are we preparing future doctors for the real world?
TRANSCRIPT
Geriatric Coverage in the Mandatory Clerkship Curriculum at the University of TorontoAre We Preparing Future Doctors for the Real World?
Katarina Lakovic MSc MD CCFP (COE Resident) Thirumagal Yogaparan MD FRCP
Faculty/Presenter Disclosure
Speaker: Dr. Katarina LakovicFaculty: Dr. Thirumagal Yogaparan
Relationships with financial sponsors:None
We have not received any financial support for this project
Disclosure of Financial Support
Not applicable
Mitigating Potential Bias
● The number of Canadians over 65 will reach 20.1% in 20241
Background
● U of T does not currently have a mandatory geriatric clerkship rotation
● Only 5‐6 % of Clerks do elective or selective geriatric rotations
● Teaching of geriatric content falls on other courses to cover
● No centralized information about what is covered
Background
● Determine which geriatric competencies are covered in clerkship
● Determine where those competencies are addressed
● Explore challenges and how the Geriatrics Lead for UME can assist Course Directors
Objectives
● REB approval not required
● Courses that were reviewed:
Family Medicine Internal Medicine PsychiatryEmergency Medicine Obstetrics and GynecologyOphthalmology
Methods
AnesthesiaENTSurgeryDermatologyTransition to Clerkship Transition to Residency
● CGS published a list of recommended Core Competencies in 2009 for UME2
● U of T Geriatric Competencies contain updates and additional topics3
● Online course material was reviewed and compared to these Core Competencies
● Documented which competencies are covered in each course, and the type of learning activity they are covered in
Methods
● Met with Course Directors one on one
● Confirm the findings of online course review
● Input on topics generally covered during informal clinical teaching/experiences
● Discussed barriers to including more geriatric teaching
Methods
● Well covered competencies = at least 2 clinical experiences (1 of which must be a mandatory experience)
● Opportunity for improvement = 0 mandatory clinical experiences, or only 1 mandatory experience without any informal clinical teaching
Methods
Most of the geriatric topics were covered by:
● Family Medicine
● Internal Medicine
● Psychiatry
● OBGYN (urogenital aging)
Results
Results
Well Covered O pportunity for Im provem ent
Cognitive testing Dementia Anatomy and physiology of aging
Delirium diagnosis Functional Assessment Adverse drug reactions
Urinary incontinence Gait and balance Atypical presentations of disease
Transfer of care Advance care planning Hazards of institutional care
Medication history Deprescribing Restraints
Falls Osteoporosis Frailty
Mood Elder abuse Caregiver stress
Hearing and vision screening Healthy aging Safety in living environm ent
Only some core geriatric competencies are covered thoroughly
Barriers identified to overcoming these gaps:
● limited time during current courses
● insufficient numbers of preceptors with a geriatric focus
● lack of prioritization of geriatric topics within other disciplines
● not appropriate for level of training
Discussion
● Only Clerkship curriculum reviewed
● Difficult to assess bedside teaching, significant variation of students’ experience based on staff and patient presentations
● No input from students
● No input from faculty
Limitations
● Large gaps remain in geriatric teaching in the Clerkship Curriculum
● Many challenges exist
● Strategic and efficient approaches will need to be used to fill these gaps
● Given the aging population, it is imperative that these gaps are addressed
Conclusions
● Dr. Thiru Yogaparan
● Dr. Amy Freedman
● Dr. Sid Feldman and Dr. Rob Madden
● Dr. Malcolm Bins
● Dr. Stacey Bernstein and Dr. Pier Bryden
● Clerkship Course Directors
Acknowledgements
1. Statistics Canada. Canada's population estimates: Age and sex, July 1, 2015. Sept 2015.
2. Parmar J. Core competencies in the care of older persons for Canadian medical students. Can Geriatr J. 2009 Jun;12(2):70‐73.
3. Yogaparan T. Core competencies in the care of older persons for University of Toronto graduating medical students ‐ publication pending
References
Questions?