160 Chapter 7 geriatrician working in an “acute frailty zone” – is not easy to implement and involves significant costs and major changes to the work routine in the ED. Second, none of the studies included were conducted in the Netherlands. Although almost all studies were conducted in the Western world (United States, Canada, United Kingdom and Australia), the results cannot be translated to the situation in the Netherlands, with its unique health care system with specific emergency department characteristics (10, 24). Third, none of the studies specifically evaluated the effect of geriatric care by emergency physicians with proper geriatric medical training on quality indicators such as ED crowding. This should be a focus for future studies. Our national survey of all emergency physicians in the Netherlands showed that Dutch emergency physicians do not feel sufficiently qualified in treating elderly patients presenting at the ED. Factors that contribute to this lack of self-perceived skills are insufficient geriatric emergency medicine training during residency and limited locally organized education programs. This is an important finding because it provides novel insights both nationally and internationally on this topic. Previous studies were mostly performed among emergency medicine residents (9, 16, 25), meaning the external validity of these studies is limited and the results are not applicable to board-certified emergency physicians. Only one study evaluated capacities to treat older adults in a group of emergency physicians who were board-certified (1). In line with our findings, those physicians felt their geriatric education during residency and their geriatric education post-residency training were insufficient for their needs. The evaluation of our geriatric education program showed positive effects on emergency physicians’ geriatric knowledge and on their medical handling of older adults. This finding is in line with the findings of other studies that also implemented geriatric education (14, 15, 26). However, in these studies, the study population consisted mainly of physicians in specialties other than emergency medicine. Studies that included physicians working in the ED included all studied residents and not emergency physicians (9, 16, 25). In our geriatric education program, emergency physicians especially valued case-based interactive teaching. This finding is in line with the literature, indicating that interactive learning yields higher retention of information and learner satisfaction (27, 28, 29). The quantitative analysis of this education program showed positive effects on emergency physicians’ knowledge and medical handling. However, these effects were measured shortly after the education program. Although the program showed clinical benefits in a short timeframe, no evaluation regarding the effect of the education program on a larger timeframe was performed. Because of the almost daily utilization of knowledge in geriatric medicine at the ED, it makes sense to assume that knowledge
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