105 Geriatric education program for emergency physicians CHAPTER 5 Data collection Before and after the program, participants were asked to fill in a multiple choice knowledge test (in Dutch) containing ten questions about common geriatric syndromes, which are also outlined by ETFGEM [18]. The pretest consisted of different questions compared to the posttest, but both tests were equal in terms of assessing EP’s knowledge level. It was developed by an experienced geriatrician with educational expertise. This test was checked by a panel of geriatricians and revised as needed. Also, two validated questionnaires were distributed before and after the program. The Needs Assessment Scale (NA) was translated to Dutch and used to evaluate participant’s self-perceived knowledge regarding most common geriatric syndromes [19]. The NA scale consists of 18 questions on a 5-point Likert scale. A higher score indicates more self-perceived knowledge. The Aging Semantic Differential (ASD) was translated to Dutch and used to measure participant’s attitudes towards older adults (e.g., pleasant-unpleasant, friendly-unfriendly, cooperative-uncooperative; 20). The ASD consists of 27 items on a 7-point Likert scale referring to aging stereotypes. A lower score indicates a more positive attitude towards older persons. To our best knowledge, ASD has not been used before at an Emergency Department setting. Additionally, 100 medical records were retrospectively analyzed, to assess before-after effects on EPs’ medical practice by completeness of a comprehensive geriatric assessment (CGA, 17). Fifty records before the start of the program (patients treated at the ED between August - October 2015) and fifty records after completion of the program (patients treated at the ED between August - October 2016) were randomly selected. Records of patients aged 70 years or older attending the ED of the Radboudumc and treated by an EP for presenting complaints in the fields of geriatrics, neurology, surgery, orthopedics or pulmonology were eligible for review. Records of patients with the most urgent triage code, U0, were excluded from selection, because a CGA is often impossible to perform in such cases. Triage levels were determined by using the Netherlands Triage System (NTS, with U0 being the highest urgency and U5 being the lowest urgency). Eligible records in thebefore andafter studyperiodswere consecutively selected and equally divided between surgical specialties (surgery, orthopedics) or analytic specialties (i.e., geriatrics, neurology, pulmonology). Two reviewers with a medical background (NH and EÖ) independently reviewed the selected records on the documentation of EPs’ history-taking, requested diagnostics, consultation of medical specialties and problem definitions of CGA. We chose to evaluate the records on these variables as these care processes may be under- or over performed by EPs without sufficient education in geriatric emergency medicine [11,13]. A third reviewer (ÖS) made final decisions on assessment discrepancies by NH and EÖ.
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