education programs. Mean ratings of preparedness for dementia care across all respondents reflected that they felt somewhat prepared for dementia care. Challenge ratings varied from low to very challenging and mean ratings reflected a high level of interest in learning more about all of the dementia-related topics; significant differences between disciplines in these ratings were identified. In most cases, perceived challenges and learning needs were not correlated with number of years in clinical practice, but in some cases lower ratings of preparedness for dementia care were associated with higher ratings of the challenges of dementia care. DISCUSSION: Clinicians perceived that their formal education had not prepared them well for managing dementia and desired more knowledge in all topic areas, regardless of years in practice. Implications for education are discussed.

Evaluation of a particle repositioning maneuver Web-based teaching module.

OBJECTIVES/HYPOTHESIS: To compare the pass rate of residents performing the Particle Repositioning Maneuver (PRM) after one of three interventions: 1) small group PRM instruction (SG); 2) standard classroom instruction (CI); and 3) Web-based learning module (WM). We hypothesize that our Web-based learning module is more effective than CI and as effective as SG. STUDY DESIGN: Prospective randomized control trial. METHODS: The study population includes all family medicine residents at the University of Western Ontario. On day 0, all subjects were tested. Residents were then randomized to one of three intervention groups: 1) SG, 2) CI, or 3) WM. On day 7, the residents were again tested. Observers were blinded to the intervention type. Testing (day 0 and day 7) was performed using the DizzyFIX (Clearwater Clinical Ltd., London, Ontario, Canada), a pass/fail test, and evaluation by a trained observer (correct or incorrect). RESULTS: There were no statistically significant differences in pass rates between the three groups before the interventions (DizzyFIX: P = .2096, observer: P = .3710). After the interventions, DizzyFIX testing pass rates were 50.0% SG, 60.0% CI and 100.0% WM (P = .3564). Observer testing pass rates were 85.7% SG, 28.6% CI, and 83.3% WM (P = .0431). CONCLUSIONS: This study demonstrated that our Web-based learning module for the PRM is comparable to small-group clinical instruction, and superior to standard classroom instruction for teaching the PRM when evaluated by a trained observer.

Education scholarship: it's not just a question of 'degree'.

BACKGROUND: Although medical faculty are frequently encouraged to participate in education scholarship, there is a paucity of literature addressing how to support those who wish to do so. AIMS: The purpose of this study was to explore faculty involvement in and support needs for pursuing education scholarship. METHODS: A purposive sample of 108 medical faculty with an interest in medical education were invited to participate in a two-phase, mixed-methods study (survey and focus groups). RESULTS: Seventy-three faculty (67.6%) completed the questionnaire with 16 subsequently participating in focus group sessions. Nearly 40% had enrolled in or completed formal education training. Although the majority had been involved in at least one education project during the past five years, few had received funding or published their work. Three support-related themes emerged: education research support; enhancing colleague interactions; and ongoing development activities. Three related barriers were identified: time, access to support staff, and knowledge of research methodology. No significant differences were identified between those with and without additional education training. CONCLUSIONS: Assisting faculty to participate in education scholarship is a complicated endeavor. Institutional supports should not be limited to those with advanced degrees nor rely on Master-level degree programs to provide all the necessary training.

Education to Improve Dementia Care: Impact of a Structured Clinical Reasoning Approach.

BACKGROUND AND OBJECTIVES: Dementia often goes undiagnosed. A workshop was developed to provide primary care clinicians with a structured clinical reasoning approach to dementia diagnosis and brain map tool to differentiate type of dementia. The purpose of this study was to examine the impact of this approach on self-perceived changes in knowledge, confidence, and ability to assess and manage memory problems and on self-reported application of learning to clinical practice. METHODS: Participants of 20 workshops (N=392) were invited to complete a reaction survey and of these, participants of 12 consecutive workshops (N=242) were invited to complete a 3-month follow-up survey to assess application of new learning to clinical practice and challenges experienced in doing so. RESULTS: In total, 355 reaction and 108 follow-up surveys were completed. Mean ratings of usefulness reflected that participants considered the clinical reasoning approach and brain map very useful to learning and knowledge transfer. At follow-up, the majority of respondents reported they were more confident (79%) and better able to assess (79%) persons with cognitive impairment and more confident (88%) and better able to manage (86%) persons with cognitive impairment. A number of practice changes and challenges were identified. CONCLUSIONS: These results add to a growing literature on strategies to improve dementia care with effective continuing medical education. A structured clinical reasoning approach to cognitive impairment is effective in improving confidence and ability to assess and manage patients with cognitive impairment, although participants continue to experience challenges in managing this complex condition.

Ensuring the success of interprofessional teams: key lessons learned in memory clinics.

Primary care-based memory clinics are attracting increasing interest because they present an opportunity to improve dementia diagnosis and management. In Ontario, more than 30 primary care setting participated in a training program aimed at assisting participants to establish an independent memory clinic in their practice setting. This article outlines the key lessons learned in implementing these clinics, on the basis of a study that--used an interview methodology with memory clinic team members and--identified facilitating factors, challenges, and suggestions for sustainability. Of key importance was access to training that facilitates knowledge transfer and supports practice change, interprofessional collaboration, and ongoing infrastructure support. Suggestions for clinic implementation and ongoing capacity building were identified. Lessons learned are applicable to the implementation of other chronic-disease care models aimed at improving the primary care management of complex chronic conditions.

Developing memory clinics in primary care: an evidence-based interprofessional program of continuing professional development.

INTRODUCTION: Primary care is challenged to meet the needs of patients with dementia. A training program was developed to increase capacity for dementia care through the development of Family Health Team (FHT)-based interprofessional memory clinics. The interprofessional training program consisted of a 2-day workshop, 1-day observership, and 2-day mentorship program. METHODS: An online survey was completed by participants prior to the training workshop and a similar survey at least 6 months following completion of the program to measure perceived changes related to knowledge, ability, and confidence to assess and manage memory problems, and comfort in speaking to patients and caregivers about concerns regarding dementia. Participants also completed a paper-based reaction survey at the end of the workshop and observership day. RESULTS: Twenty-two FHTs, with 124 health professionals, participated in this program. At follow-up there were statistically significant increases in self-reported knowledge of and ability to assess and manage cognitive impairment, confidence, comfort level in speaking to patients about memory problems, and the ability of participants' FHT to manage cognitive impairment independently. Engagement in dementia care practice activities increased following the program. All but one FHT successfully formed a memory clinic. DISCUSSION: This training program represents a significant opportunity to bring about evidence-based practice change through a capacity development initiative to support primary care providers to maintain the majority of dementia care within primary care practice. The provision of practical knowledge and resources and incorporating best teaching practices to maximize knowledge transfer contributed to the success of this program.