Mark Garside

Stroke and TIA Assessment Training: A New Simulation-Based Approach to Teaching Acute Stroke Assessment

Introduction Patient simulators provide an opportunity for teams to rehearse scenarios where a rapid coordinated response is essential for improving the clinical outcome. Treatment of acute ischemic stroke is time dependent and intravenous thrombolysis must be administered within hours of symptom onset. This requires a complicated assessment process often led in its initial stages by emergency department staff. We describe a new single-day training event that uses simulated scenarios to demonstrate stroke recognition and an intravenous thrombolysis protocol. Methods Stroke and TIA Assessment Training (STAT) uses video and audio clips from real patients in conjunction with a patient simulator to create interactive scenarios for emergency department staff. Results Between May 2009 and April 2011, 779 clinical staff in the United Kingdom attended a STAT course. Data from the first year of STAT showed that learner self-confidence for stroke assessment increased significantly. The use of the simulator was highly valued. Conclusions A patient simulator can be successfully combined with patient video material to demonstrate neurologic features in the context of acute stroke assessment.

Remote specialist assessment for intravenous thrombolysis of acute ischaemic stroke by telephone

Objective To describe the process, efficacy and safety of intravenous thrombolysis for acute ischaemic stroke in an emergency department (ED) setting with remote specialist support through structured telephone consultation. Design Retrospective case series. Setting Three EDs within a single stroke service in northern England. Participants Patients with acute stroke given intravenous thrombolytic therapy between 6 September 2007 and 1 October 2010. Outcome measures Combined death and dependency at 90 days (0–2 on the modified Rankin Scale for a good outcome vs 3–6 for a poor outcome), door-to-needle time, neurological impairment and presence of treatment related haemorrhage. Results 192 patients received intravenous thrombolysis. 94/178 (53%) were treated after remote specialist assessment. Data available from 178 patients showed similar proportions with a good outcome after each mode of assessment (56% in person and 48% by telephone). The median door-to-needle time was 8 min faster in the group assessed in person (65 vs 73 min by telephone) but there was no difference in neurological outcome or symptomatic haemorrhage. After review in person, the stroke specialist tended to treat patients with a higher median modified Rankin Scale (1 vs 0 by telephone). Conclusion In a single stroke service the clinical outcomes of treatment with intravenous thrombolysis were similar whether assessment was performed after specialist review in person or via a telemedicine service consisting of ED staff training, telephone consultation and remote review of brain imaging by a stroke specialist.

The development and evaluation of mini-GEMs - short, focused, online e-learning videos in geriatric medicine.

ABSTRACT Mini Geriatric E-Learning Modules (Mini-GEMs) are short, focused, e-learning videos on geriatric medicine topics, hosted on YouTube, which are targeted at junior doctors working with older people. This study aimed to explore how these resources are accessed and used. The authors analyzed the viewing data from 22 videos published over the first 18 months of the Mini-GEM project. We conducted a focus group of U.K. junior doctors considering their experiences with Mini-GEMS. The Mini-GEMs were viewed 10,291 times over 18 months, equating to 38,435 minutes of total viewing time. The average viewing time for each video was 3.85 minutes. Learners valued the brevity and focused nature of the Mini-GEMs and reported that they watched them in a variety of settings to supplement clinical experiences and consolidate learning. Watching the videos led to an increase in self-reported confidence in managing older patients. Mini-GEMs can effectively disseminate clinical teaching material to a wide audience. The videos are valued by junior doctors due to their accessibility and ease of use.

Geriatric medicine workforce planning: a giant geriatric problem or has the tide turned?

The UKs population is ageing and an adequately staffed geriatric medicine workforce is essential for high quality care. We evaluated the current and future geriatric medicine workforce, drawing on data relating to the UK population, current geriatric medicine consultants and trainees, recruitment into the specialty and trainee career progression. Data were derived from various sources, including the British Geriatrics Society Education and Training Committee biannual survey of training posts. The demographic of consultant geriatricians is changing and so too are their job plans, with more opting to work less than full time. The number of applicants to geriatric medicine training is increasing, yet increasing numbers of posts remain unfilled (4.7% in November 2010 and 14.1% in May 2013). The majority of geriatric medicine trainees secure a substantive consultant post within 6 months of obtaining their certificate of completion of training This work highlights challenges for the future: potential barriers to trainee recruitment, unfilled training posts and an ageing population and workforce.

New ways to teach new doctors about older people

The complex health care needs of an ageing population present health care systems with new challenges. To meet these, tomorrow ’ s doctors must receive adequate training in the care of older people, and suffi cient numbers of doctors are needed to become geriatricians (doctors practising medicine of the elderly). Of concern in the UK is the limited exposure of medical undergraduates to geriatric medicine training and the increasing numbers of unoccupied higher specialty training posts in geriatric medicine. 1,2 In the UK, a doctor can opt to specialise in geriatric medicine after completing at least 4 years postgraduate training: a period where they are commonly referred to as junior doctors. A survey of junior doctors who had expressed an interest in geriatric medicine identifi ed a number of deterrents to undertaking a career in the specialty, including: negative perceptions about the role of the medical registrar (the senior training grade for future geriatricians); a perception that geriatric medicine lacks prestige; and a sense of ‘therapeutic nihilism’ (being unable to make a difference for older patients). 3

Why geriatric medicine? A survey of UK specialist trainees in geriatric medicine

Background there is concern that there are insufficient numbers of geriatricians to meet the needs of the ageing population. A 2005 survey described factors that influenced why UK geriatricians had chosen to specialise in the field-in the decade since, UK postgraduate training has undergone a fundamental restructure. Objective to explore whether the reasons for choosing a career in geriatric medicine in the UK had changed over time, with the goal of using this knowledge to inform recruitment and training initiatives. Design an online survey was sent to all UK higher medical trainees in geriatric medicine. Methods survey questions that produced categorical data were analysed with simple descriptive statistics. For the survey questions that produced free-text responses, an inductive, iterative approach to analysis, in keeping with the principles of framework analysis, was employed. Results two hundred and sixty-nine responses were received out of 641 eligible respondents. Compared with the previous survey, a substantially larger number of respondents regarded geriatric medicine to be their first-choice specialty and a smaller number regretted their career decision. A greater number chose geriatric medicine early in their medical careers. Commitments to the general medical rota and the burden of service provision were considered important downsides to the specialty. Conclusions there are reasons to be optimistic about recruitment to geriatric medicine. Future attempts to drive up recruitment might legitimately focus on the role of the medical registrar and perceptions that geriatricians shoulder a disproportionate burden of service commitments and obligations to the acute medical take.