Developing a list of core competencies for medical aspects of healthcare delivery in care homes: scoping review and Delphi process.

BACKGROUND: Care home residents live with frailty and multiple long-term conditions. Their medical management is complex and specialised. We set out to develop a list of core competencies for doctors providing medical care in long-term care homes. METHODS: A scoping review searched MEDLINE, EMBASE and CAB Abstracts, supplemented by grey literature from the Portal of Online Geriatrics Education and the International Association of Geriatrics and Gerontology, looking for core competencies for doctors working in care homes. These were mapped to the UK nationally mandated Generic Professional Competencies Framework. A Delphi exercise was conducted over three rounds using a panel of experts in care homes and medicine of older people. Competencies achieving 80% agreement for inclusion/exclusion were rejected/accepted, respectively. RESULTS: The scoping review identified 22 articles for inclusion, yielding 124 competencies over 21 domains. The Delphi panel comprised 23 experts, including 6 geriatricians, 4 nurses, 3 general practitioners, 2 advanced clinical practitioners, 2 care home managers, and one each of a patient and public representative, palliative care specialist, psychiatrist, academic, physiotherapist and care home audit lead. At the end of three rounds, 109 competencies over 19 domains were agreed. Agreement was strongest for generic competencies around frailty and weaker for sub-specialist knowledge about specific conditions and competencies related to care home medical leadership and management. CONCLUSION: The resulting competencies provide the basis of a curriculum for doctors working in long-term care homes for older people. They are specialty agnostic and could be used to train general practitioners or medical specialty doctors.

The development and evaluation of mini-GEMs - short, focused, online e-learning videos in geriatric medicine.

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.

Equipping tomorrow's doctors for the patients of today.

As the proportion of older patients with frailty presenting to health services increases, so does the need for doctors to be adequately trained to meet their needs. The presentations seen in such patients, the evidence-based models of care and skillsets required to deliver them are different than for younger patient groups-so specific training is required. Several research programmes have used detailed and explicit methods to establish evidence-based expert-validated curricula outlining learning outcomes for undergraduates in geriatric medicine-there is now broad-consensus on what newly qualified doctors need to know. There are, despite this, shortcomings in the teaching of undergraduates about geriatric medicine. National and international surveys from the UK, EU, USA, Canada, Austria and the Netherlands have all shown shortcomings in the content and amount of undergraduate teaching. Mechanisms to improve this situation, aside from specifying curricula, include developing academic departments and professorships in geriatric medicine, providing grants to develop teaching in geriatric medicine and developing novel teaching interventions to make the best of existing resources. Under the last of these headings, innovations have been shown to improve outcomes by: using technology to ensure the most effective allocation of teaching time and resources; using inter-professional education as a means of improving attitudes towards care of older patients; focusing teaching specifically on attitudes towards older patients and those who work with them; and trying to engage patients in teaching. Research areas going forward include how to incentivise medical schools to deliver specified curricula, how to choose from an ever-expanding array of teaching technologies, how to implement interprofessional education in a sustainable way and how to design teaching interventions using a qualitative understanding of attitudes towards older patients and the teams that care for them.

Undergraduate teaching in geriatric medicine using computer-aided learning improves student performance in examinations.

BACKGROUND: computer-aided learning (CAL) is increasingly used to deliver teaching, but few studies have evaluated its impact on learning within geriatric medicine. We developed and implemented CAL packages on falls and continence, and evaluated their effect on student performance in two medical schools. METHODS: traditional ward based and didactic teaching was replaced by blended learning (CAL package combined with traditional teaching methods). Examination scores were compared for cohorts of medical students receiving traditional learning and those receiving blended learning. Control questions were included to provide data on cohort differences. RESULTS: in both medical schools, there was a trend towards improved scores following blended learning, with a smaller number of students achieving low scores (P < 0.01). Feedback from students about the CAL packages was positive. DISCUSSION: blended learning was associated with improvement in student examination performance, regardless of the setting or the methods adopted, and without increasing teaching time. Our findings support the use of CAL in teaching geriatric medicine, and this method has been adopted for teaching other topics in the undergraduate curriculum.