Simulation can help us get the basics of care right

Michael Alcorn is a Geriatric and General (Internal) Medicine Specialty Registrar at the Southern General Hospital, Glasgow and Honorary Clinical Teacher at the University of Glasgow Medical School. You can view the poster of Dr Alcorn and team at this week’s BGS Scientific Conference, at exhibition space 66.simfyss1_R1

In common with other UK doctors in training, I have been taught in many different environments by many different teachers with differing understandings of what it means to teach and to be taught.    Continue reading

Geriatrics Fellowship Training in Taiwan: What Has Been Achieved So Far

Liang-Kung Chen is the Director for the Center for Geriatrics and Gerontology, Taipei Veterans General Hospital and Associate Professor of the Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan and is International Advisory Panel member for Age and Ageing journal.shutterstock_150440705

Taiwan became an ageing country in 1993 and is estimated to become an aged country by 2017, which makes it one of the fastest ageing countries in the world. By 2025, the percentage of people aged 65 years and older will be 20%, corresponding to an increase in the elderly population from 2.5 million to nearly 5 million within 15 years. This rapid demographic transition has had a huge impact on our country, especially the healthcare systems. Continue reading

The Shape of Training report – let’s get the basics right but not at the expense of excellence

Zoe Wyrko is a Consultant physician at University Hospital Birmingham and is the Honorary Secretary for the BGS. She tweets at @geri_baby ShapeOfTraining

I’m really not quite sure what to make of the Shape of Training report which was issued last week. A lengthy consultation has taken place, to which I responded with the assistance of the BGS Education and Training committee and Trainees council.

Independent, written by Professor David Greenaway, and with the aim of  ‘…making sure we continue to train effective doctors who are fit to practice in the UK, provide high quality care, and meet the needs of patients and the public,’ its outcomes have been hotly anticipated by anyone concerned with higher speciality training, or implementing recommendations and outcomes from documents such as the Future Hospitals Commission and the Francis report.  Dr Laura Daunt, a trainee geriatrician from Nottingham and member of the BGS Trainees Council, interviewed Professor Greenaway, and the video of this is available as part of the supporting materials.

The Shape of Training Review: Securing the Future of Excellent Patient Care

The Shape of Training Review: Securing the Future of Excellent Patient Care

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The Future Hospital Commission: future-proof doctors need training in geriatric medicine

Dr Adam Gordon is a Consultant and Honorary Associate Professor in Medicine of Older People at Nottingham University Hospitals NHS Trust. He is Deputy Honorary Secretary of the British Geriatrics Society and also edits this blog. 

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The report of the Future Hospital Commission, published last week, suggested we needed “a cadre of doctors with the knowledge and expertise necessary to diagnose, manage and coordinate continuing care for the increasing number of patients with multiple and complex conditions. This includes the expertise to manage older patients with frailty and dementia.”

The most evidence-based way to manage frail older people is Comprehensive Geriatric Assessment (CGA). CGA has consistently been shown in large meta-analyses and systematic reviews over the last 20 years to improve outcomes for older patients. These include – but are not limited to – decreased risk of cognitive decline and death, increased likelihood of functional independence and a lower probability of readmission to hospital.

Doctors don’t “do” CGA – it is delivered by a multidisciplinary team (MDT). It requires assessment across multiple domains (medical, psychological, environmental, social and functional), accompanied by case management and iteration of management plans.  The role of doctors is to provide diagnosis and prognosis, to initiate medical treatments where necessary and to do so with consideration to the broader management plan agreed with the MDT.

If doctors are to do this they need first to understand how CGA works. Continue reading