Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-26T15:13:13.714Z Has data issue: false hasContentIssue false
  • English
  • Français

What Do Clinical Supervisors Require to Teach Residents in Family Medicine How to Care for Seniors?

Published online by Cambridge University Press:  09 January 2018

Anik M. C. Giguere ,
Paule Lebel ,
Michèle Morin ,
Françoise Proust ,
Charo Rodríguez ,
Valerie Carnovale ,
Louise Champagne ,
France Légaré ,
Pierre-Hugues Carmichael  and
Bernard Martineau
...Show all authors
Anik M. C. Giguere*
Affiliation:
Laval University
Paule Lebel
Affiliation:
University of Montreal
Michèle Morin
Affiliation:
Laval University Quebec Excellence Centre on Aging
Françoise Proust
Affiliation:
Research Centre of the CHU de Quebec
Charo Rodríguez
Affiliation:
McGill University
Valerie Carnovale
Affiliation:
Laval University
Louise Champagne
Affiliation:
Sherbrooke University
France Légaré
Affiliation:
Laval University Laval University Research Centre in Primary Care and Services Research Centre of the CHU de Quebec
Pierre-Hugues Carmichael
Affiliation:
Quebec Excellence Centre on Aging
Bernard Martineau
Affiliation:
Sherbrooke University
Philippe Karazivan
Affiliation:
University of Montreal
Pierre J. Durand
Affiliation:
Laval University
*
†La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Anik M. C. Giguere, Ph.D. Department of Family and Emergency Medicine Laval University Pavillon Ferdinand-Vandry, office #2881-C 1050 avenue de la Médecine Quebec, QC, G1V 0A6 <[email protected]>
Get access Rights & Permissions [Opens in a new window]

Abstract

We assessed clinicians’ continuing professional development (CPD) needs at family practice teaching clinics in the province of Quebec. Our mixed methodology design comprised an environmental scan of training programs at four family medicine departments, an expert panel to determine priority clinical situations for senior care, a supervisors survey to assess their perceived CPD needs, and interviews to help understand the rationale behind their needs. From the environmental scan, the expert panel selected 13 priority situations. Key needs expressed by the 352 survey respondents (36% response rate) included behavioral and psychological symptoms of dementia, polypharmacy, depression, and cognitive disorders. Supervisors explained that these situations were sometimes complex to diagnose and manage because of psychosocial aspects, challenges of communicating with patients and families, and coordination of interprofessional teams. Supervisors also reported more CPD needs in long-term and home care, given the presence of caregivers and complexity of senior care in these settings.

Résumé

Nous avons évalué les besoins de formation des cliniciens qui supervisent les résidents dans les cliniques d’enseignement de médecine familiale au Québec. Nous avons utilisé une méthodologie mixte comprenant: un balayage environnemental des programmes de formation des Départements de médecine familiale, un consensus d’experts pour sélectionner des situations cliniques prioritaires pour les soins aux aînés, un questionnaire pour connaître la perception des superviseurs de leurs besoins de formation, et des entrevues pour comprendre les raisons des besoins. Partant du balayage, les experts ont identifié 13 situations cliniques prioritaires. Les 352 participants au sondage (taux de réponse : 36 %) ont rapporté des besoins plus importants pour gérer les symptômes comportementaux et psychologiques de la démence, la polymédication, la dépression, et les troubles cognitifs. Les entrevues ont révélé que ces situations cliniques étaient parfois complexes à diagnostiquer et à gérer en raison de leurs aspects psychosociaux, de la communication avec les patients et les familles, et de la coordination des équipes interprofessionnelles. Les superviseurs ont également rapporté des besoins plus important en milieu soins de longue durée et à domicile par rapport aux soins ambulatoires, dû à la complexité des soins aux aînés dans ces milieux et à la présence de proches aidants.

Keywords

agingfaculty developmentgraduate programsfamily practicetraining needssupervisionvielliessementformation professoraleprogrammes d’études supérieuresmédicine familialebesoins de formationsupervision
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 37 , Issue 1 , March 2018 , pp. 32 - 49
Check for updates
Copyright
Copyright © Canadian Association on Gerontology 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

This project was funded by the Ministère de la Santé et des Services Sociaux du Québec, by the Research Chair in Aging at Laval University, by the three Departments of Family and Emergency Medicine of the Province of Quebec (Laval University, University of Montreal, University of Sherbrooke) and by McGill University’s Department of Family Medicine. We wish to thank the staff of the participating clinic; the members of the Comité Interuniversitaire et interprofessionnel de développement professoral continu en enseignement et en soins aux personnes âgées who acted as experts to select the priority clinical situations for senior care; Marie Meudec for conducting the interviews and Katherine Hastings for her writing assistance. AMCG is funded by a Research Scholar Junior 2 Career Development Award by the Fonds de Recherche du Québec-Santé.

References

Adams, W. L., McIlvain, H. E., Lacy, N. L., Magsi, H., Crabtree, B. F., Yenny, S. K., & Sitorius, M. A. (2002). Primary care for elderly people: Why do doctors find it so hard? The Gerontologist, 42(6), 835–842.CrossRefGoogle ScholarPubMed
American Geriatrics Society 2015 Beers Criteria Update Expert Panel. (2015). American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatric Society, 63(11), 2227–2246.CrossRefGoogle Scholar
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Canadian Institute for Health Information. (2014). Drug use among seniors on public drug programs in Canada. Retrieved from https://secure.cihi.ca/free_products/Drug_Use_in_Seniors_on_Public_Drug_Programs_EN_web_Oct.pdf Google Scholar
Cantor, J. C., Baker, L. C., & Hughes, R. G. (1993). Preparedness for practice: Young physicians’ views of their professional education. JAMA, 270(9), 1035–1040.CrossRefGoogle ScholarPubMed
Charles, L., Triscott, J. A., Dobbs, B. M., & McKay, R. (2014). Geriatric core competencies for family medicine curriculum and enhanced skills: Care of elderly. Canadian Geriatrics Journal, 17(2), 53–62.CrossRefGoogle ScholarPubMed
Clarke, B., Bayly, K., Frank, C., Kirk, J., Mather, F., Maxted, J., & Stickney-Lee, J. (2007). Priorities for the health care of the elderly: The role of the family physician. Retrieved from www.cfpc.ca/uploadedFiles/Directories/Priorities%20for%20the%20Health%20Care%20of%20the%20Elderly.pdf Google Scholar
Coogle, C. L., Hackett, L., Owens, M. G., Ansello, E. F., & Mathews, J. H. (2016). Perceived self-efficacy gains following an interprofessional faculty development programme in geriatrics education. Journal of Interprofessional Care, 30(4), 483–492.CrossRefGoogle ScholarPubMed
Counsell, S. R., Kennedy, R. D., & Szwabo, P. (1999). Curriculum recommendations for resident training in geriatrics interdisciplinary team care. Journal of the American Geriatrics Society, 47(9), 1145–1148.CrossRefGoogle ScholarPubMed
Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods approaches (4th ed.). Thousand Oaks, CA: Sage.Google Scholar
Darer, J. D., Hwang, W., Pham, H. H., Bass, E. B., & Anderson, G. (2004). More training needed in chronic care: A survey of US physicians. Academic Medicine, 79(6), 541–548.CrossRefGoogle ScholarPubMed
Dillman, D. A. (2011). Mail and internet surveys: The tailored design method – 2007 update with new internet, visual, and mixed-mode guide. Hoboken, NJ: Wiley.Google Scholar
Fereday, J., & Muir-Cochrane, E. (2006). Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods, 5(1), 80–92.CrossRefGoogle Scholar
Forsman, A., Jane-Llopis, E., Schierenbeck, I., & Wahlbeck, K. (2009). Psychosocial interventions for prevention of depression in older people. Cochrane Database of Systematic Reviews. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007804/abstract CrossRefGoogle Scholar
Frank, C., Su, C., & Knott, T. C. (2003). Seniors’ perceptions of their medical care. Before admission to a geriatric rehabilitation program. Canadian Family Physician, 49, 1490–1495.Google ScholarPubMed
Frank, J. R., Snell, L., Sherbino, J., Eds. (2015). Can Meds 2015 Physician Competency Framework. Ottawa, ON: Royal College of Physicians and Surgeons of Canada. Retrieved from http://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e Google Scholar
Giguere, A., Lebel, P., Morin, M., Carnovale, V., Meudec, M., Rodriguez, C., … Durand, P. J. (submitted). Preferred learning strategies of family medicine clinical supervisors to improve their skills and teaching abilities in senior care. Under review.Google Scholar
Hanlon, J. T., Schmader, K. E., Koronkowski, M. J., Weinberger, M., Landsman, P. B., Samsa, G. P., & Lewis, I. K. (1997). Adverse drug events in high risk older outpatients. Journal of the American Geriatrics Society, 45(8), 945–948.CrossRefGoogle ScholarPubMed
Harman, J. S., Edlund, M. J., & Fortney, J. C. (2004). Disparities in the adequacy of depression treatment in the United States. Psychiatric Services, 55(12), 1379–1385.CrossRefGoogle ScholarPubMed
Harris, D. P., Chodosh, J., Vassar, S. D., Vickrey, B. G., & Shapiro, M. F. (2009). Primary care providers’ views of challenges and rewards of dementia care relative to other conditions. Journal of the American Geriatrics Society, 57(12), 2209–2216.CrossRefGoogle ScholarPubMed
Hatch, T. F., & Pearson, T. G. (1998). Using environmental scans in educational needs assessment. Journal of Continuing Education in the Health Professions, 18(3), 179–184.CrossRefGoogle Scholar
Higashi, R. T., Tillack, A. A., Steinman, M., Harper, M., & Johnston, C. B. (2012). Elder care as “frustrating” and “boring”: Understanding the persistence of negative attitudes toward older patients among physicians-in-training. Journal of Aging Studies, 26(4), 476–483.CrossRefGoogle ScholarPubMed
Hinton, L., Franz, C. E., Reddy, G., Flores, Y., Kravitz, R. L., & Barker, J. C. (2007). Practice constraints, behavioural problems, and dementia care: Primary care physicians’ perspectives. Journal of General Internal Medicine, 22(11), 1487–1492.CrossRefGoogle Scholar
Hohl, C. M., Dankoff, J., Colacone, A., & Afilalo, M. (2001). Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Annals of Emergency Medicine, 38(6), 666–671.CrossRefGoogle ScholarPubMed
Hosmer, D. W. Jr., Lemeshow, S., & Sturdivant, R. X. (2013). Applied logistic regression (Vol. 398): John Wiley & Sons.Google Scholar
Jefferson, A. L., Cantwell, N. G., Byerly, L. K., & Morhardt, D. (2012). Medical student education program in Alzheimer’s disease: The PAIRS program. BMC Medical Education, 12, 80.CrossRefGoogle ScholarPubMed
Jochemsen-van der Leeuw, H. G. A. R., van Dijk, N., van Etten-Jamaludin, F. S., & Wieringa-de Waard, M. (2013). The attributes of the clinical trainer as a role model: A systematic review. Academic Medicine, 88(1), 26–34.CrossRefGoogle ScholarPubMed
Kravet, S., Christmas, C., Durso, S., Parson, G., Burkhart, K., & Wright, S. (2011). The intersection between clinical excellence and role modeling in medicine. Journal of Graduate Medical Education, 3(1949-8357 (Electronic)), 465–468.CrossRefGoogle ScholarPubMed
Krichbaum, K., Kaas, M. J., Wyman, J. F., & Van Son, C. R. (2015). Facilitated learning to advance geriatrics: Increasing the capacity of nurse faculty to teach students about caring for older adults. The Gerontologist, 55(Suppl. 1), S154–S164.CrossRefGoogle ScholarPubMed
Labesse, M. E. (2008). Terms of reference for training needs analysis – Continuing education component. Quebec City, QC: Institut national de santé publique du Québec. Retrieved from https://www.inspq.qc.ca/sites/default/files/publications/884_cadre_reference_ang.pdf Google Scholar
Lam, J. M., Anderson, G. M., Austin, P. C., & Bronskill, S. E. (2012). Family physicians providing regular care to residents in Ontario long-term care homes: Characteristics and practice patterns. Canadian Family Physician, 58(11), 1241–1248.Google ScholarPubMed
Lam, R., Gallinaro, A., & Adleman, J. (2013). Medical problems referred to a care of the elderly physician: Insight for future geriatrics CME. Canadian Geriatrics Journal, 16(3), 114.CrossRefGoogle ScholarPubMed
Lebel, P., Champoux, N., Dechêne, G., de la Chevrotière, H., Goyette, R., Lebel, S., & Sanche, S. (2013). Repenser l’enseignement des soins aux personnes âgées pour nos futurs médecins de famille: Une démarche pas à pas. Retrieved from https://medecine.umontreal.ca/wp-content/uploads/sites/8/Rapport-Enseignement_Soins_Agees.pdf Google Scholar
Lee, L., Kasperski, M. J., & Weston, W. W. (2011). Building capacity for dementia care: Training program to develop primary care memory clinics. Canadian Family Physician, 57(7), e249–252.Google ScholarPubMed
Levine, S. A., Chao, S. H., Brett, B., Jackson, A. H., Burrows, A. B., Goldman, L. N., & Caruso, L. B. (2008). Chief resident immersion training in the care of older adults: An innovative interspecialty education and leadership intervention. Journal of the American Geriatrics Society, 56(6), 1140–1145.CrossRefGoogle ScholarPubMed
Lipska, K. J., Ross, J. S., Miao, Y., Shah, N. D., Lee, S. J., & Steinman, M. A. (2015). Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Internal Medicine, 175(3), 356–362.CrossRefGoogle ScholarPubMed
Mazotti, L., Moylan, A., Murphy, E., Harper, G. M., Johnston, C. B., & Hauer, K. E. (2010). Advancing geriatrics education: An efficient faculty development program for academic hospitalists increases geriatric teaching. Journal of Hospital Medicine, 5(9), 541–546.CrossRefGoogle ScholarPubMed
McCabe, M. P., Davison, T., Mellor, D., & George, K. (2009). Barriers to care for depressed older people: Perceptions of aged care among medical professionals. The International Journal of Aging and Human Development, 68(1), 53–64.CrossRefGoogle ScholarPubMed
McGregor, M. J., & Sloan, J. (2014). Realigning training with need. A case for mandatory family medicine resident experience in community-based care of the frail elderly. Canadian Family Physician, 60(8), 697–699.Google Scholar
Mezey, M., Mitty, E., Burger, S. G., & McCallion, P. (2008). Healthcare professional training: A comparison of geriatric competencies. Journal of the American Geriatics Society, 56(9), 1724–1729.CrossRefGoogle ScholarPubMed
Mottram, P. G., Wilson, K., & Strobl, J. J. (2009). Antidepressants for depressed elderly. Cochrane Database of Systematic Reviews. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003491.pub2/abstract Google Scholar
O’Halloran, R., Worrall, L., & Hickson, L. (2012). Stroke patients communicating their healthcare needs in hospital: A study within the ICF framework. International Journal of Language & Communication Disorders, 47(2), 130–143.CrossRefGoogle ScholarPubMed
Opondo, D., Eslami, S., Visscher, S., de Rooij, S. E., Verheij, R., Korevaar, J. C., & Abu-Hanna, A. (2012). Inappropriateness of medication prescriptions to elderly patients in the primary care setting: A systematic review. PloS one, 7(8), e43617.CrossRefGoogle ScholarPubMed
Pashiardis, P. (1996). Environmental scanning in educational organizations: Uses, approaches, sources and methodologies. International Journal of Educational Management, 10(3), 5–9.Google Scholar
Pinheiro, S. O., White, H. K., Buhr, G. T., Elbert-Avila, K., Cohen, H. J., & Heflin, M. T. (2015). Advancing geriatrics education through a faculty development program for geriatrics-oriented clinician educators. Journal of the American Geriatrics Society, 63(12), 2580–2587.CrossRefGoogle ScholarPubMed
Podrazik, P. M., Levine, S., Smith, S., Scott, D., Dubeau, C. E., Baron, A. … Sachs, G. (2008). The curriculum for the hospitalized aging medical patient program: A collaborative faculty development program for hospitalists, general internists, and geriatricians. Journal of Hospital Medicine, 3(5), 384–393.CrossRefGoogle Scholar
Reeves, S., Perrier, L., Goldman, J., Freeth, D., & Zwarenstein, M. (2013). Interprofessional education: Effects on professional practice and healthcare outcomes (update). Cochrane database of systematic reviews. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002213.pub3/abstract CrossRefGoogle Scholar
Reuben, D. B., Roth, C., Kamberg, C., & Wenger, N. S. (2003). Restructuring primary care practices to manage geriatric syndromes: The ACOVE-2 intervention. Journal of the American Geriatrics Society, 51(12), 1787–1793.CrossRefGoogle ScholarPubMed
Rubin, C. D., Stieglitz, H., Vicioso, B., & Kirk, L. (2003). Development of geriatrics-oriented faculty in general internal medicine. Annals of Internal Medicine, 139(7), 615–620.CrossRefGoogle ScholarPubMed
Salter, A., Khan, K. M., Donaldson, M., Davis, J., Buchanan, J., Abu-Laban, R. B … McKay, H. A. (2006). Community-dwelling seniors who present to the emergency department with a fall do not receive guideline care and their fall risk profile worsens significantly: A 6-month prospective study. Osteoporosis International, 17(5), 672–683.CrossRefGoogle Scholar
Sikdar, K. C., Alaghehbandan, R., MacDonald, D., Barrett, B., Collins, K. D., Donnan, J., & Gadag, V. (2010). Adverse drug events in adult patients leading to emergency department visits. Annals of Pharmacotherapy, 44(4), 641–649.CrossRefGoogle ScholarPubMed
Smolders, M., Laurant, M., Verhaak, P., Prins, M., van Marwijk, H., Penninx, B., & Grol, R. (2009). Adherence to evidence-based guidelines for depression and anxiety disorders is associated with recording of the diagnosis. General Hospital Psychiatry, 31(5), 460–469.CrossRefGoogle ScholarPubMed
Stans, S. E., Dalemans, R., de Witte, L., & Beurskens, A. (2013). Challenges in the communication between ‘communication vulnerable’ people and their social environment: An exploratory qualitative study. Patient Education and Counseling, 92(3), 302–312.CrossRefGoogle ScholarPubMed
Statistics Canada. (2011). From urban areas to population centres. Ottawa, ON: Author. Retrieved from http://www.statcan.gc.ca/subjects-sujets/standard-norme/sgc-cgt/notice-avis/sgc-cgt-06-eng.htm Google Scholar
Steinweg, K. K. (2008). Embracing the ecology of geriatrics to improve family medicine education. Family Medicine, 40(10), 715–720.Google ScholarPubMed
Sternberg, S. A., Wolfson, C., & Baumgarten, M. (2000). Undetected dementia in community-dwelling older people: The Canadian Study of Health and Aging. Journal of the American Geriatrics Society, 48(11), 1430–1434.CrossRefGoogle ScholarPubMed
Voogt, S. J., Mickus, M., Santiago, O., & Herman, S. E. (2008). Attitudes, experiences, and interest in geriatrics of first-year allopathic and osteopathic medical students. Journal of the American Geriatrics Society, 56(2), 339–344.CrossRefGoogle ScholarPubMed
Willett, R. M., Boling, P. A., Meyers, M. E., Hoban, J. D., Lawson, S. R., & Schlesinger, J. B. (2007). Professional development in geriatrics for community-based generalist faculty. Journal of the American Geriatrics Society, 55(2), 300–304.CrossRefGoogle ScholarPubMed
Williams, B. C., Warshaw, G., Fabiny, A. R., Lundebjerg Mpa, N., Medina-Walpole, A., Sauvigne, K. … Leipzig, R. M. (2010). Medicine in the 21st century: Recommended essential geriatrics competencies for internal medicine and family medicine residents. Journal of Graduate Medical Education, 2(3), 373–383.CrossRefGoogle ScholarPubMed
Wilson, K., Mottram, P. G., & Vassilas, C. (2008). Psychotherapeutic treatments for older depressed people. Cochrane Database of Systematic Reviews. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004853.pub2/abstract CrossRefGoogle Scholar
Wright, S. M., & Carrese, J. A. (2002). Excellence in role modelling: Insight and perspectives from the pros. CMAJ, 167(0820–3946 [Print]), 638–643.Google ScholarPubMed
Xyrichis, A., & Ream, E. (2008). Teamwork: A concept analysis. Journal of Advanced Nursing, 61(2), 232–241.CrossRefGoogle ScholarPubMed
Supplementary material: File

Giguere et al. supplementary material

Appendix 1

Download Giguere et al. supplementary material(File)
File 228.2 KB