Overview
It s indicated in the literature that the fundamental objective of hospital education is to enhance practice through learning (Hotvedt & Laskowski, 2002) and that a commitment to lifelong learning, also referred to as continuing medical education (CME), is not only a physician’s duty but also an ethical obligation and an integral component of professionalism (Fletcher, 2001). In this context, the current paper assesses how physicians within a Geriatrics Department in a Level I health facility are committed to the concept of CME, with the view to developing a more complete appreciation of education and research in healthcare settings.
Area of Education & Research
The department of veterans health affairs in this health facility was established after the realization that the number of the elderly people in the United States was beginning to surge, yet the available practicing internists and family physicians lacked familiarity with much of the evidence-based knowledge about the medical and functional problems of the older adults and their management (Thomas et al., 2006). From its establishment, therefore, the major objectives of this department have been to educate primary physicians on the processes involved in delivering care to older adults, contribute to the advancement of aging research through undertaking numerous medical studies that are done collaboratively with the institution’s affiliated university schools of medicine, and also to provide leadership in educating healthcare providers about the special needs of older persons (Supiano et al., 2012).
Managed by a program coordinator, the department of veterans’ health affairs draws its members from the internists, general family physicians, geriatrics researchers and teachers at the affiliated university schools of medicine, as well as medical professionals and administrators manning homes for the elderly. It supports other departments and facilities (e.g., clinical care, gerontology, geriatrics, counseling, home services care and also homes for the elderly) by providing evidence-based practices on the treatment of the elderly, acting as an incubator of translational research in aging, as well as developing and evaluating innovative clinical demonstration projects to improve the clinical care of older adults (Supiano et al., 2012). Conversely, the department of veterans’ health affairs is supported by other departments in terms of collecting data on the factors that seem to hamper the elderly from leading a healthy life, including psychological, medical and social challenges (Arai et al., 2012). These data are of immense importance in designing and undertaking baseline descriptive as well as experimental research studies geared toward the promotion of health among the elderly.
Trends
One of the foremost trends in geriatrics education and research is grounded on the regulatory framework of reimbursing the financial investments made by family physicians toward their continuing medical education (CME). Available literature demonstrates that “even if practitioners increase their knowledge in geriatrics, the current procedure-weighted reimbursement structure may punish them financially for incorporating geriatrics activities into their practices” (Thomas et al., 2006 p.1610).
The other trend affecting the setting discussed is demographic shifts among the population. A strand of existing literature demonstrates that although older people are living longer than was the case before due to recent medical advancements and improvements in hygiene and food supply (Arai et al., 2012), geriatrics education and research remain a low priority for graduate medical students and other healthcare professionals (Litvin et al., 2012).
Impact of the Trends
The impact of the reimbursement issue is generally felt in terms of community-based and general practitioners finding it increasingly difficult to enhance their expertise and toolkits of geriatrics skills due to the overwhelming barriers related to funding (Thomas et al., 2006). As acknowledged by the authors, “these practitioners are under increasing financial pressure to see more patients and to spend less per patient…Consequently, they have little time to read educational materials or attend local courses – much less those that require travel” (p. 1610). Overall, therefore, it is clear that health institutions may experience deficits in qualified professionals to take care of the needs of the elderly if this trend is allowed to persist.
The demographic trend has far-reaching ramifications on education and research in healthcare. As high life expectancies continue to be experienced in most developed nations and older people continue to live much longer, it is expected that more diseases affecting them will surface, together with novel geriatric syndromes with multiple etiologies (Arai et al., 2012). Physical, psychological, social, and medical conditions involving the elderly, such as dementia, depression, falls and urinary incontinence, are bound to increase in the coming days, suggesting a need for continuous medical education (CME) and research aimed at developing novel evidence-based practices and treatment protocols to contain these conditions (Bragg et al., 2012). In equal measure, an expanding population of the elderly in the society is indicative of a bigger problem in terms of developing strategies aimed at promoting home-based and multidisciplinary care for this group of the population (Arai et al., 2012), hence the need for continuous education and research in this setting.
Capitalizing on the Trends
It is common knowledge that the regulatory challenge of financial reimbursements to primary physicians who use their financial resources for education and research may discourage many healthcare professionals from undertaking these noble activities. As a healthcare administrator in this department, therefore, it would be prudent to devise and implement “continuing medical education (CME) programs that are highly accessible to practicing physicians, will have an immediate and significant effect on practitioners’ knowledge and actions, and are financially viable” (Thomas et al., 2006 p. 1610).
To specifically reduce the financial barriers brought about by the challenges in reimbursement, it would also be appropriate to implement a knowledge translation program for geriatrics education and research known as active-mode learning, which “relies on integrative, targeted, and multifaceted techniques” (Thomas et al., 2006 p. 1610). Such a program, in my view, will assist more medical residents, associated healthcare trainees, physicians, and other professionals to pursue geriatric specialization, hence develop their capacity to provide healthcare to the elderly.
Additionally, owing to the ever-decreasing budgetary allocations for geriatrics education and training, it would be plausible to devote effort towards continuing medical education (CME) of the multidisciplinary workforces involved in providing care to the elderly in terms of national and regional conferences, seminars, symposia, grand rounds, teaching conferences, journal clubs, print, and electronic media, needs-based outreach programs as well as community-based outpatient clinics (Bragg et al., 2012; Supiano et al., 2012).
The trend of expanding population of the elderly in the society reinforces the need for promotion of home-based care and multidisciplinary care, with the view to reducing the length of stay of older patients in acute health facilities, minimizing the physical burden of healthcare professionals working in these facilities, and also meeting the demand of older people who often prefer to remain in their own homes (Arai et al., 2012). Additionally, as a healthcare administrator in such a setting, it would be plausible to introduce novel methods (e.g., electronic medical registers and clinical decision-support tools) into geriatric education and research programs with the view to improving patient treatment outcomes while also serving as potential educational tools that provide context-specific learning (Litvin et al., 2012).
Two Most Salient Trends Impacting Education & Research
Trend A
Identification: Regulatory issues in reimbursement, leading to budgetary constraints. Available literature demonstrates that fewer physicians and other healthcare professionals consider expanding their education and skills in geriatrics owing to a lack of adequate reimbursement on the investments in education. It is also common knowledge that geriatrics research programs in hospitals and universities are greatly underfunded (Thomas et al., 2006).
Impact: The impact of this trend is generally felt in lack of skills and expertise needed to provide adequate healthcare to the ever-increasing population of older people (Thomas et al., 2006), as well as lack of adequate research studies that could be used to generate evidence-based practices in the treatment of the elderly (Supiano et al., 2012)
Trend B
Identification: Loss of money in research-intensive institutions as demonstrated in the reading. It has been demonstrated in the literature that over 14 of the 20 most research-intensive institutions in the United States are currently experiencing financial stress due to loss of money and continually decreasing profit margins (Academic Medical Centers, 2000).
Impact: A key impact of this trend relates to the fact that medical schools in the United States and elsewhere are now selling their hospitals and research facilities to either for- or non-profit entities as witnessed by the sale of Georgetown University Medical Center and Tulane (Academic Medical Centers, 2000). The sale of such facilities ultimately affects the level of care provided to the elderly.
References
Academic Medical Centers. (2000). Web.
Arai, H., Ouchi, Y., Yokode, M., Ito, H., Vematsu, H., Eto, F…Kita, T. (2012). Toward the realization of a better aged society: Message from gerontology and geriatrics. Geriatrics & Gerontology International, 12(1), 16-22
Bragg, E.J., Warshaw, G.A., Meganathan, K., & Brewer, D.E. (2012). The development of academic geriatric medicine in the United States 2005 to 2010: An essential resource for improving the medical care of older adults. Journal of the American Geriatrics Society, 60(8), 1540-1545.
Fletcher, P. (2001). Continuing medical education in a district hospital: A snapshot. Medical Information, 35(10), 967-972.
Hotvedt, M., & Laskowski, R.J. (2002). Establishing priorities for hospital education. Journal of Continuing Education in the Health Professions, 22(3), 181- 186.
Litvin, C.B., Davis, K.S., Moran, W.P., Iverson, P.J., Zhao, Y & Zopka, J. (2012). The use of clinical decision-support tools to facilitate geriatric education. Journal of the American Geriatrics Society, 60(6), 1145-1149.
Supiano, M.A., Alessi, C., Chernoff, R., Goldberg A., Morley, N.E., Schmader, K.E., & Shay, K. (2012). Department of veterans’ affairs geriatric research, education and clinical centers: Translating aging research into clinical geriatrics. Journal of the American Geriatrics Society, 60(7), 1347-1356.
Thomas, D.C., Johnston, B., Dunn, K., Sullivan, G.M., Brett, B., Matzko, M., & Levine, S.A. (2006). Continuing medical education, continuing professional development, and knowledge translation: Improving care of older patients by practicing physicians. Journal of the American Geriatrics Society, 54(10), 1610-1618.