Oakley Rachel, Pattinson Joanne, Goldberg Sarah, Daunt Laura, Samra Rajvinder, Masud Tahir, Gladman John R F, Blundell Adrian G, Gordon Adam L
Department of Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK.
Age Ageing. 2014 Jul;43(4):442-7. doi: 10.1093/ageing/afu077.
As the proportion of older patients with frailty presenting to health services increases, so does the need for doctors to be adequately trained to meet their needs. The presentations seen in such patients, the evidence-based models of care and skillsets required to deliver them are different than for younger patient groups-so specific training is required. Several research programmes have used detailed and explicit methods to establish evidence-based expert-validated curricula outlining learning outcomes for undergraduates in geriatric medicine-there is now broad-consensus on what newly qualified doctors need to know. There are, despite this, shortcomings in the teaching of undergraduates about geriatric medicine. National and international surveys from the UK, EU, USA, Canada, Austria and the Netherlands have all shown shortcomings in the content and amount of undergraduate teaching. Mechanisms to improve this situation, aside from specifying curricula, include developing academic departments and professorships in geriatric medicine, providing grants to develop teaching in geriatric medicine and developing novel teaching interventions to make the best of existing resources. Under the last of these headings, innovations have been shown to improve outcomes by: using technology to ensure the most effective allocation of teaching time and resources; using inter-professional education as a means of improving attitudes towards care of older patients; focusing teaching specifically on attitudes towards older patients and those who work with them; and trying to engage patients in teaching. Research areas going forward include how to incentivise medical schools to deliver specified curricula, how to choose from an ever-expanding array of teaching technologies, how to implement interprofessional education in a sustainable way and how to design teaching interventions using a qualitative understanding of attitudes towards older patients and the teams that care for them.
随着体弱老年患者前往医疗服务机构就诊的比例不断增加，医生接受充分培训以满足其需求的必要性也日益凸显。这类患者的临床表现、基于证据的护理模式以及提供护理所需的技能组合与年轻患者群体不同，因此需要专门培训。一些研究项目采用了详细且明确的方法，以建立基于证据的、经专家验证的课程体系，概述老年医学本科学生的学习成果。目前，对于新获得资格的医生需要了解的内容已达成广泛共识。尽管如此，本科阶段老年医学教学仍存在不足。来自英国、欧盟、美国、加拿大、奥地利和荷兰的国内及国际调查均显示，本科教学在内容和数量上存在缺陷。除了明确课程设置外，改善这种状况的机制还包括发展老年医学学术部门和教授职位、提供资助以发展老年医学教学，以及开发新颖的教学干预措施以充分利用现有资源。在最后一点中，已证明创新可通过以下方式改善教学效果：利用技术确保教学时间和资源的最有效分配；采用跨专业教育以改善对老年患者护理的态度；将教学专门聚焦于对老年患者及其护理人员的态度；以及让患者参与教学。未来的研究领域包括如何激励医学院校提供规定的课程、如何从不断扩展的教学技术中进行选择、如何以可持续的方式实施跨专业教育，以及如何根据对老年患者及其护理团队态度的定性理解来设计教学干预措施。
