GERONTOLOGY & GERIATRICS EDUCATION最新文献

We describe the development and delivery of a seminar to train emerging geriatric leaders from diverse disciplines in quality improvement science utilizing the Institute for Healthcare Improvement Model for Improvement. We implemented a six-session synchronous virtual quality improvement seminar employing a "flipped classroom" approach consistent with experiential learning, involving pre-work, in-session application through exercises and work-time, and homework, over three cohorts of learners (2022-2024). Content was adapted through formative evaluation in year one, with additional refinements in years two and three. Of those who completed a summative evaluation survey in year three (N = 23, 46% response), 60.8% pursued a quality improvement project described as completed (21.7%) or in progress (39.1%); 21.7% had presentations or publications about their projects. Most participants rated seminar topics and tools as somewhat or very useful (on a 1-3 scale), particularly the aims statement (M = 2.95, SD = 0.22), and project planning tools (M = 2.81, SD = 0.40). Participants agreed or strongly agreed they were using seminar information now (82.6%) and/or in the future (91.3%), and that their project improved patient care (60.8%). A quality improvement seminar for interprofessional emerging geriatric leaders was well received and may contribute to dissemination of scholarly products and improvements in patient care.

Various educational programs have been designed to reduce dementia-related stigma. However, the most effective content remains unclear owing to the integration of multiple contents. This study aimed to compare the efficacy of different content. Participants from a crowdsourcing website were randomly assigned to one of five online interventions: (1) a lecture video on dementia and the lives of people living with dementia (15.2 min); (2) a short drama about a person living with dementia and their families (28.4 min); (3) drama combined with virtual reality (VR), allowing participants to experience part of the drama from a person living with dementia perspective (37.5 min), (4) mini-games simulating interactions with people living with dementia (12.6 min); and (5) documentary videos about people living with dementia (15.0 min). Attitudes and helping intentions toward people living with dementia were assessed before and after the interventions. All groups demonstrated significant within-group improvements, but no significant differences in score changes were observed between groups. Considering their short duration and ease of development and delivery, and comparable effects with other methods, lecture videos are recommended as an efficient method for reducing dementia stigma via online education.

The VA Geriatric Scholars Program is a continuing professional development (CPD) program for interprofessional primary care clinicians to enhance skills in the care of older adults. Following intensive didactic education, participants select and initiate local quality improvement (QI) projects. This evaluation examines the types and range of variation among learner-selected QI. Using a qualitative thematic analysis with a constant comparison approach, we characterized variation among 813 QI project reports from a variety of clinical care settings, resulting in a multi-level schema of 3 themes, 13 subthemes, and 79 foci. Using this typology, we then compared a subsample of projects in general primary care (n = 401) and home based primary care (n = 330). Overall, 72.8% of these QI directly impacted clinical care in identifying and managing health conditions by clinicians or through patient education. The remaining projects addressed organizational barriers to clinic efficiencies. These practical, successful QI strategies might be diffused more broadly, perhaps through implementation science research, policy proposals, or as exemplars for other clinical training programs or locally initiated projects, such as Age Friendly Action Communities.

Depression affects up to 40% of Veterans in Veterans Health Administration's nursing homes, known as Community Living Centers (CLCs). We adapted an evidence-based intervention (Behavioral Activities Intervention; BE-ACTIV) to create BE-ACTIV(VA): a manualized behavioral activation intervention for CLC short-stay Veterans with depression. While BE-ACTIV relied on intensive in-person staff training, we developed online, self-paced trainings to fit staff members' busy schedules. The goals of this article are to report on the creation and content of BE-ACTIV(VA) trainings and CLC staff perceptions of their efficacy, feasibility, and acceptability. We used data from post-training surveys (survey responses: All CLC Staff Training n = 13; Activity Facilitator Training n = 10; Mental Health Provider Training n = 18) and qualitative interviews (n = 16) with staff. Survey responses were summed and averaged to provide a mean score for each question. We conducted brief, semi-structured interviews with staff implementing BE-ACTIV(VA), coded transcripts, and employed a thematic analysis approach to identify salient themes from the coding output. Survey data showed that staff were satisfied with the trainings (100% were satisfied with the Mental Health Provider Training; 100% were satisfied with the Activity Facilitator Training; 85% were satisfied with the All CLC Staff Training) and found the content to be effective and useful for their practice. We identified four main themes related to staff perceptions of the efficacy of the training (staff were prepared to implement BE-ACTIV(VA) post trainings, and felt trainings were clear and useful), feasibility of the training (fit well into staff workflow), and suggestions for improvement (to add interactive components or knowledge checks). To our knowledge, this is the first study to show that behavioral activation intervention training can be successfully done in a brief, online format within a CLC setting among a range of staff. Findings suggest that this training approach can support the dissemination and scale-up of manualized behavioral activation interventions to reduce depression across long-term care settings.

With the increasing aging population there is a need for more gerontological social work practitioners; however, such training for social workers in Canada is limited. To help address this gap, one faculty of social work developed a graduate level clinical social work practice certificate with a specialization in gerontology. In this paper we explore students' and instructors' perspectives about the curriculum, delivery, and impact of this certificate, and provide recommendations for improvement, particularly with respect to the clinical nature of the courses. Eight students and four instructors participated in the study. Strengths and opportunities for enhancement were identified for curriculum and delivery. Study findings also indicated that further curriculum development should focus on enhancing clinical skill development and providing more practice experience. Implications arising from these findings included developing clinical skills through experiential learning, interprofessional education, and service learning.

Over the last two decades, the rate of fatal overdoses among adults 65 years and older has risen exponentially. Older adults are more vulnerable to opioids yet are less likely to have their opioid use disorder (OUD) recognized and treated. The prevalence of geriatric syndromes is higher among older adults with OUD, yet there is limited attention on how improving current OUD treatment for older adults can address their complex care needs. A case-based workshop was presented at the 2023 Annual Meeting of the Society of General Internal Medicine to provide generalists with training, skills, and resources to care for aging adults with OUD through the lens of the Geriatrics 5 Ms framework. After an introductory background, workshop participants engaged in a 5-part mega-case designed to encourage discussion and empower participants to apply each of the 5 Ms to the care of older adults with OUD. Attendees rated the workshop highly in achieved learning objectives, quality, facilitation, and planned incorporation of learned knowledge to teaching, research, patient care, or administration. An interactive case-based workshop on applying the 5 Ms framework to the care of older adults with OUD is feasible, replicable, and may promote age-friendly care for this patient population.

Trauma experience is common and may impact health and health care experiences for older adults. As such, training in trauma-informed care (TIC) is essential for health professions trainees. In this paper, we describe the use of life-story work, in the form of the My Life, My Story (MLMS) program as one platform to enhance TIC competencies. Trainees (N = 74) who were physician (57.0%) and other health professions trainees who did MLMS interviews completed a post-experience survey about trauma disclosures and confidence in responding to these. During these interviews, 36.5% of the patients described a traumatic event and 56.8% described a stressful event, framed by the patient as "ultimately positive" - leading to resilience (42.6%) or "ultimately negative" - leading to negative life outcomes (29.5%), with other responses as not sure or ambivalent. Confidence in responding to trauma disclosures increased following participation in MLMS (t(df = 60) = 5.52, p < .001). Qualitative comments indicated that MLMS helped them recognize the various expressions of trauma and provided insights into possible responses to trauma disclosure, among other TIC competencies. About half (50.8%) of trainees expressed interest in additional resources or training in responding to trauma disclosures. In conclusion, life-story work and MLMS may be one tool to enhance TIC.

Fellowship is a prime opportunity for sub-specialists to hone their teaching skills, however many fellowships lack formal teaching curricula. Existing curricula may not include supervision of fellows' teaching skills. We designed a Fellows as Teachers curriculum for geriatric medicine fellows that incorporates direct observation and feedback to improve their teaching skills. Based on a needs assessment, we implemented the program in the academic year 2021-2022 where fellows were observed in their teaching of third-year medical students. Fellows first participated in a Train the Trainer session, then were observed teaching a geriatrics skills session to medical students after which they received feedback from faculty and students. Fellows completed a survey rating the program's effectiveness in improving their teaching skills. Twenty fellows completed the needs assessment; the majority felt uncomfortable teaching a geriatrics assessment. Eighteen fellows taught at least one skills session; 36% found the program to be extremely helpful, 38% very helpful, and 28% somewhat helpful in improving their teaching skills. We successfully designed and implemented a Fellows as Teachers program consisting of a Train the Trainer session and formal observation with feedback for our geriatric medicine fellows. All fellows felt the curriculum was helpful in improving their teaching skills.

Most physicians will not practice in post-acute or long-term care (PALTC), yet many will care for older adults who transition across these settings. However, medical student education on PALTC is extremely limited. This is a pilot study of a curriculum on PALTC. The curriculum was developed by a geriatrician and social worker. Students participated in a case-based, didactic lecture with interactive components to learn about various care settings, then engaged in a small group exercise to evaluate a challenging transition of care scenario. 168 students participated in the lecture and 145 provided feedback (86.9%). On average, students scored a 1.8/5 (35%) on the pre-course knowledge assessment and 4.3/5 (86%) at the conclusion of the course. Qualitative feedback was analyzed thematically. Students reported positive sentiments regarding the clarity, relevance, engagement, and practicality of the session. Furthermore, students anticipated that the course would improve their own practice patterns and care of older adults. Students felt more empowered to work with interprofessional colleagues because of this course. Opportunities for improvement included a desire for more interactivity and additional reference resources. The course was well-received; students indicated that it would positively influence their practice patterns. This course structure is both highly practical and replicable.