Development of an international undergraduate curriculum for delirium using a modified delphi process

Development of a curriculum for interdisciplinary e-learning on delirium in nursing homes-a modified Delphi study

BACKGROUND

Health care professionals (HCPs) in nursing homes, such as nurses and general practitioners (GPs), indicate a need for delirium-specific education. However, establishing educational interventions in the nursing home setting is challenging. e-learning is one method of compensating for these difficulties. Therefore, this study aims to develop a curriculum for interdisciplinary e-learning to improve delirium-specific knowledge in HCPs in nursing homes.

METHODS

Delirium-specific competencies were formulated on the basis of exploratory setting-independent literature. The competencies were assessed for relevance (very relevant, relevant, less relevant and not relevant) by an expert panel through a two-stage Delphi study that included an integrated workshop. A consensus was assumed if 80% of the experts rated a competence as very relevant or relevant in the first round. Competencies with approval ratings between 75% and 80% after the first round and/or that were critically commented upon were discussed in the subsequent workshop and assessed again in the second round. The competencies that received approval ratings below 75% in the first Delphi round were removed. In the second Delphi round, competencies that did not achieve at least 80% approval were ultimately excluded.

RESULTS

A total of 120 competencies were formulated, including 108 that addressed both disciplines, 4 addressed nurses, and 8 addressed GPs. Nineteen experts participated in the first Delphi round, after which n=92 (76.7%) of the competences were approved and n=18 (15%) were deleted. A total of 10 (8.3%) of the competencies were critically discussed by 10 experts in the subsequent workshop, of which 6 were deleted. Four competencies (3 addressed nurses and 1 GP) were evaluated by 11 experts in the second Delphi, 3 of which were confirmed (the competence addressing GPs was deleted). Overall, n=97 (81.2%) competencies were included in the final curriculum. Of these, n=64 (66%) addressed both disciplines, n=16 (16.5%) addressed nurses, and n=17 (17.5%) addressed GPs.

CONCLUSIONS

Delirium is an interdisciplinary challenge. Hence, the majority of our newly developed competencies address both disciplines. However, discipline-specific competencies must be addressed in the development of e-learning. A competence-based curriculum is a necessary basis for providing interdisciplinary e-learning for HCPs in nursing homes.

Assessing delirium knowledge among health care professionals: findings from a scoping review

BACKGROUND

Delirium is highly prevalent among older adults in various healthcare settings. Healthcare professionals' knowledge is crucial for preventing, recognizing, and managing delirium and delirium-related adverse outcomes. Despite its importance, little is known about how delirium knowledge is assessed.

OBJECTIVES

To map instruments and items used to assess delirium knowledge among healthcare professionals.

DESIGN

A scoping review based on the methodological framework of Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005).

MATERIALS AND METHODS

A systematic literature search was performed in Medline, Embase, CINAHL, Scopus, and PsycINFO to include studies that assessed delirium knowledge among healthcare professionals.

RESULTS

After removing duplicates, 760 studies were assessed for eligibility and 98 studies were included. Delirium knowledge was mainly assessed among nurses (57/98, 58.8%) and physicians (12/98, 12.4%) with a focus on critical care (32/98, 33.0%) over long-term care settings (4/98, 4.1%). Most studies used self-developed instruments (50/93, 53%), followed by original or modified versions of the Delirium Knowledge Questionnaire (14/93, 15%). Among the 32 identified instruments, limited evidence of validity and reliability was reported for six (18.8%). Analysis at the item level (n = 392 items) revealed five domains: (a) definition, signs and symptoms (81 items); (b) risk factors, incidence, and prevention (139 items); (c) detection and tools (89 items); (d) management and therapy (64 items); and (e) outcomes, prognosis and consequences (19 items).

CONCLUSIONS

Delirium poses a significant burden on patients and on the healthcare system. This scoping review provides a comprehensive overview on how healthcare professionals' delirium knowledge has been assessed. Further research in this field is needed to provide stronger evidence of instruments' validity and reliability and to explore delirium knowledge among healthcare professionals in long-term care settings.

Improving the Recognition and Assessment of ICU Delirium

BACKGROUND

Delirium is acute neurological failure that alters cognition and results in a state of confusion and lack of self-awareness. It commonly affects critically ill patients within intensive care units (ICUs), and the wide array of fluctuating symptoms frequently leads to underdiagnosis. Delirium results in cognitive impairment and increased rates of fatality, and accurate assessments are essential for improving patient outcomes. Barriers to delirium assessment stem from a lack of knowledge and assessment training among ICU nurses.

METHOD

Using the Cumulative Index to Nursing and Allied Health Literature electronic database, a literature synthesis was conducted, analyzing journal articles addressing delirium education and training among ICU nurses and barriers associated with assessment.

RESULTS

Current literature identifies methods to overcome barriers through training, education, and continuous reinforcement of delirium assessment. The goals of this review are to identify the barriers to delirium assessment and make recommendations for education methods to increase the confidence of ICU nurses in the recognition of delirium to improve patient outcomes.

CONCLUSION

Early identification of delirium is crucial to improving patient outcomes. A standardized delirium educational program should be developed and implemented throughout the U.S. health care system. [J Contin Educ Nurs. 2024;55(11):530-534.].

A narrative overview of undergraduate geriatric medicine education worldwide

There is a mismatch between the healthcare needs of the ageing population worldwide and the amount of education medical students receive in geriatric medicine. In 2014, Mateos-Nozal et al. published a systematic review of all undergraduate education surveys in geriatric medicine-a decade on, it is timely for an up-to-date overview of the state of undergraduate geriatric medicine education globally. In this review, we outline the international evidence in the field, exploring the results of national and multi-national teaching surveys, and discussing the relative strengths and weaknesses of nationally recommended curricula. We set these findings in the context of ageing population demographics, concluding with recommendations for the future of education and educational research in geriatric medicine, that aims to build capacity in the healthcare workforce and improve quality of care for older people.

Transgender health objectives of training for adult Endocrinology and Metabolism programs: Outcomes of a modified-Delphi study

BACKGROUND

Transgender people encounter significant barriers when seeking timely, high-quality healthcare, resulting in unmet medical needs with increased rates of diabetes, asthma, chronic obstructive pulmonary disease, and HIV. The paucity of postgraduate medical education to invest in standardization of transgender health training sustains these barriers, leaving physicians feeling unprepared and averse to provide transgender health care. Closing this education gap and improving transgender healthcare necessitates the development of consensus-built transgender health objectives of training (THOOT), particularly in Adult Endocrinology and Metabolism Residency programs.

METHODS

We conducted a two-round modified-Delphi process involving a nationally representative panel of experts, including Adult Endocrinology and Metabolism program directors, physician content experts, residents, and transgender community members, to identify THOOT for inclusion in Canadian Endocrinology and Metabolism Residency programs. Participants used a 5-point Likert scale to assess THOOT importance for curricular inclusion, with opportunities for written feedback. Data was collected through Qualtrics and analyzed after each round.

FINDINGS

In the first Delphi round, panelists reviewed and rated 81 literature extracted THOOT, achieving consensus on all objectives. Following panelists' feedback, 5 THOOT were added, 9 removed, 34 consolidated into 12 objectives, and 47 were rephrased or retained. In the second Delphi round, panelists assessed 55 THOOT. Consensus was established for 8 THOOT. Program directors' post-Delphi feedback further consolidated objectives to arrive at 4 THOOT for curriculum inclusion.

CONCLUSIONS

To our knowledge, this is the first time a consensus-based approach has been used to establish THOOT for any subspecialty postgraduate medicine program across Canada or the United States. Our results lay the foundation towards health equity and social justice in transgender health medical education, offering a blueprint for future innovations.

New horizons in undergraduate geriatric medicine education

Current projections show that between 2000 and 2050, increasing proportions of older individuals will be cared for by a smaller number of healthcare workers, which will exacerbate the existing challenges faced by those who support this patient demographic. This review of a collection of Age and Ageing papers on the topic in the past 10 years explores (1) what best practice geriatrics education is and (2) how careers in geriatrics could be made more appealing to improve recruitment and retention. Based on these deeper understandings, we consider, as clinician educators, how to close the gap both pragmatically and theoretically. We point out paradigm shifting solutions that include innovations at the Undergraduate level, use of simulation, incorporation of learner and patient perspectives, upskilling professionals outside of Geriatrics and integration of practice across disciplines through Interprofessional Learning. We also identify an education research methodological gap. Specifically, there is an abundance of simple descriptive or justification studies but few clarification education studies; the latter are essential to develop fresh insights into how Undergraduate students can learn more effectively to meet the needs of the global ageing challenge. A case of improving understanding in delirium education is presented as an illustrative example of a new approach to exploring at greater depth education and outlines suggested directions for the future.

Health care for older adults in Europe: how has it evolved and what are the challenges?

Geriatric medicine has evolved to an accepted specialty in 23 European countries. Despite much heterogeneity of postgraduate geriatric curricula, European societies have succeeded in defining a common core curriculum with a list of minimum training requirements for obtaining the specialty title of geriatric medicine. Geriatricians play a leading role in finding solutions for the challenges of health care of multimorbid older patients. One of these challenges is the demographic shift with the number of adults aged 80 years and older in Europe expected to double by 2050. Although geriatric units will play a role in the care of frail older patients, new care models are needed to integrate the comprehensive geriatric assessment approach for the care of the vast majority of older patients admitted to non-geriatric hospital units. Over the last few years, co-management approaches have been developed to address this gap. Innovative models are also in progress for ambulatory care, prevention and health promotion programs, and long-term care. Efforts to implement geriatric learning objectives in undergraduate training, and the generation of practice guidelines for geriatric syndromes may help to improve the quality of care for older patients.

Teaching delirium to undergraduate medical students: Exploring the effects of a cross‐professional group objective structured clinical examination compared to standard education

OBJECTIVES

To compare a cross-professional facilitated delirium group objective structured clinical examination (GOSCE) educational intervention with standard delirium education for medical students during clinical placement, and explore the differences in the examiner's written feedback between the two groups.

METHODS

A non-randomised clustered controlled designed study at a single metropolitan university across several campuses in Sydney, Australia. A convenience sample of third-year medical students was recruited. Students' knowledge, communication, and clinical reasoning skills were assessed using a delirium case mock OSCE at the end of the academic year. The OSCE marks and the examiner's feedback for the intervention and control group were compared.

RESULTS

The intervention group (n = 41) had a higher total mean OSCE mark compared to the control group (n = 29) (36.5, SD 2.9 vs. 33.7, SD 2.9, p < 0.001). Content analysis of the examiner's feedback showed the intervention group had a greater understanding of the need for forward planning and future cognitive assessments, and the roles of the interdisciplinary team in delirium care.

CONCLUSIONS

The innovative cross-professional facilitated delirium GOSCE education was effective in increasing delirium knowledge, communication, and clinical reasoning skills compared to conventional education for medical students during clinical placement. Further studies are needed to investigate how this is translated into practice.

Development of a list of core clinical topics suitable for a shared primary care curriculum for medical undergraduates in Malaysia: A Delphi study

In the last few decades, primary care medicine (PCM) is increasingly recognised as a cornerstone of an efficient and effective healthcare system. However, the PCM discipline is now facing challenges such as a shortage of doctors. One of the possible reasons could be the lack of comprehensive PCM curricular components in the undergraduate medical programmes. This study aimed to develop a list of core clinical topics suitable to be used as a shared PCM curriculum for undergraduate education in Malaysia. A Delphi survey that consisted of three iterative rounds with feedback was used in this research. The participants included PCM experts involved in the undergraduate level of PCM teaching. These experts were selected based on the criteria developed by two senior academicians in PCM medical education. The final developed list contained 34 core clinical topics that should be incorporated into the undergraduate PCM curriculum. The findings will be useful in establishing the policies and guidelines of PCM education for undergraduates in various medical schools. This study may also promote the field of PCM and encourage more doctors to take up the speciality. Lastly, it provides essential information to address the knowledge gap in PCM education among undergraduate medical students in Malaysia.

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.

Geriatric medicine learning objectives and entrustable professional activities in undergraduate medical curricula: a scoping review

BACKGROUND

entrustable professional activities (EPAs) have become an important component of competency-based medical education. The aim of this study is to evaluate how geriatric medicine learning objectives are addressed by undergraduate medical curricula including EPAs.

METHODS

we performed a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines to identify undergraduate medical curricula that include EPAs. A content analysis was conducted to examine how these curricula address the care of older individuals. In addition, we mapped the curricula to 19 geriatric medicine learning objectives identified from the European curriculum of undergraduate medical education.

RESULTS

we found nine curricula, each containing between 4 and 16 core EPAs. In the sections describing the EPAs, three of the nine curricula specify that all core EPAs apply to all age groups including older patients, whereas the remaining six curricula either only refer to older patients in selected EPAs or not at all. Mapping revealed that some geriatric medicine learning objectives are covered by most curricula (e.g. medication use, multidisciplinary team work), whereas others are lacking in the majority (e.g. normal ageing, geriatric assessment, cognitive assessment, nutrition assessment, decision-making capacity assessment, long-term care). Three curricula cover most geriatric learning objectives by using a matrix aligning EPAs with geriatric competencies.

CONCLUSIONS

geriatric learning objectives continue to be missing from undergraduate medical curricula, also from those adopting the novel approach of EPAs. However, this review also identified some curricula that might serve as models for how geriatric learning objectives can be successfully covered within future EPA frameworks.

Core procedural skills competencies and the maintenance of procedural skills for medical students: a Delphi study

BACKGROUND

It is well recognised that medical students need to acquire certain procedural skills during their medical training, however, agreement on the level and acquisition of competency to be achieved in these skills is under debate. Further, the maintenance of competency of procedural skills across medical curricula is often not considered. The purpose of this study was to identify core procedural skills competencies for Australian medical students and to establish the importance of the maintenance of such skills.

METHODS

A three-round, online Delphi method was used to identify consensus on competencies of procedural skills for graduating medical students in Australia. In Round 1, an initial structured questionnaire was developed using content identified from the literature. Respondents were thirty-six experts representing medical education and multidisciplinary clinicians involved with medical students undertaking procedural skills, invited to rate their agreement on the inclusion of teaching 74 procedural skills and 11 suggested additional procedures. In Round 2, experts re-appraised the importance of 85 skills and rated the importance of maintenance of competency (i.e., Not at all important to Extremely important). In Round 3, experts rated the level of maintenance of competence (i.e., Observer, Novice, Competent, Proficient) in 46 procedures achieving consensus.

RESULTS

Consensus, defined as > 80% agreement, was established with 46 procedural skills across ten categories: cardiovascular, diagnostic/measurement, gastrointestinal, injections/intravenous, ophthalmic/ENT, respiratory, surgical, trauma, women's health and urogenital procedures. The procedural skills that established consensus with the highest level of agreement included cardiopulmonary resuscitation, airway management, asepsis and surgical scrub, gown and gloving. The importance for medical students to demonstrate maintenance of competency in all procedural skills was assessed on the 6-point Likert scale with a mean of 5.03.

CONCLUSIONS

The findings from the Delphi study provide critical information about procedural skills for the Clinical Practice domain of Australian medical curricula. The inclusion of experts from medical faculty and clinicians enabled opportunities to capture a range of experience independent of medical speciality. These findings demonstrate the importance of maintenance of competency of procedural skills and provides the groundwork for further investigations into monitoring medical students' skills prior to graduation.

A delirium prevalence audit and a pre and post evaluation of an interprofessional education intervention to increase staff knowledge about delirium in older adults

Background

Delirium is more prevalent in older people and estimated to occur in up to 50% of the hospital population. Delirium comprises a spectrum of behaviours, including cognitive and attention deficits, and fluctuating levels of consciousness, often associated with an underlying physiological disturbance. Delirium has been increasingly associated with adverse outcomes. Although often preventable or can at least be mitigated, delirium may not be a standard part of assessment and thus may not be recognized in the early stages when it is most likely to be treated successfully. The aim of this study was to evaluate the level of knowledge of delirium amongst clinicians caring for patients at high risk of developing delirium and to determine whether education can improve clinical assessment of delirium.

Methods

Two hundred and forty-six case notes were audited before and 149 were reviewed after the education intervention and implementation of a delirium screening tool. Clinicians at the hospital were invited to complete a questionnaire on knowledge of delirium. The questionnaire was based on a validated tool which contained 39 questions about delirium. The questionnaire also contained 28 questions on delirium knowledge. Additional questions were included to gather demographic information specific to the hospital. Descriptive statistics, chi square and independent t-tests were conducted to test for differences in knowledge between the pre and post periods. The Squire Checklist Reporting Guidelines for Quality Improvement Studies informed the preparation of the manuscript.

Results

The audit demonstrated that the use of a cognitive assessment tool overall increased from 8.5% in pre education to 43% in the post education period. One hundred and fifty-nine staff completed the questionnaire in total, 118 the pre and 41 post. The knowledge subscale score was high pre and post education and no statistically significant difference was observed. The greatest increase in knowledge was related to knowledge of the risk factors subscale. The increase in knowledge (6.8%) was statistically significant.

Conclusion

An interprofessional approach to delirium education was effective in not only increasing awareness of the factors associated with this syndrome but also increased the use of a delirium assessment tool.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00692-2.

Motivations for and Challenges in the Development of Global Medical Curricula: A Scoping Review

PURPOSE

The aim of this scoping review is to understand the motivations for the creation of global medical curricula, summarize methods that have been used to create these curricula, and understand the perceived premises for the creation of these curricula.

METHOD

In 2018, the authors used a comprehensive search strategy to identify papers on existing efforts to create global medical curricula published from 1998 to March 29, 2018, in the following databases: MEDLINE; MEDLINE Epub Ahead of Print, In-Process, and Other Non-Indexed Citations; Embase; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; PsycINFO; CINAHL; ERIC; Scopus; African Index Medicus; and LILACS. There were no language restrictions. Two independent researchers applied the inclusion and exclusion criteria. Demographic data were abstracted from publications and summarized. The stated purposes, methods used for the development, stated motivations, and reported challenges of curricula were coded.

RESULTS

Of the 18,684 publications initially identified, 137 met inclusion criteria. The most common stated purposes for creating curricula were to define speciality-specific standards (50, 30%), to harmonize training standards (38, 23%), and to improve the quality or safety of training (31, 19%). The most common challenges were intercountry variation (including differences in health care systems, the operationalization of medical training, and sociocultural differences; 27, 20%), curricular implementation (20, 15%), and the need for a multistakeholder approach (6, 4%). Most curricula were developed by a social group (e.g., committee; 30, 45%) or Delphi or modified Delphi process (22, 33%).

CONCLUSIONS

The challenges of intercountry variation, the need for a multistakeholder approach, and curricular implementation need to be considered if concerns about curricular relevance are to be addressed. These challenges undoubtedly impact the uptake of global medical curricula and can only be addressed by explicit efforts to make curricula applicable to the realities of diverse health care settings.

Delirium in Emergency Departments: Is it Recognized?

BACKGROUND

Delirium is a complex neurocognitive manifestation of an underlying medical or surgical abnormality such as substance abuse, infection, sepsis, or organ failure. A recognized risk factor for delirium is advanced age (age >65 years). The projected demographic changes over the next 2 decades suggest that the number of aging adults will grow dramatically, and emergency nurses will see an increasing number of older patients manifesting the wide range of neuropsychiatric symptoms associated with delirium.

METHOD

An examination of 5 commonly used delirium assessment tools was undertaken specific to clinical features, use, scoring, findings, advantages, and disadvantages.

FINDINGS

Numerous factors contribute to the lack of effective delirium recognition. However, emergency nurses, with educational support, can successfully use the delirium assessment tools to recognize delirium.

CONCLUSION

Emergency nurses face challenges in recognizing delirium. One key challenge for many of these nurses is the appropriate use of assessment tools suitable for the ED setting.

Optimizing outcomes for patients with metastatic prostate cancer: insights from South East Asia Expert Panel

AIMS

Clinical decision making is challenging in men with metastatic prostate cancer (mPC), as heterogeneity in treatment options and patient characteristics have resulted in multiple scenarios with little or no evidence. The South East Asia Expert Panel 2019 addressed some of these challenges.

METHODS

Based on evidence in the literature and expert interviews, 19 statements were formulated for key challenges in the treatment of men with castration-sensitive and -resistant prostate cancer in clinical practice. A modified Delphi process was used to reach consensus among experts in the panel and develop clinical practice recommendations.

RESULTS

The majority of the panel preferred a risk-based stratification and recommended abiraterone or enzalutamide as first-line therapy for symptomatic chemotherapy naïve patients. Abiraterone is preferred over enzalutamide as a first-line treatment in these patients. However, the panel did not support the use of abiraterone in high risk lymph-node positive only (N+M0) or in non-metastatic (N0M0) patients. In select patients, low dose abiraterone with food may be used to optimize clinical outcomes. Androgen receptor gene splice variant status may be a useful guide to therapy. In addition, generic versions of approved therapies may improve access to treatment to a broader patient population. The choice of treatment, as well as sequencing are guided by both patient and disease characteristics, preferences, drug access, cost, and compliance.

CONCLUSION

Expert recommendations are key to guidance for the optimal management of mPC. Appropriate choice, timing, and sequence of treatment options can help to tailor therapy to maximize outcomes in men with mPC.

Evaluation of a delirium awareness podcast for undergraduate nursing students in Northern Ireland: a pre-/post-test study

BACKGROUND

Delirium is a common disorder affecting several people in primary, secondary, and tertiary settings. The condition is frequently under-diagnosed leading to long-lasting physical and cognitive impairment or premature death. Despite this, there has been limited research on the impact of innovative approaches to delirium education amongst undergraduate nursing students. The aim of this study was to evaluate the effect of a delirium awareness podcast on undergraduate nursing student knowledge and confidence related to the condition in Northern Ireland.

METHODS

The intervention was a 60-min delirium awareness podcast, available throughout May 2020, to a convenience sample of year one undergraduate nursing students (n = 320) completing a BSc Honours Nursing degree programme in a Northern Ireland University. The podcast focused on how nursing students could effectively recognise, manage, and prevent delirium. Participants had a period of 4 weeks to listen to the podcast and complete the pre and post questionnaires. The questionnaires were comprised of a 35-item true-false Delirium Knowledge Questionnaire (DKQ), a 3-item questionnaire about professional confidence and a 7-item questionnaire evaluating the use of podcasting as an approach to promote knowledge and confidence about delirium. Data were analysed using paired t-tests and descriptive statistics.

RESULTS

Students improved across all three core areas in the post-test questionnaire, demonstrating improvements in knowledge about symptoms of delirium (7.78% increase), causes and risk factors of delirium (13.34% increase) and management of delirium (12.81% increase). In relation to perceived confidence, students reported a 46.50% increase in confidence related to recognition of delirium, a 48.32% increase in relation to delirium management and a 50.71% increase their ability to communicate about delirium. Both questionnaires were statistically significant (P < 0.001). The final questionnaire illustrated that nursing students positively evaluated the use of podcast for promoting their knowledge and confidence about delirium and 96.32% of nursing students believed that the podcast met their learning needs about delirium.

CONCLUSIONS

A 60-min podcast on delirium improved first year student nurse knowledge about delirium. Nursing students also expressed that this approach to delirium education was effective in their learning about the condition.

The influence of a serious game's narrative on students' attitudes and learning experiences regarding delirium: an interview study

BACKGROUND

Delirium is a neuropsychiatric syndrome that affects patients' attention and awareness as a result of a physical condition. In recent years, persistent gaps in delirium education have led to suboptimal delirium care. Still, little is known about what are the most important aspects of effective delirium education. Serious games are both entertainment and an interactive, safe learning environment where players can experiment and create new knowledge. They have the potential to contribute to improved delirium education. We used a video-based serious games' narrative to explore aspects essential to enhance students' attitudes and learning experiences regarding delirium.

METHODS

We created a semi-structured interview guide and interviewed seven nursing and nine medical students about their attitudes and learning experiences, after they had played the game. A qualitative descriptive design and inductive content analysis with constant comparison were used.

RESULTS

The patient's and nurse's perspective, interactivity to experiment, realistic views on care options, and feedback on care actions were important for enhancing students' attitudes and learning experiences regarding delirium. Students felt these aspects encouraged them to get actively involved in and experiment with the study material, which in turn led to enhanced reflection on delirium care and education. Our findings highlight the importance of a more patient-oriented focus to delirium education to drive attitudinal change. Students' learning experiences were further enhanced through their affective responses provoked by the perspectives, interactivity, realism, and feedback.

CONCLUSIONS

Students considered the characters' perspectives, interactivity, realism, and feedback important aspects of the game to enhance their attitudes towards delirious patients and enrich their learning experiences. A patient-oriented narrative provides a clinically relevant experience in which reflection plays an important role. The serious game also serves as medium to actively experiment with care solutions to create better understanding of how healthcare professionals can influence a delirious patient's experience.

A curriculum for behaviour and oral healthcare management for dentally anxious children-Recommendations from the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE)

BACKGROUND

Dentists need training in the management of children's anxiety (DA), fear (DF) and behaviour management problems (DBMP) but little is known of their competence on this topic.

AIM

To report dentists' opinions and attitudes about protective stabilisation and pharmacological techniques for the management of children with DA/DF/DBMP; to propose a postgraduate curriculum focussing on DA/DF/DBMP.

DESIGN

A survey of 301 Brazilian dentists and later a modified Delphi process to outline the curriculum in two phases: (a) face-to-face discussions with 33 early career researchers mentored by six researchers, both from UK and Brazil; (b) online discussions by eight early and senior researchers on the knowledge, experience, and competencies necessary for a specialist in paediatric dentistry in Brazil that should be included in the core curriculum of postgraduate courses.

RESULTS

Almost all (99.0%) of the survey respondents provide treatment to children with DA/DF/DBMP, and 91.2% do not systematically diagnose these conditions; 94.3% use protective stabilisation, and 20.0%-30.0% have training in pharmacological techniques. The four-domain framework supporting the proposed curriculum is as follows: DA/DF/DBMP assessment, non-pharmacological and pharmacological approaches, and decision-making.

CONCLUSION

Dental curricula should be customised to solve the misconceptions and promote a comprehensive and positive attitude to DA/DF/DBMP by paediatric oral healthcare practitioners.

Evaluation of a co-produced delirium awareness programme for undergraduate nursing students in Northern Ireland: a pre-test/post-test study

BACKGROUND

Delirium is recognised internationally as a common disorder that causes acute deterioration in a person's cognitive abilities. Healthcare professionals play a key role in the early identification and management of delirium and effective education can support timely recognition and treatment. There is currently a lack of research exploring the delirium education provided to undergraduate nursing students. The aim of this study was to evaluate the effectiveness of a co-produced delirium awareness programme on undergraduate nursing students in Northern Ireland.

METHODS

The intervention was a 2-h delirium workshop, delivered in April 2019, to a convenience sample of year one undergraduate nursing students (n = 206) completing a BSc Honours Nursing degree programme in a Northern Ireland University. The workshop focused on four core elements: defining delirium, reflecting on practice, recognition of delirium and management of delirium. Participants completed a 35-item true-false Delirium Knowledge Questionnaire (DKQ) at baseline and post intervention using Socrative, a cloud-based student response system. In addition, students also completed a short questionnaire at baseline and post-workshop, designed by the authors, to ascertain perceived confidence about caring for people with delirium. Data were analysed using paired t-tests and descriptive statistics.

RESULTS

In the DKQ, Scores were normally distributed around the mean at baseline (71.89%) and post intervention (81.89%). Students improved across all three core areas in the post-test questionnaire, demonstrating improvements in knowledge about symptoms of delirium (7.32% increase), causes and risk factors of delirium (17.91% increase) and management of delirium (5.72% increase). In relation to perceived confidence, students reported a 60.20% increase in confidence related to recognition of delirium, a 49.51% increase in relation to delirium management and a 45.04% increase their ability to communicate about delirium. Both questionnaires were statistically significant (P < 0.01).

CONCLUSIONS

A 2-h workshop on delirium improved first year student nurse knowledge about delirium. Nursing students expressed that this approach to delirium education enabled collective thinking about how knowledge could be transferred into individual practises. Students also stated that learning incorporating the voice of the person who has experienced delirium, was an effective and powerful way to deliver education.

An interdisciplinary statement of scientific societies for the advancement of delirium care across Europe (EDA, EANS, EUGMS, COTEC, IPTOP/WCPT)

BACKGROUND

Delirium is a geriatric syndrome that presents in 1 out of 5 hospitalized older patients. It is also common in the community, in hospices, and in nursing homes. Delirium prevalence varies according to clinical setting, with rates of under 5% in minor elective surgery but up to 80% in intensive care unit patients. Delirium has severe adverse consequences, but despite this and its high prevalence, it remains undetected in the majority of cases. Optimal delirium care requires an interdisciplinary, multi-dimensional diagnostic and therapeutic approach involving doctors, nurses, physiotherapists, and occupational therapists. However, there are still important gaps in the knowledge and management of this syndrome.

MAIN BODY

The objective of this paper is to promote the interdisciplinary approach in the prevention and management of delirium as endorsed by a delirium society (European Delirium Association, EDA), a geriatrics society (European Geriatric Medicine Society, EuGMS), a nursing society (European Academy of Nursing Science, EANS), an occupational therapy society (Council of Occupational Therapists for European Countries, COTEC), and a physiotherapy society (International Association of Physical Therapists working with Older People of the World Confederation for Physical Therapy, IPTOP/WCPT).

SHORT CONCLUSION

In this paper we have strongly promoted and supported interdisciplinary collaboration underlying the necessity of increasing communication among scientific societies. We have also provided suggestions on how to fill the current gaps via improvements in undergraduate and postgraduate delirium education among European Countries.

Delirium research, education and practice

Delirium research and clinical care have seen great strides in the last decade. Age and Ageing is making freely available an online collection of 15 papers published since 2012 which provides an overview of the range of research in delirium. It covers prevention and prediction, interventions and their health economic evaluations, outcomes following delirium, and clinical application in a review of the recent SIGN guidelines. The majority of studies took place in hospitals, but we also introduce some important research about another group at high risk of delirium: care home residents. We highlight the importance of delirium education. The studies comprised a range of methodologies (systematic reviews/meta-analysis, observational studies, trials and qualitative research). The selected papers are exemplars of work that has clear clinical implications. Given that delirium affects 15-20% of hospital patients, studies or analysis of existing data with clinical relevance have the potential for enormous impact on practice and on more efficient use of healthcare resources. There is, however, still a great deal of work to be done to implement what is known to be effective, and so reduce the incidence of this distressing condition, and to support those affected: not only patients, but also families and carers, as well as staff in secondary and primary care, including care homes.

Do we need a core curriculum for medical students? A scoping review

OBJECTIVE

The General Medical Council (GMC) recommends medical schools to develop and implement curricula enabling students to achieve the required learning outcomes. UK medical schools follow the GMC's Outcomes for graduates, which are generic. GMC plans to introduce a national Medical Licensing Assessment (MLA) for the medical graduates wanting to practise medicine in the UK in 2022. With no standardised or unified undergraduate (UG) curriculum in UK, various specialties have expressed concerns about not being represented in medical schools and developed specialty-specific core curricula. The aim of this review was to identify learned bodies who have developed a core curriculum for UK medical schools and highlight the drivers, gaps and future approaches to curricular development and implementation.

METHODS

A literature search was conducted using online databases (EMBASE, MEDLINE, ERIC, HMIC, PubMed and CDSR), search engines and related websites (Google and Google Scholar, Department of Health, GMC and BMA) for relevant articles from 1996 to 5 March 2019 (~20 years). A methodological framework to map the key concepts of UG medical curriculum was followed. Any relevant body with a core curriculum for UK medical UGs was included.

RESULTS

A total of 1283 articles were analysed with 31 articles included in the qualitative synthesis, comprising 26 specialties (clinical n=18, foundation subjects n=4 and professionalism related n=4). WHO, European and national (eg, Royal Colleges of UK) specialty bodies provided specific core learning outcomes for the medical graduates. Patient safety, disease burden, needs of society and inadequate preparedness of medical graduates were drivers for the development of these curricula.

CONCLUSIONS

This is the first comprehensive review of literature on UG core curricula recommending minimum standards on knowledge and skills, in alignment with GMC's Outcomes for graduates for all the UK medical students. Adopting and assessing unified standards would help reduce variability across UK medical schools for both generic and specialty-specific competencies.

Developing a National Competency-Based Diabetes Curriculum in Undergraduate Medical Education: A Delphi Study

OBJECTIVES

In recent years there has been an increased emphasis on competency-based medical education (CBME) in Canada and internationally, as can be seen with the implementation of competency-based curriculums for postgraduate medical education (PGME) through the Royal College of Physicians and Surgeons of Canada. Currently, no Canada-wide consensus exists on educational competencies relating to diabetes in undergraduate medical education (UGME). Our aim in this study was to develop a list of competencies and objectives for UGME in diabetes using a modified Delphi method.

METHODS

Representatives involved in the development of the diabetes curriculum at all 17 medical schools across Canada were contacted. A draft list of competencies and objectives was developed by the research team using the existing curriculums at 9 Canadian medical schools and was organized using the CanMEDS framework. A Delphi method was used, with 2 iterations in order to reach consensus.

RESULTS

Twelve of 17 medical schools agreed to participate. Of the 12 surveys sent in the first round, 8 responses were received (response rate 66.7%). The revised version was then resent to the 8 respondents and 7 responses were received (response rate 87.5%). A list of 9 competencies and 62 objectives was finalized.

CONCLUSIONS

A competency-based consensus curriculum for diabetes education for undergraduate medical students was developed using a modified Delphi method. The final consensus syllabus will be disseminated across the country. This curriculum serves as a step in the transition to competency-based UGME and in ensuring that future medical school graduates are proficient in diabetes care.