A Slow Trickle: Addressing how limited Continence training impacts Geriatric Sub-specialisation

Introduction:

Continence optimisation, investigation and management is an essential part of any CGA¹, and its importance in Geriatric Medicine is reflected in the Higher Specialty Curriculum². Despite this, training in continence care is inadequate with limited opportunities to develop expertise and practical skills. As a result, few HSTs pursue Continence as a Theme for Service or feel equipped to lead on continence care post-CCT. Fragmented service provision by Urology, Gynaecology and Geriatric services undermines a holistic approach required when caring for the complexities of a frail elderly population.

To address this gap, we developed a Pan-London teaching programme for HSTs, in line with curriculum requirements and patient need. 

Method:

Training was delivered in hybrid format to optimise access with lecture-based teaching and simulation for those attending in-person. Pre- and post-course questionnaires assessed knowledge and confidence related to continence care, and attendee feedback facilitated content design of future Day 2 of the programme. 

Results:

Only 8% of course attendees reported planning to achieve Continence as their Theme of Service, whilst 58% reported remaining unsure.

Course feedback was overwhelmingly positive with an average rating of 4.83/5. Prior to the course, 95.8% of HSTs in attendance reported having “far too little” or “too little” training in Continence. Confidence in assessing continence as part of a CGA improved from 29% pre-course, to 94.5% post course. Only 25% of HSTs were “somewhat confident” at assessing patients as part of a specialty continence service prior to the teaching, but this improved to 94.5% being “confident” or “somewhat confident” after the training. 

Conclusions:

Geriatrics HSTs in the London region are keen to develop continence sub-specialty competencies but are limited by access to training opportunities. We propose that the well-recognised unmet need for continence care in older patients is reflected in, or perhaps even contributed to, by the unmet training need for continence education.

Focussed teaching on the sub-specialty resulted in increased knowledge and confidence, supporting the aim to embed this programme for Pan-London HSTs. We would advocate for similar reproducible teaching days to be more widely available in other regions. 

References:

1. Healy A, Ryan S, Brewer L, A Review of Patient Continence and Related Staff Knowledge on Specialist Geriatric Wards, Age and Ageing, Volume 53, Issue Supplement_4, September 2024, afae178.269,  [accessed online via: https://doi.org/10.1093/ageing/afae178.269]
2. Joint College of Physicians Training Board, Curriculum for Geriatric Medicine Training. Implementation August 2022. The Federation. [accessed online via: https://www.thefederation.uk/sites/default/files/Geriatric%2520Medicine…]