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  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, face- to-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.Successful aging 2.Interprofessional team work 3.Falls 4.Medications and the older adult 5.Chronic neurological disorders 6.Depression and grief 7.Dementia I (early) 8.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 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