Abstract
Introduction
We know continence is important to older people but can often be overlooked in clinical practice. Continence can now be selected as a theme for service in the new geriatric medicine curriculum but there is concern that the uptake of this is poor. Our aim was to understand and quantify continence training opportunities and understand current and potential uptake of Continence as a Theme for Service.
Method
A short online survey was created and resident doctors training in geriatric medicine were invited to complete it from December 2024-April 2025. The survey was included in the BGS trainees bulletin in January 2025 and sent to trainee representatives to distribute.
Results
56 responses were received. Responses were from doctors from 12 regions and doctors from both early (48%) and late (52%) stages of training. Most responses reported including continence in a comprehensive geriatric assessment always, or almost always (55%), however most felt unconfident or very unconfident (52%) that they could meet the core continence curriculum outcomes. Only a small proportion of doctors from this sample were very likely, or likely, to pursue continence as a theme for service (9%). The most selected reason for not pursuing a theme for service in continence, following being more interested in another theme, was lack of access to specialist continence clinics (25%) and a lack of consultants with a specialist interest (8.9%).
Conclusion
Resident doctors training in geriatric medicine recognise continence as an important aspect of a comprehensive geriatric medicine. However, interest in continence as a theme for service is limited and lack of access to specialist clinics and training is a major factor in this. Ensuring resident doctors are aware of specialist clinics, and can access them, as well as consultants who have an interest, is key to improving interest in the sub-speciality.
Comments
Reflects personal experience
I'm a specialist registrar working in Northern Ireland, and to the best of my knowledge, none of us have chosen continence as our theme for service. Our TPD has been working hard at ensuring we are made aware of all opportunities available in different healthcare trusts, and as we tend to rotate through most if not all of these during our training, we have been able to gain relevant experience, but it is clear that widely more work needs to be done to improve uptake. Thanks for raising awareness of this, and for very relevant suggestions as to how we could develop this.
Thanks, it’s good to…
Thanks, it’s good to generate evidence that more needs to be done to support this area of training. Hannah did a great job collecting this data and highlighting the issue.
Useful project
I also agree that seems frustrating that continence has been added to the curriculum and is an increasingly acknowledged important area of CGA but there is limited opportunity to gain exposure in this area - it would be interesting to know the difference between DGH and tertiary opportunities and further develop ideas for how we can improve uptake and access to clinics but this would likely be in one hospital base.
Opportunity for Collaboration
This projects highlights some key aspects of the Theme for Service, we've certainly noticed issues with availability of specialist clinics & trainers for a few of the available themes so it is interesting to hear your recommendations. This is definitely an opportunity to collaborate more widely, I think it's helpful to see the Theme as only loosely based at a particularly hospital as one of the benefits will be seeing how that subspecialty is managed in different hospitals/locations.
A regional lead sounds helpful as having a clear point of contact; we have a Sharepoint for all geri's trainees in South Yorkshire and now have pages for the different Themes with details of contacts and useful tips - could a similar forum be created for sharing ideas more widely across/between regions, or an option to use the BGS website platform for this?
Timely reminder
hi - thanks for this timely reminder of a gap in my own knowledge and confidence. I had meant to arrange to get to a urogynae clinic and am pledging to do so!
Exactly my experience!
This project reflects exacty how my experience has been in gaining experience in continence training. Especially in relation to older patients. All of my sessions have been seeing young post partum women in pelvic floor PT sessions or urogynae clinics, then younger fit men in prostate clinics. The experience with community continence clinics and care home visits essentially seems to just be focussed on looking at what continence products are right for that patient, rather than treating incontinence in our cohort of patients. Surely, if continence is going to be a theme for service in our geriatric medicine training there should be better services available for our patients.
Poor uptake for theme for service
I fully appreciate the issues raised here - as far as I am aware there are no Mersey trainees who have chosen continence as their theme for service. From what I have heard from ST7 registrars who are due to CCT soon, continence is the aspect of the curriculum they have most trouble in attaining. There seems to be a distinct lack of continence services across the region and these few that are there vary greatly from hospital to hospital. We have found all 30+ registrars are all going to the same few clinics which doesn’t seem fair on those few physios, continence nurses, urogynae consultants, etc. I agree that there needs to be more training opportunities so that doctors will feel more inclined to take this up as a theme for service. Otherwise this theme for service should be changed for something else!
Really interesting to read…
Really interesting to read this. Through my foundation training I had a GP job in which continence disorders were commonly experienced. The consensus from a primary care point of view was that GPs found it difficult to manage these patients effectively, with limited availability of specialist support. It's interesting to see the other end, where training opportunity for COTE trainees seems sparse, and the issues that this raises.