A scoping review of the changing landscape of geriatric medicine in undergraduate medical education: curricula, topics and teaching methods

Purpose The world’s population is ageing. Therefore, every doctor should receive geriatric medicine training during their undergraduate education. This review aims to summarise recent developments in geriatric medicine that will potentially inform developments and updating of undergraduate medical curricula for geriatric content. Methods We systematically searched the electronic databases Ovid Medline, Ovid Embase and Pubmed, from 1st January 2009 to 18th May 2021. We included studies related to (1) undergraduate medical students and (2) geriatric medicine or ageing or older adults and (3) curriculum or curriculum topics or learning objectives or competencies or teaching methods or students’ attitudes and (4) published in a scientific journal. No language restrictions were applied. Results We identified 2503 records and assessed the full texts of 393 records for eligibility with 367 records included in the thematic analysis. Six major themes emerged: curriculum, topics, teaching methods, teaching settings, medical students’ skills and medical students’ attitudes. New curricula focussed on minimum Geriatrics Competencies, Geriatric Psychiatry and Comprehensive Geriatric Assessment; vertical integration of Geriatric Medicine into the curriculum has been advocated. Emerging or evolving topics included delirium, pharmacotherapeutics, healthy ageing and health promotion, and Telemedicine. Teaching methods emphasised interprofessional education, senior mentor programmes and intergenerational contact, student journaling and reflective writing, simulation, clinical placements and e-learning. Nursing homes featured among new teaching settings. Communication skills, empathy and professionalism were highlighted as essential skills for interacting with older adults. Conclusion We recommend that future undergraduate medical curricula in Geriatric Medicine should take into account recent developments described in this paper. In addition to including newly emerged topics and advances in existing topics, different teaching settings and methods should also be considered. Employing vertical integration throughout the undergraduate course can usefully supplement learning achieved in a dedicated Geriatric Medicine undergraduate course. Interprofessional education can improve understanding of the roles of other professionals and improve team-working skills. A focus on improving communication skills and empathy should particularly enable better interaction with older patients. Embedding expected levels of Geriatric competencies should ensure that medical students have acquired the skills necessary to effectively treat older patients.

MERIA – Conflict Lines: Experience with Two Innovative Teaching Materials

The design of inquiry-based tasks and problem situations for daily mathematics teaching is still a challenge. In this article, we study the implementation of two tasks as part of didactic scenarios for inquiry-based mathematics teaching, examining teachers’ classroom orchestration supported by these scenarios. The context of the study is the Erasmus+ project MERIA – Mathematics Education: Relevant, Interesting and Applicable, which aims to encourage learning activities that are meaningful and inspiring for students by promoting the reinvention of target mathematical concepts. As innovative teaching materials for mathematics education in secondary schools, MERIA scenarios cover specific curriculum topics and were created based on two well-founded theories in mathematics education: realistic mathematics education and the theory of didactical situations. With the common name Conflict Lines (Conflict Lines – Introduction and Conflict Set – Parabola), the scenarios aim to support students’ inquiry about sets in the plane that are equidistant from given geometrical figures: a perpendicular bisector as a line equidistant from two points, and a parabola as a curve equidistant from a point and a line. We examine the results from field trials in the classroom regarding students’ formulation and validation of the new knowledge, and we describe the rich situations teachers may face that encourage them to proceed by building on students’ work. This is a crucial and creative moment for the teacher, creating opportunities and moving between students’ discoveries and the intended target knowledge.

879 Establishing the First Eoe Deanery-Wide Trainee Led Virtual Journal Club: Keeping Up Morale by Encouraging Trainee Interaction and Continuous Professional Development During the Hiatus to Teaching Activities Enforced by Coronavirus

Introduction Over the initial COVID months and with the cancellation of several teaching programs / courses/ conferences; we identified a NEED for trainee interaction and continuous professional development, despite staff redeployments. We since established a deanery-wide trainee led VIRTUAL journal club, run by the Surgical Trainees of East of England Research collaborative (STEER) group. Method Following decision in May2020, the STEER group collated curriculum topics and related landmark papers, drafting a programmed-schedule for sessions (45mins – 1hour). CPD accreditation was sought and received from RCSEd prior to some sessions. Sessions were delivered using the Microsoft Teams app (via desktop/tablet/phone). Targeted audience included FYs, CTs, STs, JCFs, SCFs (candidates preparing for MRCS/FRCS or interested in academia). Live polling / feedback forms and attendance certificates were distributed. Results Six journal club sessions have been run to-date. A minimum of 15-20 participants attended each session with spread of junior/senior trainees. Sessions were video recorded for repeat playback for those unable to attend. Feedback was overwhelmingly positive, with good engagement from participants. Conclusions A deanery wide virtual journal club was positively received by trainees and benefits included: critique and dissemination of evidence (especially recently with COVID-related literature), trainee interaction and keeping up-to-date and understanding and analysing information.

Liver disorders

This chapter covers core curriculum topics relating to liver disorders including the anatomy, physiology, and biochemistry of the liver as it relates to disease processes. There is a focus on the investigation and management of acute hepatitis including viral, drug- and toxin-induced, and the risk stratification of patients with acute liver failure. All major chronic liver diseases are discussed including non-alcoholic fatty liver disease, autoimmune liver disease, alcohol related liver disease and chronic viral hepatitis. There is also education on managing the complications of cirrhosis including renal dysfunction, hepatic encephalopathy, variceal haemorrhage, and spontaneous bacterial peritonitis. Additional important topics covered include nutrition in liver disease, hepatocellular carcinoma, liver transplantation indications and assessment, and complications following liver transplantation. Additional curriculum material regarding liver disorders will also be covered in the mock examination chapter.

Oesophageal disorders

This chapter covers core curriculum topics relating to disorders of the oesophagus. A diagnostic and therapeutic approach to symptoms of gastro-oesophageal reflux disease is covered including physiology testing and the role of anti-reflux surgery. Other benign conditions causing dysphagia and chest pain are presented incorporating disorders of motility, infections, and the management of eosinophilic oesophagitis and oesophageal stricturing. Coverage is given to the investigation and management of patients with foreign body or caustic substance ingestions. There is particular focus on the investigation and management of oesophageal malignancy including in palliative stages, along with the various stages of Barret’s oesophagus. This includes diagnostic features, surveillance intervals and management of dysplasia associated with Barrett’s. Additional curriculum material regarding disorders of the oesophagus will also be covered in the mock examination chapter.

Gastrointestinal haemorrhage

This chapter covers core curriculum topics relating to gastrointestinal haemorrhage. This includes risk assessment for upper gastrointestinal haemorrhage incorporating natural history and prediction of rebleed following peptic ulcer bleeding. Comprehensive coverage of assessment and management of variceal bleeding (gastric and oesophageal) is included including the role of stenting. Causes of presentations with lower gastrointestinal bleeding, including following radiotherapy, are presented along with guidance on assessing shock index, investigation and management strategies. The role of acute imaging versus endoscopic intervention is discussed. Furthermore, investigation and management of obscure and occult gastrointestinal bleeding is covered including small bowel endoscopy and specialist imaging. Additional curriculum material regarding gastrointestinal haemorrhage will also be covered in the mock examination chapter.

Nutrition

This chapter covers core curriculum topics relating to nutrition including assessment of nutritional risk. Specific micronutrient deficiencies are largely covered in the ‘Small Intestine’ chapter but, where appropriate, additional information is provided in this chapter. Decision making about enteral feeding routes and complications of longer-term feeding tubes such as percutaneous endoscopic gastrostomies, and their management, is discussed. Key aspects of intestinal failure requiring parenteral nutrition, including short bowel syndrome, are presented including management of types 2 and 3 intestinal failure. Education is provided on electrolyte content of key intravenous fluids. Coverage of bariatric surgical techniques and their complications round off this chapter. Additional curriculum material regarding nutrition will also be covered in the mock examination chapter.

Inflammatory bowel disease and colonic disorders

This chapter covers core curriculum topics relating to inflammatory bowel disease (IBD) and colonic disorders. A diagnostic approach to IBD is covered including the role of imaging, endoscopy, histopathology and clinical features. Pathophysiology and epidemiology of IBD is detailed. Management of Ulcerative colitis and Crohn’s disease includes assessment of disease severity, imaging modalities and therapeutic management. Particular focus is given to therapeutic drug monitoring and indications for biologic therapies. Surgical management of IBD is broadly covered including indications, timing and approach. Coverage is also given to the diagnosis and management of extra-intestinal manifestations of IBD, IBD in special situations (pregnancy, elderly, transition) and the prevention of cancer in IBD. Colorectal cancer and benign conditions including constipation, functional gut disorders and other colitides are also featured.

Stomach and duodenal disorders

This chapter covers core curriculum topics relating to benign and malignant conditions of the stomach and duodenum. Particular focus is given to the diagnostic approach to and therapeutic management of Helicobacter pylori infection and peptic ulcer disease. Other benign conditions covered include gastroparesis and duodenal adenomas, namely the investigation and management thereof. Attention is given to the identification of and management of GISTs, pre-malignant gastric lesions, gastric dysplasia and gastric polyps. Also importantly covered are the epidemiology, presentation, investigation and treatment of gastric adenocarcinoma. Finally, a selection of questions covers the rare presentations of neuroendocrine tumours, Ménétrier’s disease and Zollinger-Ellison syndrome.

Pancreatic disorders

This chapter covers core curriculum topics relating to pancreatic disorders. This includes the investigation and management of acute pancreatitis incorporating knowledge on aetiology, staging of acute pancreatitis, complications including pseudocyst and walled off necrosis, nutritional support, and role of imaging and endoscopy. The chapter also covers genetic pancreatic disorders, anatomical variants of the pancreas, and describes the different cell types of the pancreas. These is also an emphasis on the aetiology and complications of chronic pancreatitis including pancreatic exocrine insufficiency and chronic pain. Finally the chapter also covers the presentation, diagnosis and management of benign and malignant pancreatic tumours. Additional curriculum material regarding pancreatic disorders will also be covered in the mock examination chapter.