In December 2017, a Comprehensive Geriatric Assessment (CGA) Knowledge to Action Working Group was established to aid in the development of a tactical plan and deliverables that would advance the translation of A Competency Framework for Interprofessional CGA into positive, interprofessional geriatric practice change.
The Framework describes detailed practice expectations of health professionals participating in the CGA in order to help them adequately prepare themselves to deliver interprofessional comprehensive geriatric assessments and interventions and work effectively in a specialized geriatrics environment. The Framework is organized into six practice areas which include 99 behavioural statements that are intended to describe the knowledge, skills, attitudes, judgments and actions expected of members of the interprofessional team participating in the CGA. The Framework outlined several implications for practice including: (1) improved quality of assessments; (2) improved goal-based care planning; (3) better tailoring of appropriate interventions; (4) appropriate follow-up and follow through; and (5) improved consistency in assessment practices across SGS providers.
In developing the Competency Framework, the Working Group recognized the importance of health professionals having a way to assess their knowledge against the behavioural statements, and subsequently access educational offerings to assist them in increasing competence in areas identified as having learning needs. The Interprofessional Comprehensive Geriatric Assessment (CGA) Self-Assessment Tool was developed for that purpose. The tool was developed to support the growth of the core competencies outlined in the CGA Framework.
In addition to development of the self-assessment tool, the Knowledge to Action working group identified the need for learners to have access to freely available and high quality educational offerings to support any areas of improvement identified on self-assessment. As such, the North East Specialized Geriatric Services (NESGC), Seniors Care Network, and Laurentian Research Institute for Aging (LRIA) joined forces to create a Compendium of Educational Offerings Relevant to Interprofessional Comprehensive Geriatric Assessment. The compendium provides an extensive array of educational offerings that a health professional can utilize to respond to their learning needs as shown by the self-assessment.
A stepwise approach was taken to identify educational offerings and match them with the behavioural statements of the Competency Framework. The approach was guided by the recommendation from project partners at North East Specialized Geriatric Centre (NESGC) that too much content would be better than not enough, considering all educational offerings would be reviewed by an expert panel upon completion. It was also recommended that the primary focus be placed on practice area one, Core Geriatric Knowledge, and practice area two, Screening, Assessment, and Risk Identification, of the Competency Framework.
The challenge was to match the 99 behavioural statements (competencies) with appropriate educational offerings. In many cases, the educational offerings outlined learning objectives, which made the matching process much easier. When learning objectives were not available, the name of the educational offering, the table of content information, or any other descriptive content was matched to the behavioural statements. Further navigation of these educational offerings was often required in order to determine the subject matter and subsequently match the materials to the behavioural statements. When dates of completion could be located for educational offerings, only those 2010 or newer were included in the compendium.
It was necessary to consider how the compendium would take form and where it would eventually be housed. The project team began experimenting with Google Docs, which proved to be an effective electronic platform for the accumulation of compendium materials. In Google Docs, the compendium was created as a table with the behavioural statements functioning as the categories by which the educational offerings are grouped. A behavioural statement and its unique identifier (i.e. 1.a.vi) are written in a row, and the row immediately below it contains the educational offerings that were matched to that competency.
There were a number of discussions focussed on how any educational offering identified would be recorded electronically in the compendium. Initially, hyperlinks were proposed to input educational offerings, however, hyperlinks alone are very cryptic. The project team then considered generating brief summaries for each of the educational offerings, and soon into that approach it was realized that the size of the compendium would become unwieldy. The project team recognized that adequate detail was needed to provide sufficient context to enable an individual to more easily identify educational offerings that would meet their learning needs.Th solution was to use the titles of the educational offerings along with hyperlinks for input into the compendium.
Within the Competency Framework, there is overlap in language across some of the behavioural statements. The project team learned early that this would result in identical lists of educational offerings matched to the overlapping competencies. To avoid this, educational offerings were placed with the matching behavioural statement that appeared first in the compendium, which was then referred to by the other matching behavioural statement(s). Further, as material was found, it became evident that a large proportion of educational offerings were topic-focused on specific geriatric health problems or conditions. Often these materials would cover content from more than one practice area, but in the context of a client with the specific health issue. When this occurred, these educational offerings were placed only with the appropriate behavioural statement in practice area one, Core Geriatric Knowledge, as this section covers a number of geriatric health concerns. Both of these strategies were used in an attempt to reduce redundancy in the compendium.
The search to identify educational offerings began with a preliminary list of sources provided by our partners from Seniors Care Network. The list included the following:
- Behavioural Support Ontario (BSO): GPA, U-First, Montessori Methods, PIECES
- South West Assessment & Restore Website: Interprofessional CGA Toolkit
- Rehabilitative Care Alliance: Assess and Restore Frail Seniors
- Seniors Health Knowledge Network
- Dementia Education Resources for Health Care Providers
- Previous reviews completed by the Council of Universities of Ontario and Sim-ONE:
- Health Workforce Education Needs for Seniors Care – Continuing Professional Development
- Core Curricula for Entry-to-Practice Health and Social Care Worker Education in Ontario
- Perceptions of Practitioners and Practitioner Organizations About Gaps and Required Competencies for Seniors’ Care Among Health and Social Care Graduates and Workers
- Priority Learning Needs and Practice Challenges of Healthcare Providers Supporting Seniors Aging at HomeInterprofessional Education and Care for Seniors: An Environmental Scan
These sources were carefully and thoroughly explored for appropriate educational offerings. In this process, it was learned that many of these sources often directed the reader to external sources or links for more information. When this occurred, these new search directions were explored further for educational offerings. There were also numerous searches completed in electronic databases using keywords from the foundational report. The collection of keywords included: geriatric, older adult, geriatric assessor, medical history, surgical history, medication, social history, falls, function, cognition, mood, mental health, sleep, pain, nutrition, continence, physical assessment, interprofessional, curriculum and education. The databases used included the Education Resources Information Centre (ERIC) and Google. It was not the intent of this project to collect academic literature, therefore electronic databases for such content were not used. The search process evolved iteratively as the project team continued to search, identify, review and match educational offerings. Searches were discontinued at the point when no new educational offerings were being identified for a particular search term and when there were repetitions in the search results. Searches were conducted to find educational offerings in both English and French, which are colour coded in the compendium. Throughout this process, project partners from both Seniors Care Network and NESGC provided assistance when needed.
Two calls for feedback on both the compendium and any additional sources were sent out during the project. The first was directed to the RGPs of Ontario, and the second was disseminated to conference attendees at the RGPs of Ontario Annual Education Day. Project team members also attended the Education Day.
The project charter outlined the scope of the search as post-basic, formal (college, university) and informal (i.e. workshops, online modules) geriatric content. As the project team began identifying educational offerings and their differing characteristics, it was soon realized the need for an organizational scheme in the compendium.The project team decided to divide it into three sections. The first section, which houses all of the behavioural statements, contains educational offerings that are freely available and accessible online. Some of these require registration with the parent organization, but none have fees. There was a guiding rule established early in the project that it was ideal for educational offerings to be freely available and accessible. However, the project team did not want to disclude educational offerings that had costs. The second section was created to contain informal educational offerings that have fees. In this section, there are details provided about each of the educational offerings including cost, format of delivery, time requirement, and content information, when applicable.
The third section contains continuing professional development (CPD) or continuing education programs or courses offered by post-secondary institutions in Ontario and Quebec, which have associated fees. The search parameters outlined earlier did not capture this content, therefore an additional search strategy was needed. The report Health Workforce Education Needs for Seniors – Continuing Professional Development provided important background information for this section. The report contains a number of appendices with varying CPD programs and courses. To confirm the currency of these programs and courses, they were cross-checked with searches on both the ecampus Ontario website and on the website of each post-secondary institution itself. Once this process was complete, searches for additional programs and courses were completed on these sites. Specific searches were completed using the keywords dementia, aging, caregiving, older adult, geriatric, gerontology, continuing education, professional development, and open enrolment. Searching also included the navigation of CPD or continuing education program pages when they were available on institution websites. Full-time degree and diploma post-secondary programs were deliberately excluded, as well as courses that were requirements for such programs. Single courses and programs focusing on palliative and end of life care were also excluded because expertise in these areas is not a component of CGA.
The matching of CPD programs and courses to the behavioural statements is represented differently in this section of the compendium. The project team learned that recording the CPD programs and courses with a title and a hyperlink was insufficient because program components became separated among the behavioural statements. This section was organized by institution, program name, course names and course descriptions to keep program information grouped together. Each course description was added to the compendium and within this text made reference to the unique identifier of the matching behavioural statements, which are shown in parentheses and highlighted yellow.
The final result of this project is a 70 page compendium of educational offerings. It contains over 250 free resources that can be easily accessed online. These offerings vary widely in media type and include learning modules, powerpoint presentations, lecture slides, videos, pdf documents, and conference recordings, among others. In section two, more than 20 educational offerings are provided, mostly in the form of courses that can be taken online or in a classroom setting, such as Gentle Persuasive Approaches (GPA) in Dementia Care. These offerings have varying costs, time requirements and delivery methods. The third section includes over 15 CPD programs offered by colleges in Ontario and Quebec, as well as close to 10 CPD programs offered by universities. Most of these programs can be completed online. There are varying degrees of complexity across the entire compendium of resources, from a simple list of factors to consider when evaluating sleep in older adults, to a very comprehensive geriatric certificate program that is endorsed by McMaster University. Once a clinician has evaluated his or her learning needs using the Self-Assessment Tool, these compendium resources may be utilized to help increase competence in the practice areas of the CGA Framework.