Research in Teaching Geriatric Medicine

Overview

This programme aims to:

develop and maintain effective curricular guidance to drive teaching in ageing and geriatric medicine
modernise the teaching in ageing and geriatric medicine to take full advantage of technological advances and to evaluate the effect of innovations on undergraduate learning.

Background

All doctors, not only those who specialise in geriatric medicine, need good core skills in the management of frail older patients. These patients make up the bulk of the patient-base within most healthcare systems internationally and benefit from comprehensive approaches to care, with close attention to detail, across a broad range of assessment domains, to build a full view of their needs.

Traditional models of medical teaching have emphasised the importance of diagnosis and disease, but neglected the broader understanding of functioning and health. This traditional diagnosis-based model is inadequate for the needs of frail older patients. Work is required to develop teaching which meets the needs of the types of patients doctors really see.

Workstream 1

The UK Undergraduate Curriculum and National Surveys of Undergraduate Teaching in Ageing and Geriatric Medicine

In 2007, we began a programme of work with the British Council of Ageing and British Geriatrics Society to develop an evidence-based curriculum for medical undergraduates covering ageing and geriatric medicine. We held an expert content development and validation meeting attended by biogerontologists, social gerontologists, gerontechnologists and geriatricians. We established a consensus curriculum in ageing and geriatric medicine, which became the British Geriatrics Society Recommended Curriculum for Medical Undergraduates.

Using this curriculum, we conducted the first national survey of undergraduate teaching in ageing and geriatric medicine in 2008. This showed that core aspects of geriatric medicine were taught at most medical schools – but most were not adequately assessed. There were obvious deficiencies in the teaching of biogerontology and social gerontology. Teaching on pressure ulcers and elder abuse were widely overlooked. Inadequate time was devoted to teaching about medicine of older people. These results were circulated to every UK medical school.

A repeat survey, conducted in 2013, showed improvements in the teaching and assessment of most subject areas but a continued failure to devote adequate time to teaching in geriatric medicine.

Beyond the UK, the curriculum was used as the basis of a pan-European Delphi consensus process conducted through the Union of European Medical Specialists in conjunction with colleagues from Klinikum Nurnberg, Medizinische Universitat Graz, Geriatrie Universitat Bern and Letterkenny General Hospital. This has now established a consensus undergraduate curriculum accepted by geriatric medicine specialists in 29 European countries.

Workstream 2

Developing innovative ways of teaching geriatric medicine and ageing

This has focussed on the development of computer aided learning resources that allow students to explore complex, knowledge and theory-laden topics in ageing and geriatric medicine in their own time, freeing up valuable contact time for small group teaching on complex issues such as ethics and communication and, most importantly, to meet with patients and learn about their care.

The programme started in 2007, with the development of Reusable Learning Objects (RLOs, short standardised computer assisted learning packages) on the topics of the International Classification of Functioning, Disability and Health and stroke diagnosis. Subsequent initiatives have used the Xerte open access CAL development package to develop a more comprehensive computer aided learning suite in topics related to geriatric medicine including continence, falls, physical activity and ageing, the demography of ageing, dementia and delirium. Evaluations conducted alongside implementation have shown improved student performance in examinations.

With funding from an Alzheimer's Society Dissemination Grant, the programme extended to develop three RLO on caring for people with dementia in the general hospital: 'Dementia and cognitive loss', 'Person-centred dementia care' and 'Communication'. These have been found to be helpful to all staff groups, not merely medical students.

The packages can be found online at: http://www.nottingham.ac.uk/medicine/study/learningresources/geriatricmedicine.aspx

Key Publications

Geriatric Medicine at a Glance. Edited by BLUNDELL A & GORDON A. 2015 John Wiley & Sons Ltd.

SAMRA R, GRIFFITHS A, COX T, CONROY S, GORDON A, & GLADMAN JRF 2015. Medical students' and doctors' attitudes towards older patients and their care in hospital settings: a conceptualisation. Age & Ageing 2015. http://dx.doi.org/10.1093/ageing/afv082

MASUD T, BLUNDELL AG, GORDON AL, MULPETER K, ROLLER R, SINGLER S, GOELDLIN A, STUCK A. 2014. European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique. Age Ageing 2014:afu019–.

FORRESTER-PATON C, FORRESTER-PATON J, GORDON A, MITCHELL HK, BRACEWELL N, MJOJO J, MASUD T, GLADMAN JRF, BLUNDELL A. 2014. Undergraduate Teaching in Geriatric Medicine: Mapping the British Geriatrics Society Undergraduate Curriculum to Tomorrow’s Doctors 2009 Age Ageing 2014;43 (3): 436-439. doi: 10.1093/ageing/afu204

GORDON AL, BLUNDELL AG, DHESI J, FORRESTER-PATON C, FORRESTER-PATON J, MITCHELL H, BRACEWELL N, MJOJO J, MASUD T, GLADMAN JRF. 2014. UK Medical teaching about ageing is improving but there is still work to be done. Age Ageing. 43(2): 293-297

DAUNT LA, UMEONUSULU PI, GLADMAN JRF, BLUNDELL AG, CONROY SP, GORDON AL. 2013. Undergraduate teaching in geriatric medicine using computer-aided learning improves student performance in examinations. Age Ageing, 42, 4, 541-544

TULLO ES, GORDON AL. 2013 Teaching and learning about dementia in UK medical schools: a national survey. BMC Geriatr. Mar 27;13:29

ROBBINS TD, CROCKER-BUQUE T, FORRESTER-PATON C, CANTLAY A, GLADMAN JRF, GORDON AL. 2011. Geriatrics is rewarding but lacks earning potential and prestige: responses from the national medical student survey of attitudes to and perceptions of geriatric medicine. Age Ageing. 40(3): 405-408

BLUNDELL A, GORDON AL, MASUD T, GLADMAN J. 2011. Innovations in teaching undergraduates about geriatric medicine and ageing - results from the UK National Survey of Teaching in Ageing and Geriatric Medicine. European Geriatric Medicine. 2(1): 12-14

GORDON AL, BLUNDELL AG, MASUD T and GLADMAN JR. 2010. Are we teaching our undergraduates what they need to know about ageing? Results of the National Survey of Undergraduate Teaching in Ageing and Geriatric Medicine. Age & Ageing. 39(3), 385-388.

GORDON A and BLUNDELL A. 2010. Top tips for formal teaching. CME Geriatric Medicine. 12(1), 37-43

BLUNDELL A, GORDON A, GLADMAN J and MASUD T. 2009. Undergraduate teaching in geriatric medicine: the role of national curricula. Gerontology & geriatrics education, 30(1), 75-88.

Contacts

Dr Adam Gordon; Dr Adrian Blundell; Dr Sarah Goldberg