Hostname: page-component-7c8c6479df-ph5wq Total loading time: 0 Render date: 2024-03-28T15:00:32.727Z Has data issue: false hasContentIssue false

What should we be teaching medical students about dementia?

Published online by Cambridge University Press:  04 April 2011

Ellen Tullo*
Affiliation:
Institute of Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
Louise Allan
Affiliation:
Institute of Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
*
Correspondence should be addressed to: Ellen Tullo, Academic Clinical Fellow in Geriatric Medicine, Institute of Ageing and Health, Campus for Ageing and Vitality, Newcastle University, NE4 5PL, UK. Phone: +44 191 2481300. Email: ellentullo@doctors.net.uk.

Abstract

Background: Doctors working in the majority of medical subspecialties provide care for patients with dementia, but there is current international concern that many do not have adequate knowledge or skills to deliver appropriate care for these patients in hospital or community settings. The aim of this review is to draw together recommendations for medical education on dementia and empirical research on teaching interventions concerning dementia in order to assess the current provision of training using the UK model as an example.

Methods: Database and manual searches were undertaken to identify relevant articles for a narrative review.

Results: UK national guidelines recommend that dementia-specific education should be available to trainees in the undergraduate and postgraduate environment. A sample of undergraduate curricula shows considerable variation in the delivery of teaching about dementia. “Non-specialist” postgraduate curricula make reference to care of patients with confusion, but do not always include learning outcomes specific to cognitive impairment or dementia. Teaching interventions trialed in the postgraduate environment provide encouraging qualitative feedback from participants, but do not consistently demonstrate improvement in participants' knowledge, skills or attitudes.

Conclusions: There is a pressing need to improve undergraduate medical education on dementia in order to help future doctors obtain the ability to provide competent care for patients. There is scope for ongoing research to refine existing curricula covering dementia and to build an evidence-base for successful dementia-specific teaching interventions.

Type
Review Article
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alzheimer's Disease International (2009). World Alzheimer Report 2009. Available at http://www.alz.co.uk/research/worldreport/; last accessed October 2010.Google Scholar
Beer, C. et al. (2009). Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities. BMC Geriatrics, 9, 36.CrossRefGoogle ScholarPubMed
British Geriatrics Society (2010). Undergraduate Curriculum. Available at: http://www.bgs.org.uk/index.php?option=com_content&view=article&id=306:undergraduatecurriculum&catid=49:generalinfo&Itemid=171; last accessed June 2010.Google Scholar
Byszewski, A. M. et al. (2003). A continuing medical education initiative for Canadian primary care physicians: the driving and dementia toolkit. A pre- and post-evaluation of knowledge, confidence gained, and satisfaction. Journal of the American Geriatrics Society, 51, 14841489.CrossRefGoogle Scholar
Cahill, S., Clark, M., O'Connell, H., Lawlor, B., Coen, R. F. and Walsh, C. (2008) The attitudes and practices of general practitioners regarding dementia diagnosis in Ireland. International Journal of Geriatric Psychiatry, 23, 663669.CrossRefGoogle ScholarPubMed
Chodosh, J. et al. (2006). A quality of care intervention for dementia: impact on provider knowledge, attitudes, and perceptions of dementia care quality. Journal of the American Geriatrics Society, 54, 311317.CrossRefGoogle Scholar
Cook, S., Brauner, D., Baron, A. and Sachs, G. (2004). Improving medical care of persons with Alzheimer disease through clinical teaching: the IMPACT program. Gerontology and Geriatrics Education, 24, 921.CrossRefGoogle ScholarPubMed
Dalsgaard, T., Kallerup, H. and Rosendal, M. (2007). Outreach visits to improve dementia care in general practice: a qualitative study. International Journal of Quality Health Care, 19, 267273.CrossRefGoogle ScholarPubMed
Department of Health (2009). Living Well with Dementia: A National Strategy. London: Department of Health.Google Scholar
Department of Health and the Medical Research Council (2009). Report from the Ministerial Summit on Dementia Research. Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107955; last accessed May 2010.Google Scholar
Downs, M. et al. (2006). Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study. BMJ, 332, 692696.CrossRefGoogle ScholarPubMed
Doyle, C. (2009). International perspectives on dementia education, training and knowledge transfer. International Psychogeriatrics, 21, S1S2.CrossRefGoogle ScholarPubMed
Education Committee Writing Group of the American Geriatrics Society (2000). Core competencies for the care of older patients: recommendations of the American Geriatrics Society. Academic Medicine, 75, 252255.Google Scholar
Gifford, D. R. et al. (1999) Improving adherence to dementia guidelines through education and opinion leaders: a randomized, controlled trial. Annals of Internal Medicine, 131, 237246.CrossRefGoogle ScholarPubMed
Goldstein, M. Z., MaLossi, R. A., Kye, K. and Young, B. (1999). A course in dementia for third-year medical students. Academic Psychiatry, 23, 142150.CrossRefGoogle Scholar
Gordon, A. L., Blundell, A. G., Gladman, J. R. F. and Masud, T. (2010). Are we teaching our students what they need to know about ageing? Results from the UK national survey of undergraduate teaching in ageing and geriatric medicine. Age and Ageing, 39, 385388.CrossRefGoogle ScholarPubMed
Hammick, M., Dornan, T. and Steinert, Y. (2011). Conducting a best evidence systematic review. Part 1: From idea to data coding. BEME Guide, 13. Available at: http://www2.warwick.ac.uk/fac/med/beme/reviews/published/; last accessed February 2011.Google Scholar
Hasselbalch, S. G. et al. (2007). Education and training of European neurologists in dementia. European Journal of Neurology, 14, 505509CrossRefGoogle ScholarPubMed
Intercollegiate Surgical Curriculum Programme (2010a). Core Surgical Training Syllabus. London: Intercollegiate Surgical Curriculum Programme.Google Scholar
Intercollegiate Surgical Curriculum Programme (2010b). Professional Behaviour and Leadership Syllabus. London: Intercollegiate Surgical Curriculum Programme.Google Scholar
Joint Royal Colleges Postgraduate Training Board (2009). Specialty Training Curriculum for General Internal Medicine. London: Federation of Royal Colleges of Physicians.Google Scholar
Kitwood, T. and Bredin, K. (1992). Towards a theory of dementia care: personhood and well-being. Ageing and Society, 12, 269287.CrossRefGoogle ScholarPubMed
Leipzig, R. M., Granville, L. M. D., Simpson, D., Anderson, M. B., Sauvigné, K. M. A. and Soriano, R. P. (2009). Keeping granny safe on July 1: a consensus on minimum geriatrics competencies for graduating medical students. Academic Medicine, 84, 604610.CrossRefGoogle ScholarPubMed
Murray, L. M. and Boyd, S. (2009). Protecting personhood and achieving quality of life for older adults with dementia in the US health care system. Journal of Aging and Health, 21, 350373.CrossRefGoogle Scholar
National Collaborating Council for Mental Health (2007). Dementia: A NICE-SCIE Guideline on Supporting People with Dementia and their Carers in Health and Social Care. London: Alden Press.Google Scholar
Nuffield Council on Bioethics (2009). Dementia: Ethical Issues. London: Nuffield Council.Google Scholar
Pachana, N. A. (2010). Special issue on training in psychogeriatrics. International Psychogeriatrics, 22, 851853.CrossRefGoogle ScholarPubMed
Perry, M., Draaskovic, I., Lucassen, P., Vernooij-Dassen, M., Van Achterberg, T. and Rikkert, M. O. (2011). Effects of educational interventions on primary dementia care: a systematic review. International Journal of Geriatric Psychiatry, 26, 111.CrossRefGoogle ScholarPubMed
Pond, C. D., Mant, A., Kehoe, L., Hewitt, H. and Brodaty, H. (1994). General practitioner diagnosis of depression and dementia in the elderly: can academic detailing make a difference? Family Practice, 11, 141147.CrossRefGoogle Scholar
Rampitage, R., Dunt, D., Doyle, C., Day, S. and van Dort, P. (2009). The effect of CPE on health care outcomes: lessons for dementia care. International Psychogeriatrics, 21, S34S43.CrossRefGoogle Scholar
Robinson, B. E., Barry, P. P., Resnick, N., Bergen, M. R. and Stratos, G. A. (2001). Physician confidence and interest in learning more about common geriatric topics: a needs assessment. Journal of the American Geriatrics Society, 49, 963967.CrossRefGoogle ScholarPubMed
Robinson, L., Bamford, C., Briel, R., Spencer, J. and Whitty, P. (2010). Improving patient centred care for people with dementia in medical encounters: an educational intervention for old age psychiatrists. International Psychogeriatrics, 22, 129138.CrossRefGoogle Scholar
Royal College of General Practitioners (2007). Curriculum Statement 9: Care of Older Adults. London: RCGP.Google Scholar
Stirrat, G. M., Johnston, C., Gillon, R. and Boyd, K. (2010). Medical ethics and law for doctors of tomorrow: the 1998 Consensus Statement updated. Journal of Medical Ethics, 36, 5560.CrossRefGoogle ScholarPubMed
Teodorczuk, A., Welfare, M., Corbett, S. and Mukaetova-Ladinska, E. (2010). Developing effective educational approaches for Liaison Old Age Psychiatry teams: a literature review of the learning needs of hospital staff in relation to managing the confused older patient. International Psychogeriatrics, 22, 874885.CrossRefGoogle ScholarPubMed
Tsolaki, M. et al. and the European Alzheimer Disease Consortium (2010). Consensus statement on dementia education and training in Europe. Journal of Nutrition Health and Aging, 14, 131135.CrossRefGoogle ScholarPubMed
Tullo, E., Gordon, A. L., Blundell, A. G., Masud, T. and Gladman, J. (2010a). Putting in the hours? Dementia teaching for medical undergraduates around the UK. Poster presentation at British Geriatrics Society Conference. November 2010, Brighton, UK.Google Scholar
Tullo, E., Spencer, J. and Allan, L. (2010b). Systematic review: helping the young to understand the old. Teaching interventions in geriatrics to improve the knowledge, skills and attitudes of undergraduate medical students. Journal of the American Geriatrics Society, 58, 19871993.CrossRefGoogle Scholar
Turner, S. et al. (2004). General practitioners' knowledge, confidence and attitudes in the diagnosis and management of dementia. Age and Ageing, 33, 461467.CrossRefGoogle ScholarPubMed
Union Européen des Médecins Specialistes (2010). Section geriatrique. Available at: http://www.uemsgeriatricmedicine.org; last accessed March 2010.Google Scholar
UK Foundation Programme Curriculum (2010). Available at: http://www.foundationprogramme.nhs.uk/pages/home/key-documents#curriculum; last accessed February 2011.Google Scholar
Waldorff, F. B., Almind, G., Marjukka, M., Møller, S. and Waldemar, G. (2003). Implementation of a clinical dementia guideline. Scandinavian Journal of Primary Health Care, 21, 142147.CrossRefGoogle ScholarPubMed
Young, T. and Manthorp, C. (2009). Towards a code of practice for effective communication with people with dementing illnesses. Journal of Language and Social Psychology, 28, 174189.CrossRefGoogle Scholar