157 General discussion and future perspectives CHAPTER 7 In the Netherlands, older adults presenting to the ED are often first treated by emergency physicians, although this may vary based on local protocols. The treatment decisions for older adults made by emergency physicians are highly dependent on the available tools and on emergency physicians’ expertise with the core principles of geriatric emergency medicine. It is not only the choice of treatment that is affected by emergency physicians’ geriatric emergency medicine expertise; the utilization of diagnostic and therapeutic measures is also impacted by emergency physicians’ familiarity with the specialized medical care of older adults (1, 2). It is clear that emergency physicians’ expertise in the field of geriatric emergency medicine is important because better diagnostics and treatments could improve the quality of care for older adults (3,4), prevent a prolonged ED length of stay (5, 6) and reduce ED crowding (7, 8). However, there are insufficient data about the extent to which emergency physicians are able to meet the requirements necessary to provide adequate geriatric emergency care (2, 9). The current chapter is a reflection focused on the methods and findings of our studies. The chapter concludes with reflections on the challenges of performing educational program research in the emergency department and future perspectives for the care of older adults in the ED. Reflections on the study methods First, we performed an online survey among emergency physicians and ED managers regarding the geriatric emergency medicine educational needs of emergency physicians. This is the first study – both in the Netherlands and internationally – involving a nationwide survey on this subject. The results of this study must be interpreted in light of the intrinsic limitations of studies based on survey data. There is a chance that only emergency physicians with an affinity for the study topic or scientific research in general responded to our invitation to participate in the study. This may have introduced bias, which is a limitation of our study. This bias could have been reduced by choosing a qualitative study design (e.g., focus groups and interviews) to explore emergency physicians’ needs and experiences in geriatric emergency medicine education through in-depth questioning. However, the use of a qualitative design would have eliminated the possibility of finding results that we can generalize to the entire population of emergency physicians and ED managers in the Netherlands. Considering these limitations that are intrinsic to study designs, we believe that a national survey study was the most appropriate method, as the focus of our study was not locally oriented. We aimed to investigate the needs of all EPs in the Netherlands. The emergency physician profession is relatively new in the Netherlands (10), and little is known about regional differences in education and
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