115 Geriatric education program for emergency physicians CHAPTER 5 type of program may have an even greater effect at other institutions that lack such a service, because EPs may find greater benefit from this added educational initiative. Third, there were several limitations to the measurement of program effects. It is possible that the number of questionnaire items was insufficient to adequately measure change. We did not perform a test-retest reliability check to determine the stability and consistency of the multiple choice knowledge test. Therefore, found changes in EP’s knowledge may be a random effect. We did not apply methods (e.g., Bonferroni correction) to reduce the chance of obtaining false-positive results (type I errors) when performing multiple statistical comparisons on a single set of patient record data. Therefore, we cannot fully rule out that EP’s improved attention for the older patient’s social history and circumstances after following the educational program may be an erroneous significant effect purely by random chance. Furthermore, we did not evaluate pre and post use of chemical sedation and catheter placement while both are previously identified as valid indicators for measuring EP’s appropriate medical handling when caring for older adults at the ED [21]. Despite we guaranteed anonymity, it is also possible that self-perceived knowledge scores and self-reported improvements in practice after completion of the program could be attributed to social desirability [23]. However, the eight month period between pre- and post questionnaires made it difficult for participants to recall their previous answers. On the other hand, the half-year period between the ending of the program and the start of interviews may have led to recall bias in perceived experiences with the program. Furthermore, the reviewers of the medical charts were not blinded to the study purpose and timing of the program. This may have introduced bias that could overestimate the effect of the program. Finally, some may consider evaluations of clinical practice and patient outcomes more substantial outcome measures. We recognize that practice change and patient outcomes are important endpoints of education interventions and they should be part of future research. In the Netherlands, Emergency Medicine is not a recognized specialty jet. Postgraduate physicians are recognized as EPs after completing the Emergency Medicine residency curriculum. The Dutch Emergency Medicine residency curriculum was started in 2000 and consists of three years of residency [24]. Currently, almost all Emergency Departments in the Netherlands are staffed by EPs. Previous studies have shown, that EPs lack geriatric competencies, most likely because these competencies are not implemented neither in core curricula nor in postgraduate residency training [8,21]. Recently, the European Task Force on Geriatric Emergency Medicine (ETFGEM) produced a European Curriculum of Geriatric Emergency Medicine (ECGEM) that outlines competencies relevant to the emergency care of older patients [18]. When implemented in residency
RkJQdWJsaXNoZXIy MjY0ODMw