Transcript Care for Elders A Case Based Modular Interdisciplinary

Care for Elders A Case Based
Modular Interdisciplinary
Curriculum in Geriatric Care:
Implementation and Evaluation
CCSMH Conference, September 2007
There are no apparent conflicts
of interest that may have a
direct bearing on the subject
matter of the presentation
Authors
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Martha Donnelly, MD, FRCPC
David Jewell, MSW, MHSC
David Lewis, PhD
Janet Kushner-Kow, MD, MEd., FRCP
Purpose
To discuss development and
evaluation of an interdisciplinary
case based geriatric curriculum
Background
• Care for Elders is an interdisciplinary
group of academics at UBC
• Project to develop a geriatric
educational curriculum for diverse
audiences
• Modules to be accessible and always
evaluated
Partners
• Departments of Family Practice,
Psychiatry, Medicine
• College of Health Disciplines
• School of Nursing
• School of Rehab Sciences
• School of Social Work
• School of Audiology and Speech Sciences
• Seniors representative
Target Learners
• Undergraduate
• Postgraduate
• Continuing professional
development (in an
interdisciplinary form)
Facilitators non-expert
STRUCTURE
• Pre-reading 1 ½ hours evidence
based
• Case based
• Stand alone two hour modules in the
context of a possible eleven to fifteen
week course
• Mode of delivery – small group, faceto-face (with a possible move to
internet teaching later)
Curricular Objectives
1. To improve interprofessional team
functioning
2. To learn basic geriatric evidence
based content
3. To foster self-directed learning
4. To ultimately improve health care for
seniors
Curriculum Topics
1.
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6.
7.
8.
Successful aging
Interprofessional team work
Falls
Medications and the older adult
Chronic neurological disorders
Depression and grief
Dementia I (early)
Dementia II (late)
Curriculum Topics
9. Delirium
10. Persistent Pain
11. Palliative care
12. Informal support systems (Long Journey)
13. Incontinence
14. Nutrition and oral health
15. Patient safety (being developed)
Non-expert Facilitation
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Written guide: key points
Guide, do not lecture!
Ask group to introduce themselves
Ask for volunteers for scribe, timekeeper, reader
Talk as little as possible, but as much as
necessary
• Questions are the best form of interventions
• Illuminate group functioning issues
• Identify teaching moments
Non-expert Facilitation
Video:
To demonstrate:
• Poor, fair and good facilitation styles
Evaluations
Immediate:
• Degree of realism in case
• Degree of complexity in case
• How could case be improved?
• Completeness of pre-readings
• Degree of content learning
• Degree of team functioning learning
• Facilitator functioning
• Write down two or three things newly learned
• Name two to three changes you will make in
your practice
Hamilton Evaluation
• Learner evaluation (comparison to BC
experience)
• Qualitative component
- written commentary
- focus groups
• Client outcomes using a controlled before and
after analysis of administrative data bases for
urban and rural services and chart reviews
• 11 modules, 36 participants in the pilot, 425
learner evaluations
• 1,986 clients pre and post – admin data review
• 9 focus group participants
• 20 chart reviews
Hamilton Evaluation
• Content evaluation somewhat negative
• Focus group more positive (enthusiasm
for the form of the course, the dynamics
of networking and interdisciplinarity)
• Practice involved increased referrals
(confirmed by chart review)
• Data on patient benefit inconclusive
Hamilton Evaluation
Later comments:
People learned about other disciplines and
how they contribute to good care outcomes.
Also learned about other resources and
learned about overlap in roles.
One group carried on after the program
concluded and met as a book club –
ongoing professional education.
Hamilton Evaluation
Later comments:
Curriculum worked best it seemed in more
rural areas. At least there was more
enthusiasm. Also well received for new staff
People wanted to use in a more flexible way.
At the time these sites took on this
education endeavor, they had to do all of the
components. Now a flexible approach
should be helpful.
Hamilton Evaluation
Later comments:
• Students really benefit. Dr. Joy St. Onge
is using individual components with med
students. They shadow another discipline,
read one of the curriculum pieces and then
come together in the role of a PT or SW to
discuss the case. Very well received and
will be continuing.
• LTC wanted more specific material for
them. This group was the largest.
Hamilton Evaluation
Later comments:
• Might have been helpful to have a
physician lead to really add more
credibility to this whole process. We didn’t
have a physician at any of the sites.
Exception is Joy’s role.
• Might be good to move learning on line
rather than paper based only.
BC Evaluation
• Appreciation of content according to
level of education and experience
• Interdisciplinary forum very much
appreciated
• Team building in smaller communities
apparent
Implementation
• Vancouver: GPEP
• Fraser Health Authority
• North
- Smithers and Fort St. John
• Interior Health Authority
- Penticton, Vernon
• Hamilton
• Calgary
• NICE
- (? Palliative care and Persistent Pain)
Learning Points
• Interdisciplinary small groups
effective
• Revisions needed in content ongoing
• Revisions needed per province for
national approach
• Non-expert facilitators work but some
groups still like experts