84 Chapter 4 Discussion The findings of our nationwide survey first and foremost showed that a large proportion of EPs in theNetherlands needmore skills on all geriatric competency domains. EPs reported the need for medical skills (i.e., recognizing geriatric problems, determining the right diagnostic approach, treatment of older adults). They also described the need for skills allowing them to better work with counterpart colleagues and determining the right community follow-up for older adults at the ED. These described needs are not met with sufficient possibilities and supporting conditions for EPs to follow GEM education. The majority of EPs in our survey stated that there was no GEM education offered in the hospital employed, and only 12% of EPs was aware of where (else) to obtain GEM education. Moreover, the EPs themselves play an important role in not fulfilling their geriatric educational needs as only a small part spends sufficient time to follow GEM education. More than half the EPs reported to receive sufficient time to follow GEM education. As emergency medicine covers a wide clinical domain, we believe that EPs are challenged with a broad range of educational topics offered. Many clinical expertise areas are relevant to their clinical practice, which might contribute to a lower priority for GEM education. Table 4 ED managers view on older adult care and GEM education of emergency physicians Statement Disagree* n (%) Undecided* n (%) Agree* n (%) The management of the ED finds improving care for the older adult at the ED an important issue. 0 (0) 4 (13.8) 25 (86.2) The management of the ED finds improving geriatric skills of EPs an important issue. 4 (13.8) 11 (13.9) 14 (48.3) Sufficient expertise is available within the hospital employed, to provide GEM education for EPs. 2 (6.9) 10 (34.5) 17 (58.6) Sufficient time is available to provide GEM education for EPs. 11 (37.9) 13 (44.9) 5 (17.2) Sufficient finances are available to provide GEM education for EPs. 6 (20.7) 144 (48.3) 9 (31.0) ED= Emergency department; GEM= Geriatric emergency medicine; EP= Emergency physician * Disagree = Likert score 1 or 2, Undecided = Likert score 3, Agree = Likert score 4 or 5
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