Enhancing specialty training in geropsychology competencies: An evaluation of a VA Geriatric Scholars Program advanced topics workshop.

There is a growing need for psychologists with specialized training in geriatric mental health competencies. The Geriatric Scholars Program for Psychologists (GSP-P) was created to address this shortage within a large integrated healthcare system. In 2019, GSP-P piloted an advanced workshop designed to enhance expertise in geriatric mental health competencies among graduates of its foundational competencies core course. The workshop included 3.5 days of expert-led seminars regarding the biopsychosocial needs of older adults with chronic medical illness and was followed by completion of an individualized learning plan. This paper describes the evaluation of the course using a mixed methods with data collected prior to the workshop, immediately post-workshop, and six months post-workshop. Results indicated enthusiasm for the workshop, significant improvements in four geropsychology domains on the Pikes Peak Geropsychology Knowledge and Skill Assessment Tool, and benefit from completion of the independent learning plans. Our findings demonstrate that continued enhancement of geropsychology competencies through advanced coursework is feasible and improves knowledge and skill, particularly when combined with individualized learning plans.

Evidence-oriented teaching of geriatric psychiatry: a narrative literature synthesis and pilot evaluation of a clerkship seminar.

Introduction: The field of geriatric psychiatry has in recent decades developed into an independent discipline, incorporating elements of psychiatry, neurology and internal medicine. In view of demographic changes, this field is becoming increasingly relevant for primary care and undergraduate medical training. So far, however, there is little educational guidance for instructional design of geriatric psychiatry in undergraduate medical education. Project description: A narrative literature review of medical education studies in the field of geriatric psychiatry was conducted. Student evaluations of a geriatric psychiatry clerkship seminar were analyzed, followed by a target group analysis. Results informed the iterative development of new clerkship seminar content and structure. This was implemented and evaluated over several academic cycles. Learning material was made available via the open-source learning management system "ILIAS". Results: A total of 29 medical education articles were identified and evaluated. The previous seminar in geriatric psychiatry at our university hospital was rated below average (Likert item overall rating of 4.3/6 compared to other seminars with an average overall rating of 5.2, p<0.001). An evidence-oriented revision of the content and instructional design was implemented. Activation of learners, self-reference effect, and audience questioning were used during the lecture. Additionally, two geriatric psychiatry case scenarios were adapted for discussion. We saw continuous improvement of student evaluations of the revised course, reaching a rating improvement of 5.3 out of 6 (p<0.01, U=135.5 Cohen's d=1.28). Conclusion: A systematic approach was used to develop a geriatric psychiatry clerkship seminar, based on medical education evidence, for undergraduate medical students, resulting in better student evaluations. The teaching materials can be adapted for local implementation at other teaching hospitals. Future studies should also explore effects regarding higher learning outcomes.

A Survey of Geriatric Psychiatry Fellows and Program Directors: Specialty Choice, Program Choice, and Program Quality.

OBJECTIVE: This study explored factors influencing a physician's choice to pursue geriatric psychiatry fellowship training from fellow and program director perspectives to improve recruitment into this critical need specialty. METHODS: Questionnaires were sent to the 54 fellows and 79 fellowship program directors of programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) available through the American Association for Geriatric Psychiatry (AAGP) listserv. A 5-point Likert scale (strongly disagree, disagree, neutral-undecided, somewhat agree, strongly agree) was used to score and rank these questionnaires. RESULTS: Thirty-three program directors (42%) on the AAGP listserv and 24 (44%) of all ACGME accredited fellows responded. The clinical quality of the faculty (Fellows 92%, Program Directors 92%) and the fellowship's national reputation (Fellows 75%, Program Directors 88%) were most highly ranked by both. Fellows ranked proximity to family (79%) high (2nd) in their program choice, while ranking workload, salary, and visa issues as low. CONCLUSION: This study emphasizes that family and cultural/ethnographic considerations, along with the core values of a training program, remain highly valued by trainees, and should inform structural changes to incentivize training, and enhance the inherent quality of fellowship programs.

Gender and Racial Trends among Geriatric Psychiatry Fellows in the USA: A Call to Action.

OBJECTIVE: The United States (USA) is a culturally and ethnically diverse country with an estimated 5.6 to 8 million elderly population living with psychiatric and substance use disorders and a dwindling geriatric psychiatry workforce. In this study, we explored the gender and racial trends in USA geriatrics psychiatry fellowship programs from 2007-20, and forecasted the 2030 geriatric psychiatry workforce to identify the gaps and provide recommendations. METHOD: This retrospective analysis of the Accreditation Council for Graduate Medical Education (ACGME) data included trainees in geriatric psychiatry fellowship programs in the USA from 2007-20. Races were classified as White (Non-Hispanic), Asian/Pacific Islander, Hispanic, Black (Non-Hispanic), Native American/Alaskan, Others, and Unknown. Gender was categorized as Male, Female, and Not Reported. RESULTS: Amongst the geriatric psychiatry fellowship trainees, there was an overall decrease in the representation of all races from 2011-20. There was a relative decrease of 16%, 8.6% and 2.3% for White (Non-Hispanic), Asian/Pacific Islander, and Black (Non-Hispanics) respectively whereas the Hispanic and Native American/Alaskan trainees remained unchanged. Women relatively increased 28.4% from 2007-20 while men relatively decreased 27.1%. Our projections suggest that without changes in the current health professional recruitment trends and the shortage of geriatric psychiatrists will persist with a shortfall of 1,080 (9.7%) by 2030. CONCLUSION: There are critical gaps in racial and gender representation in geriatric psychiatry fellowship programs in the USA. An inclusive workforce is required to address diverse communities and bridge gaps in physician workforce gender and racial disparities.

Palliative Care Training for Geriatric Psychiatry Fellows: A National Survey Project.

OBJECTIVES: Palliative care is an essential part of the standard of care for individuals with serious medical illnesses. Integration of palliative care and mental health is important for elderly patients with medical and psychiatric comorbidities. Geriatric psychiatrists are natural stewards of palliative care-mental health integration, however this is contingent on palliative care training. Currently, palliative care training in geriatric psychiatry fellowship programs is uncharacterized. We surveyed geriatric psychiatry fellowship program directors in the United States to assess current palliative care training practices. METHODS: Web-based anonymous survey of geriatric psychiatry fellowship training directors RESULTS: Forty-six percent (28/61) of program directors responded. Seventy one percent (20/28) of programs provide didactics on palliative care. Seventy-seven percent (20/26) of programs provide clinical experiences in palliative care. Sixty-three percent (15/24) have formalized interactions between geriatric psychiatry and palliative care fellows. CONCLUSIONS: Palliative care training for geriatric psychiatry fellows is robust but unstandardized. Operationalizing palliative care training for geriatric psychiatrists may improve mental health integration into serious illness care.

Predictors for Matriculation into Geriatric Psychiatry Fellowship: Data from a 2019-2020 National Survey of U.S. Program Directors.

OBJECTIVE: With the number of geriatric psychiatry fellows declining from a peak of 106 during 2002-2003 to 48 during 2020-2021, this study aims to investigate characteristics of the geriatric psychiatry training requirement across U.S. psychiatry residency programs and to identify specific factors which may influence residents to pursue geriatric psychiatry subspecialty training. METHODS: The authors queried the American Medical Association's Fellowship and Residency Electronic Interactive Database Access system to compile a list of program directors from the Accreditation Council for Graduate Medical Education sponsored general adult psychiatry residency programs. Program directors were emailed an anonymous multiple-choice survey to ascertain specific characteristics of their program's geriatric psychiatry training experiences. This study's primary outcome was the percentage of residents entering geriatric psychiatry fellowship after completion of general psychiatry training. Linear regression analysis determined which variables may be associated with this primary outcome. RESULTS: Of 248 surveyed, 60 programs (24%) responded to the survey. Only one of the independent variables revealed a statistically significant association with the percent of residents that became geriatric psychiatry fellows: the number of geriatric psychiatrists at the residents' home institution (p=0.002). CONCLUSIONS: Consistent with previous data, the presence of geriatric psychiatry faculty members is strongly associated with the decision to pursue subspecialty training in geriatric psychiatry.

Current Educational Practices for Major Neurocognitive Disorders in Psychiatry: a Scoping Review.

OBJECTIVE: A scoping review of the literature was performed to examine the current state of education on major neurocognitive disorders within psychiatry, to review influential factors for pursuing a career working with these patients, and to review what has been done in education to address the shortage of providers to care for patients with major neurocognitive disorders. METHODS: Using the Arksey and O'Malley framework for conducting scoping reviews, twenty-eight studies on education in geriatric psychiatry, neuropsychiatry, and major neurocognitive disorders were selected. Learner groups included medical students, residents, and psychiatrists. The results from the studies were compared, and major themes were presented. RESULTS: Several studies found that positive clinical experiences with older adult patients and effective teachers in geriatric psychiatry play a role in influencing trainees to pursue a career in geriatric psychiatry. Topics pertaining to major neurocognitive disorders are taught by the majority of medical schools during the psychiatry rotation and are rated as the most important teaching topic in neurology among psychiatry residency program directors. Several interventions have resulted in increased comfort working with geriatric patients and patients who have major neurocognitive disorders among students, but fewer studies have resulted in an increase in interest seeing these patients in practice. There is a lack of research pertaining to psychiatry residents working with patients that have major neurocognitive disorders. CONCLUSIONS: While research on geriatric psychiatry and neuropsychiatry education exists, more research is needed that focuses specifically on how medical students and psychiatry residents are being taught major neurocognitive disorders.

The AAGP Scholars Program: Predictors of Pursuing Geriatric Psychiatry Fellowship Training.

OBJECTIVE: The American Association for Geriatric Psychiatry (AAGP) Scholars Program was developed to recruit trainees into geriatric psychiatry fellowships and is considered a pipeline for fellowship recruitment. Nonetheless, the number of trainees entering geriatric psychiatry fellowship is declining, making it important to identify modifiable factors that may influence trainees' decisions to pursue fellowship. We analyzed survey data from Scholars Program participants to identify demographic characteristics, attitudes toward program components, and behaviors after the program that were independently associated with the decision to pursue fellowship. METHODS: Web-based surveys were distributed to all 289 former Scholars participants (2010-2018), whether or not they had completed geriatric psychiatry fellowships. We conducted a hierarchical binary logistic regression analysis to examine demographics, program components, and behaviors after the program associated with deciding to pursue geriatric psychiatry fellowship. RESULTS: Sixty-one percent of Scholars decided to pursue geriatric psychiatry fellowship. Attending more than one AAGP annual meeting (relative variance explained [RVE] = 34.2%), maintaining membership in the AAGP (RVE = 28.2%), and rating the Scholars Program as important for meeting potential collaborators (RVE = 26.6%) explained the vast majority of variance in the decision to pursue geriatric psychiatry fellowship. CONCLUSION: Nearly two-thirds of Scholars Program participants decided to pursue geriatric psychiatry fellowship, suggesting the existing program is an effective fellowship recruitment pipeline. Moreover, greater involvement in the AAGP longitudinally may positively influence Scholars to pursue fellowship. Creative approaches that encourage Scholars to develop collaborations, maintain AAGP membership, and regularly attend AAGP annual meetings may help attract more trainees into geriatric psychiatry.

[Delirium in the elderly; article for education and training purposes]. / Delier bij ouderen.

In delirium, there is an acute change of consciousness with fluctuations in attention, cognition and perception. Delirium can be provoked by medical conditions, or the use or withdrawal of drugs. Risk factors include older age and cognitive impairment. Delirium is associated with many complications, represents a significant emotional burden for the patient and caretakers, increases length of stay in the hospital, and causes higher health care costs. Non-pharmacological measurements can sometimes prevent delirium, and are essential for its treatment with proven effectiveness. Antipsychotics should be administered only as an exception, not as a rule. Antipsychotics may be of use when the patient puts himself or others in danger, or when he suffers substantially from hallucinations.

The COVID-19 AAGP Online Trainee Curriculum: Development and Method of Initial Evaluation.

OBJECTIVE: One effect of the COVID-19 pandemic is the disruption of in-person clinical experiences within geriatric psychiatry residency education. Online resources for trainees are needed to fill resultant gaps. METHODS: The American Association of Geriatric Psychiatry (AAGP) Teaching and Training Committee leadership collaborated with geriatric psychiatry experts to develop a web-based geriatric psychiatry curriculum for psychiatry residents and other learners. In addition, we planned to obtain initial self-report outcomes of the curricular modules. RESULTS: The COVID-19 AAGP Online Trainee Curriculum (aagponline.org/covidcurriculum) consists of approximately 30 video-recorded lectures provided by AAGP member experts. A demographic survey and pre-/postsurvey attached to each module allow us to obtain learner characteristics and feedback on each module. CONCLUSIONS: The Curriculum has the potential to supplement psychiatry residency education during the pandemic and potentially raise the profile of AAGP, with the goal of inspiring interest within geriatric psychiatry. Results of the initial self-report evaluation should be available in 1 year.

The American Association for Geriatric Psychiatry's Trainee Programs: Participant Characteristics and Perceived Benefits.

OBJECTIVE: The number of physicians trained in geriatric psychiatry is dwindling. The American Association for Geriatric Psychiatry (AAGP) developed novel educational programs designed to foster interest in the field. The objective of this study was to compare participant characteristics and perceived benefits of two AAGP educational programs for trainees: Stepping Stones (1997-2007) and the Scholars Program (2010-2016). METHODS: Web-based surveys were distributed to former participants of the Stepping Stones and Scholars Programs. Characteristics of participants in the two programs were compared using χ2, t tests, or Mann-Whitney U tests, as appropriate. The five-point Likert scale responses for each perceived benefit were compared using t tests, when normally distributed, or Mann-Whitney U tests as appropriate. RESULTS: Of the 476 Stepping Stones participants, 132 (27.8%) responded to the survey, while 64 (29.0%) of the 221 Scholars Program participants responded to the survey. Participant characteristics differed only in age. Compared to Stepping Stones participants, Scholars Program participants endorsed greater advancement of their scholarly work, more support and recognition from their home institution, and increased networking opportunities. CONCLUSION: Innovative approaches to addressing the geriatric psychiatry workforce shortage are critical. The member-funded AAGP Scholars Program offers several advantages over its predecessor Stepping Stones. Highlighted by the addition of medical student participants, a carefully matched mentoring program, and a required scholarly project, the Scholars Program is poised to enhance recruitment into geriatric psychiatry subspecialty training, although its impact on recruitment should be investigated directly in future research.

Geriatric Psychiatry Inpatient Primer for Residents.

OBJECTIVE: The authors describe a novel curricular intervention that enhances first- and second-year psychiatry residents' geriatric psychiatry knowledge while preparing them for overnight call. METHODS: A brief, four-page document covering evaluation and management of common clinical scenarios in older adults, including agitation, falls, insomnia, chest pain, abnormal vital signs, and review of pharmacologic interventions, was presented to first- and second-year psychiatry residents. The residents completed an anonymous survey including their comfort level in answering pages and knowledge-based questions regarding evidence-based interventions both before and after the intervention. The pre-survey and post-survey were analyzed using the Wilcoxon-signed rank test, paired T test, and Mann-Whitney U test. RESULTS: The residents demonstrated statistically significant changes in first-line medication choices for common clinical scenarios such as non-aggressive agitation and insomnia. They were less likely to choose medications that should be avoided in elderly based on expert panel recommendations. CONCLUSIONS: Findings support the need for educational interventions designed to help residents taking call with geriatric patients. The results demonstrated an improvement in clinical knowledge following this brief intervention.