77 Geriatric education of Dutch emergency physicians CHAPTER 4 Introduction Demographic changes have led to increasing numbers of older adults visiting the Emergency Department (ED) (1, 2). Older adults currently make up one third of all ED visits in the Netherlands and this number is expected to further increase in the coming decades (3). The increase of older adults visiting the ED challenges the provision of timely and adequate emergency care at the ED. Older adults often attend the ED in a vulnerable state with multimorbidity, polypharmacy, impaired cognitive health, and atypical symptoms, which complicate the diagnosis and treatment in the ED (4). As a result, older adults have a higher risk of experiencing a prolonged ED length of stay (5), misdiagnoses and adverse events (6), and unplanned ED revisits (7). This also puts a strain on the resources in healthcare and society as a whole (8). Numerous strategies have been used in the ED to facilitate adequate emergency care for older adults, such as: establishing geriatric emergency units (9), interdisciplinary meetings in the ED (10), an ED-embedded geriatrician, and the use of geriatric screening instruments (11). Another important strategy is geriatric emergency medicine (GEM) education for healthcare providers working in the ED (12). GEM educational programs aim to increase the holistic view and geriatric expertise of physicians and nurses working in the ED, who are mainly used to treat acute health problems (8). Evidence suggests that GEM education increases specific geriatric knowledge and skills to treat older adults better (13, 14), which may improve the quality of care and reduce adverse outcomes. While the education in GEM for emergency physicians (EPs) is increasingly recognized as vital for providing high-quality emergency care (15), insight lacks into EPs’ perceived educational needs on this topic and the factors determining these needs. This while several studies have reported that EPs feel unconfident in the treatment of older adults with complex problems (16, 17). In the Netherlands, GEM education has no high priority during emergency medicine residency training (18). No specific geriatric curriculum is offered for EM residency training in the Netherlands, and during EM residency training a geriatric internship is not mandatory. Therefore, we assume that EPs might lack specific geriatric skills and might need continuing medical education in GEM. Moreover, managerial recognition of the importance of GEM education and education support is an important prerequisite to equip EPs with adequate geriatric skills. To our best knowledge, there is no data available showing to what extent EPs are supported by their ED managers to be educated in GEM. Therefore, the aim of this study is to assess and explore EPs’ current educational needs in- and utilization of GEM education, factors determining these educational needs, and the recognition of- and support for GEM education by ED managers.
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