Acquiring competencies for elderly care; dealing with complexity.
General Practitioners (GPs) in training learn in practice (workplace learning) and during return days at the training institute. Elderly care is an important part of the general practitioner medical specialty training. It is complex care because of the multiple problems that elderly people often have, both somatically and in social, psychological and functional areas and the associated polypharmacy. GPs who are able to adequately provide care for the growing population of vulnerable elderly people, will become increasingly necessary in the future. Unfortunately, there is little research available to determine how doctors of the future can be adequately trained to provide such care.
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.
- 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.
- 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.
- 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.
Author: Koetsenruijter, Krista
Magazine: Huisarts & Wetenschap
Author: Koetsenruijter, KWJ. Teunissen, P. Muris, JWM. van Leeuwen, Y. Veldhuijzen, W.
Author: Koetsenruijter, KWJ Veldhuijzen, W. Muris, JWM Teunissen, PW.
Author: Koetsenruijter, KWJ. Veldhuijzen, W.
Author: Koetsenruijter, KWJ.
Author: Koetsenruijter, KWJ. Teunissen, PW. Muris, JWM. Veldhuijzen, W. van Leeuwen, YD.
Author: Koetsenruijter, KWJ Muris, JWM Teunissen, P Veldhuijzen, W van Leeuwen, Y
Author: Koetsenruijter, KWJ. Teunissen, P. Muris, JWM. Veldhuijzen, W. van Leeuwen, YD.
Author: Koetsenruijter, KWJ. Veldhuijzen, W. van Leeuwen, Y. Muris, JWM
Author: Koetsenruijter, KWJ. Muris, JWM. van Leeuwen, Y. Veldhuijzen, W.
Author: Koetsenruijter, KWJ.
Author: Koetsenruijter, KWJ. Veldhuijzen, W. van Leeuwen, Y. Muris, JWM. Teunissen, P.
Author: Koetsenruijter, KWJ
Author: Koetsenruijter, KWJ. Veldhuijzen, W. Muris, JWM. Teunissen, P.
Author: Koetsenruijter, KWJ. van Leeuwen, YD. Veldhuijzen, W. Muris, JWM.
Summary of the application
Ouderenzorg is maatschappijbreed een punt van aandacht, ook voor de huisarts. De complexiteit van de zorg voor kwetsbare ouderen vraagt dat huisartsen proactief werken en samen met de oudere en diens omgeving zinvolle oplossingen zoeken. Hoe leer je dat? Hoe ontwikkel je expertise in complexe patiëntenzorg, waarin de combinatie van problemen, hulpbronnen en wensen steeds anders is en maatwerk vereist?
De huisartsopleidingen in Nederland en Vlaanderen hebben op grond van didactische ervaring allerlei onderwijs ontwikkeld. We bestuderen hun ervaringen met als vragen:
- Hoe bekwamen huisartsen in opleiding zich in complexe patiëntenzorg?
- Via welke mechanismes leren ze van de verschillende onderwijsvarianten?
De manier waarop we onderwijsresultaten meten is ook onderwerp van studie: hoe meet je bekwaamheid in complexe zorg? We analyseren hiervoor consulten van ouderen met huisartsen in opleiding en vragen de laatsten het eigen denken en handelen toe te lichten.