Acquiring competencies for elderly care; dealing with complexity.

Results show that residents can be motivated to learn how to provide complex care. It is therefore essential to fine the right balance between stimulating, letting go and coaching. Besides, using authentic problems as basis, asking questions and asking residents to reflect on these problems helps. Teachers and GP-trainers play a key role in this part. GP-trainees also appear to have three leaningstrategies in how to learn to deal with complex elderly care. These strategies are creating, recognizing and using educational moment. All these strategies are not on its own, but interact with each other. GP-trainees use them interchangeably.

A couple of key points have emerged from the research so far: some things require improvement and there are strategies that have proven to be effective in teaching complex elderly care.

1. Improvement: a lot of fragmented education was observed in the curriculum. Unfortunately, few moments were encountered in which these fragments were integraded and discussed. In elderly care it is essential to learn that multiple domains interact with each other. Teaching this complexity can, for instance, be done by unravelling. When the complexity is not unravelled, cases are approached superficial, create no in-depth learning experience, which results in no knowledge expansion. Further contribution to this is the focus on zooming in (looking at isolated aspects of the problem) without zooming out (seeing it as a whole). In zooming out the focus is more on the interactions of these isolated aspects. These interactions make complex elderly care difficult to learn. By skipping zooming out, GP trainees miss integration and the real complexity of the problem. Besides this, it seems that the curriculum and daily practice don’t correspond with each other. During daily practice, specific curriculum exercises are experiences as time consuming and insufficient. It’s unclear to GP-trainees why specific methods for elderly care are benificial. Especialy since GP-trainers don’t use them in their daily- care either It’s inclear to GP-trainees.
2. Learning strategies: for learning complex care for the elderly, residents appear to use 3 different learning strategies. These are: creating, recognizing and using learning moments. In order to learn well, conscious learning moments are necessary. GP-residents create these by establishing a patient flow. They do this by, for example, asking their GP-supervisor or assistants, but also by consciously following up the more complex older person who came to their consultation hours. In order to recognize learning moments, GP-residents often have to be consciously stimulated. Daily practice is so busy that many learning moments pass without noticing it. By setting learning goals and patient goals, GP-residents consciously work with problems and recognize the learning moments sooner. While using learning moments, residents consciously use a patient case to put what they have learned into practice with the aim of further expanding their knowledge and skills.
3. Short and long loops: complex elderly care mainly consists of long loops. However, these long loops also appear to consist of smaller partial loops, short loops, that together form a larger whole within a long loop. Working out and sorting out short loops, problems that are well-defined and easy to look up, takes little time and investment from GP-residents. This makes them easy, motivating and helpful with sub-facets within a complex problem. However, we also know that short loops alone are not enough to master the complexity of elderly care. Long loops in complex care for the elderly require more time and investment from the GOP-residents. Within these long loops, the learning strategies that GP-residents have mastered.