Time to catch up: dementia, medical education and 21st-century healthcare
Dr Ellen Tullo is a Teaching and Research Fellow at the Biomedical Research Centre in Ageing at the University of Newcastle, UK. Her particular area of interest is in how we teach about dementia in order to improve outcomes for patients.
In centuries past, medical students in the UK studied rheumatic fever, smallpox and syphilis as a reflection of the needs of the community that they served. However medical advances and demographic change mean that health and social care professionals now face new challenges and opportunities. Many of these are related to ageing and the need to provide the best possible care to an increasing number of increasingly complex frail older patients. In this context, dementia is an area of current – and growing – importance.
Over the last decade, multiple national audits, reports and policy statements highlighted concerns about the care afforded to people with dementia in both primary and secondary care. The recurrent message from these documents was that education and training about dementia for health and social care professionals must improve.
Moreover, just in the last few weeks , the government's response to the Francis report reiterated the importance of the issue by affirming their commitment to improving dementia-related training for professionals. So the past decade of auditing, reporting and policy stating does not seem to have prompted the necessary change.
How should we take things forward?
Instigating appropriate and effective training about dementia cannot happen overnight. The focus of both undergraduate and postgraduate medical curricula traditionally lag behind demographic changes, epidemiological developments and healthcare innovations - not least because curriculum planning in medicine is a highly complex task. To truly emphasise the importance of dementia care for healthcare professionals, whatever specialty they ultimately pursue, requires fundamental changes to the current curricula of a wide range of medical specialties at progressive stages of training. However, early medical education is crucial to setting priorities for future professionals and must be a key focus for clinicians and educators who want to make a difference.
I recently led, with Adam Gordon, a national survey of UK medical schools about dementia-related education. This identified that dementia appears at least once in the curriculum of all responding schools. There were, however, problems. Learning outcomes about dementia care were not formally assessed in all schools, and a number of schools could not confirm whether students would ever come into contact with people with dementia or their carers. Whilst medical schools involved a range of medical specialists in teaching about dementia (old age psychiatrists, geriatricians and GPs most commonly), students were less likely to be taught by other members of the multi-professional team, risking a narrow view of dementia care.
The deficiencies in undergraduate medical education about dementia highlighted by the survey can, perhaps, more optimistically be viewed as immediate opportunities to start improving things. Whilst acknowledging that medical schools should retain the autonomy to develop their curriculum to suit local needs, we outlined in our paper a number of recommendations for improving integration of dementia care into medical education.
- Embed dementia as a core curriculum topic and consider the knowledge, skills and attitudes relevant to dementia care
- Use dementia teaching as an opportunity to explore behaviours and attitudes to encourage professional development
- Ensure that dementia-specific learning outcomes are assessed
- Involve the full multidisciplinary team in teaching.
- Involve people with dementia and their carers in teaching.
Geriatricians, whether in formal or informal educational roles, have the expertise to be leaders in bringing dementia-care to the heart of the undergraduate curriculum. It is time for us to play our part in ensuring that the evolution of medical education keeps apace with the changing needs of our older patients.