Lesley Charles

Geriatric Core Competencies for Family Medicine Curriculum and Enhanced Skills: Care of Elderly

Background There is a growing mandate for Family Medicine residency programs to directly assess residents’ clinical competence in Care of the Elderly (COE). The objectives of this paper are to describe the development and implementation of incremental core competencies for Postgraduate Year (PGY)-I Integrated Geriatrics Family Medicine, PGY-II Geriatrics Rotation Family Medicine, and PGY-III Enhanced Skills COE for COE Diploma residents at a Canadian University. Methods Iterative expert panel process for the development of the core competencies, with a pre-defined process for implementation of the core competencies. Results Eighty-five core competencies were selected overall by the Working Group, with 57 core competencies selected for the PGY-I/II Family Medicine residents and an additional 28 selected for the PGY-III COE residents. The core competencies follow the CanMEDS Family Medicine roles. Both sets of core competencies are based on consensus. Conclusions Due to demographic changes, it is essential that Family Physicians have the required skills and knowledge to care for the frail elderly. The core competencies described were developed for PGY-I/II Family Medicine residents and PGY-III Enhanced Skills COE, with a focus on the development of geriatric expertise for those patients that would most benefit.

The Development and Implementation of a Decision-Making Capacity Assessment Model

Background Decision-making capacity assessment (DMCA) is an issue of increasing importance for older adults. Current challenges need to be explored, and potential processes and strategies considered in order to address issues of DMCA in a more coordinated manner. Methods An iterative process was used to address issues related to DMCA. This began with recognition of challenges associated with capacity assessments (CAs) by staff at Covenant Health (CH). Review of the literature, as well as discussions with and a survey of staff at three CH sites, resulted in determination of issues related to DMCA. Development of a DMCA Model and demonstration of its feasibility followed. Results A process was proposed with front-end screening/problem- solving, a well-defined standard assessment, and definition of team member roles. A Capacity Assessment Care Map was formulated based on the process. Documentation was developed consisting of a Capacity Assessment Process Worksheet, Capacity Interview Worksheet, and a brochure. Interactive workshops were delivered to familiarize staff with the DMCA Model. A successful demonstration project led to implementation across all sites in the Capital Health region, and eventual provincial endorsement. Conclusions Concerns identified in the survey and in the literature regarding CA were addressed through the holistic interdisciplinary approach offered by the DMCA Model.

Training of Specialized Geriatric Physicians to Meet the Needs of an Aging Population—A Unique Care of the Elderly Physician Program in Canada

accepted at the North American Primary Care Research Group 2013 for a poster presentation. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Funded by the Northern Alberta Academic Family Physician Endowment Fund. Author Contributions: LC: conception and design, acquisition of data, interpretation of data, drafting the article, critical revision of the article for important intellectual content, final approval of the version to be published. BD: conception and design, analysis and interpretation of data, critical revision of the article for important intellectual content, final approval of the version to be published. RM: conception and design, analysis and interpretation of data, drafting the article, critical revision of the article for important intellectual content, final approval of the version to be published. OB: analysis and interpretation of data, critical revision of the article for important intellectual content; final approval of the version to be published. JT: conception, drafting the article, critical revision of the article for important intellectual content, final approval of the version to be published. Sponsor’s Role: None.

Identifying the Priority Topics for the Assessment of Competence in Care of the Elderly

Background With Canada’s senior population increasing, there is greater demand for family physicians with enhanced skills in Care of the Elderly (COE). The College of Family Physicians Canada (CFPC) has introduced Certificates of Added Competence (CACs), one being in COE. Our objective is to summarize the process used to determine the Priority Topics for the assessment of competence in COE. Methods A modified Delphi technique was used, with online surveys and face-to-face meetings. The Working Group (WG) of six physicians acted as the nominal group, and a larger group of randomly selected practitioners from across Canada acted as the Validation Group (VG). The WG, and then the VG, completed electronic write-in surveys that asked them to identify the Priority Topics. Responses were compiled, coded, and tabulated to identify the topics and to calculate the frequencies of their selection. The WG used face-to-face meetings and iterative discussion to decide on the final topic names. Results The correlation between the initial Priority Topic list identified by the VG and that identified by the WG is 0.6793. The final list has 18 Priority Topics. Conclusion Defining the required competencies is a first step to establishing national standards in COE.

Understanding How to Support Family Caregivers of Seniors with Complex Needs

Purpose of the Study The purpose of this study was to describe the experiences and challenges of supporting family caregivers of seniors with complex needs and to outline support strategies and research priorities aimed at supporting them. Design and Methods A CIHR-funded, two-day conference entitled “Supporting Family Caregivers of Seniors: Improving Care and Caregiver Outcomes” was held. An integrated knowledge translation approach guided this planning conference. Day 1 included presentations of research evidence, followed by participant engagement Qualitative data was collected regarding facilitators, barriers/gaps, and recommendations for the provision of caregiver supports. Day 2 focused on determination of research priorities. Results Identified facilitators to the provision of caregiver support included accessibility of health-care and community-based resources, availability of well-intended health-care providers, and recognition of caregivers by the system. Barriers/gaps related to challenges with communication, access to information, knowledge of what is needed, system navigation, access to financial resources, and current policies. Recommendations regarding caregiver services and research revolved around assisting caregivers to self-identify and seek support, formalizing caregiver supports, centralizing resources, making system navigation available, and preparing the next generation for caregiving. Implication A better understanding of the needs of family caregivers and ways to support them is critical to seniors’ health services redesign.

Effectiveness of a Core-Competency-based Program on Residents' Learning and Experience.

Background The Care of the Elderly (COE) Diploma Program is a six-to-twelve-month enhanced skills program taken after two years of core residency training in Family Medicine. In 2010, we developed and implemented a core-competency–based COE Diploma program (CC), in lieu of one based on learning objectives (LO). This study assessed the effectiveness of the core-competency–based program on residents’ learning and their training experience as compared to residents trained using learning objectives. Methods The data from the 2007–2013 COE residents were used in the study, with nine and eight residents trained in the LO and CC programs, respectively. Residents’ learning was measured using preceptors’ evaluations of residents’ skills/abilities throughout the program (118 evaluations in total). Residents’ rating of training experience was measured using the Graduate’s Questionnaire which residents completed after graduation. Results For residents’ learning, overall, there was no significant difference between the two programs. However, when examined as a function of the four CanMEDS roles, there were significant increases in the CC residents’ scores for two of the CanMEDS roles: Communicator/Collaborator/Manager and Scholar compared to residents in the LO program. With respect to residents’ training experience, seven out of ten program components were rated by the CC residents higher than by the LO residents. Conclusion The implementation of a COE CC program appears to facilitate resident learning and training experience.

Intermediate and long-term cognitive effects in older adults secondary to cardiovascular procedures is uncommon but current evidence is insufficient.

Commentary on: Fink HA, Hemmy LS, MacDonald R, et al. Intermediate- and long-term cognitive outcomes after cardiovascular procedures in older adults: a systematic review. Ann Intern Med 2015;163:107–17[OpenUrl][1][CrossRef][2][PubMed][3]. Cardiovascular procedures are common in the older population.1 There is suspicion that these procedures may have a negative outcome on cognition.2 However, further research has indicated that there may have been pre-existing cognitive deficits as cognitive impairment is common in the older population.3 This systematic review examines the evidence of the relationship of coronary and carotid revascularisation, cardiac valve replacement and repair and ablation for atrial fibrillation on intermediate-term and long-term cognitive outcomes in adults 65 years or above, including the effects of procedure related stroke or transient ischaemic attack. This was a systematic review of randomised controlled trials (RCTs) and prospective cohort studies of adults aged 65 years … [1]: {openurl}?query=rft.jtitle%253DAnn%2BIntern%2BMed%26rft.volume%253D163%26rft.spage%253D107%26rft_id%253Dinfo%253Adoi%252F10.7326%252FM14-2793%26rft_id%253Dinfo%253Apmid%252F26192563%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.7326/M14-2793&link_type=DOI [3]: /lookup/external-ref?access_num=26192563&link_type=MED&atom=%2Febmed%2F20%2F6%2F221.atom