Setting competencies and standards for a European Leadership Program in Geriatric Medicine: “The European Academy for Medicine of Ageing (EAMA) reloaded”

Setting competencies and standards for a European Leadership Program in Geriatric Medicine:... Background The European Academy for Medicine of Ageing (EAMA) was founded in 1995 as an “Advanced Postgradu- ate Course in Geriatric Medicine”, in order to train future key opinion leaders in geriatric medicine. Recent changes across European Healthcare systems have changed the needs for leadership competences for geriatricians. Therefore, it became mandatory to further develop EAMA’s learning objectives catalogue. Materials and methods Following a comprehensive needs assessment among students and visiting professors of the EAMA, a template containing seven key domains derived from the needs assessment was developed. EAMA professors had the chance to feedback learning objectives aligned with the seven domains. Feedbacks were transcribed into a first draft of a learning objectives catalogue during this meeting. This first draft was reflected with EAMA network members (former EAMA stu - dents) and finalized following a second focus group among board members. Results 24 learning objectives which cover the spectrum of knowledge, skills and attitudes necessary to develop leadership roles in geriatric medicine are included in the new EAMA learning objectives catalogue. Rate of agreement achieved in open ratings was > 90% for all selected items among the board members. Conclusions The recently developed learning objectives catalogue of EAMA presented within this publication reflects a clear shift from knowledge-based education and training towards a comprehensive programme design for leadership development. Keywords European Academy for Medicine of Ageing · Learning objectives · Leadership programme · Competence based programme · Kirkpatrick evaluation Background leaders in the field to support professional development in all countries of Europe is strong. The concept of geriatric medicine has been proven ee ff ctive: The European Academy for Medicine of Ageing (EAMA) nowadays, the Comprehensive Geriatric Assessment repre- was founded in 1992 as an Advanced Postgraduate Course sents the gold standard for effective care of frail older peo - in Geriatric Medicine and addresses the demand for leader- ple, who are prone to functional decline [1]. However, post- ship in geriatric medicine across Europe [3]. Most of the graduate training in geriatric medicine varies across Europe, professors teaching in EAMA are former EAMA students. and consistent undergraduate teaching is still uncommon in Selections of students follow structured criteria of workforce this field [ 2]. Therefore, the demand to train trainers and experience and academic background. Since its inception the major objective has been to improve knowledge and skills in geriatric medicine for emerging leaders in geriatrics and to establish a network among those doctors responsible for the care of older people across Europe [4]. The 2 years course * Regina Elisabeth Roller-Wirnsberger Regina.Roller-Wirnsberger@medunigraz.at (provided as four 1-week life educational events) has out- lined clear learning objectives since then. Teaching methods Extended author information available on the last page of the article Vol.:(0123456789) 1 3 400 European Geriatric Medicine (2018) 9:399–406 included traditional class room teaching and learning sets aligned with Kirkpatrick’ evaluation criteria [6] of recent using interactive discussions and presentations, also given courses. by students. Both the teachers’ and students’ activities were In addition, informal and non-structured interviews with evaluated by students. expert teachers during their stay in EAMA, reflecting the Given the changes in public health due to ageing across current goals and learning objectives were performed. Con- Europe, the demand for progressive development of the tent was elaborated and extracted and, if possible, translated established EAMA program became evident [5]. The current into overarching domains. publication describes the process and results of the devel- Additionally, a structured focus group with participation of opment of a new learning objectives catalogue (LOC) for all EAMA board members was held. Like in the interviews attendees of EAMA. with expert teachers before, all domains to be covered due to board members’ opinion were collected. Domains were than clustered according to competence levels [7]. The objectives Methods detected were than transcribed into a template of learning objectives structured to Bloom’s taxonomy [8] and transfer- Needs assessment rable to Miller’s pyramid of competence [9] (see Fig. 1). Using this concept, it was possible to align learning con- To determine the needs for new learning objectives, authors tent with needs expressed by EAMA students. chose a multidimensional approach. The first draft of a learning objectives catalogue was A general needs assessment for leadership knowledge, than presented to board members of EAMA for further skills and attitudes was performed using feedback evaluation evaluation. Focus group of EAMA board members The first draft of learning objectives created upon student’s feedbacks and on written programme evaluation feedbacks from 2014 to 2016 and interviews is shown in Table 1. The draft included seven domains aligned with the Can- MedRoles [7]. EAMA Board members were given the opportunity to reflect upon these domains and to introduce possible learning objectives according to their individual experience. In a next step, the two coordinating board mem- bers (RRW, KS) transcribed the raw data into a learning cat- alogue format aligned with Miller’s pyramid of competence [10] (see Fig.  1) and used semantic background aligned with Bloom’s taxonomy [8]. The taxonomy describes a set Fig. 1 The concept of Miller’s pyramid of competences and how the of three hierarchical models used to classify educational level of learning objectives is aligned with educational levels [9] Table 1 The first draft of domains possibly to be covered in a new among EAMA students and visiting professors and built upon EAMA EAMA learning objectives catalogue. The domains were developed evaluation feedbacks from courses held from 2014 to 2016 according to the results obtained from an open needs assessment Domain Function as medical experts, integrating all roles of an expert to provide optimal, ethical and patient-centred medical care (e.g. basic and clinical research, profound competencies on knowledge and skills in all fields of geriatric medicine) Interpersonal and communication skills (e.g. presentation techniques, etc.) Development of geriatric services/administrative duties (e.g. project management, training on leadership, quality control, etc.) Interdisciplinary team management (including communication skills, etc.) Creation, dissemination, application and translation of medical knowledge (including educational skills, etc.) Advocacy of well-being of individual patients, communities, and populations (including advocacy of the specialisation of geriatric medicine, etc.) Self-management, self-resilience 1 3 European Geriatric Medicine (2018) 9:399–406 401 learning objectives into levels of complexity and specific- with its long standing tradition, however, could not contrib- ity. The three lists primary developed by Benjamin Bloom ute to the whole programme development as their visits usu- cover the learning objectives in cognitive, affective and sen - ally did not last longer than 2 days of a programme week. sory domains. The cognitive domain has mainly been used to structure curriculum learning objectives in the past [8]. Results from focus groups with EAMA board The first “raw version” of learning objectives was summa - members rised by the two coordinating board members. All 10 board members were then invited to rate the new learning objec- In a first raw version of the new learning objectives cata- tives catalogue in an open focus group format during one of logue, each of the seven domains (see Table  1) included the EAMA courses. detailed learning objectives created and suggested by board members. In total professors developed eleven up to 28 new Student’s feedback on preliminary draft of LOS learning objectives per domain (data not shown). catalogue The transcription of the LOs consented by the whole EAMA board finally contained overall 24 items which cover The preliminary version of the new learning objectives cata- the spectrum of knowledge, skills and attitudes necessary to logue was sent to five randomly assigned former EAMA develop leadership roles in geriatric medicine. Rate of agree- students (EAMA network members at advanced stage of ment achieved in open ratings was > 90% for all selected academic career and geographically distributed across the items among the board members. European Union) asking for feedback on the following Knowledge domains of the new EAMA curriculum parameters: relevance for further career planning, options mainly cover topics related to professional work of geriatri- for migration within the European Union, need for rephras- cians, critically reflecting daily business towards evidence, ing of learning objectives (LOs) for better understanding. but also considering strength of bottom-up approaches of Feedback was evaluated by the EAMA board members best practice models or eminence delivered by experts in independently, rated and transcribed and introduced in the the field (see Table  2). final draft of the learning objectives catalogue afterwards. Skills to be developed during the course were structured according to CanMed Roles [7], an educational framework Final focus group of experts developed by the Canadian Royal College in the 1990s. It describes the abilities that physicians require to effectively The final consensus building for LOs catalogue presented meet the health care needs of the people they serve. The in this paper was achieved by a teleconference call held on framework is organized into seven thematic groups of com- February 2017 among board members of EAMA. All board petencies, which are expressed as CanMed roles. members had been sent out the final proposal for the LOs The four domains developed for attitudes to be achieved catalogue including former students’ comments and board during the EAMA courses were strengthened by adding members’ reflections upon. All comments were discussed leadership competences (including service development) to and evaluated towards current training standards of the develop geriatric medicine at the national and international EAMA course and transferability to the future course outline level and to contribute to innovation and research. of EAMA as planned by the board. Results from EAMA network feedbacks Results Feedback from EAMA network members did not reveal any deletion or addition of new items in the list. Two stu- Results from needs assessment dents commented on the wording of communication and management competences learning objectives. One student The biggest strength of the EAMA programme outlined by requested to introduce “cultural differences in Europe” to be students was the network building. However, many students included in the wording of any of the learning objectives. A expressed their wish to change venue for the meetings. Stu- second comment pointed towards lobbying for partnerships dents felt that gain of knowledge was high. However, the exist- between the EAMA network members. ing learning style did not seem to support their personal learn- ing styles. Furthermore, the wish for extended training for Results from final focus group of the EAMA board leadership skills became obvious from the students’ feedback. Results from interviews with visiting professors in The board discussed openly and decided not to include the EAMA did not have high impact on the development of the two comments in the final version of the learning objectives primary LOs list. Visiting professors reflected upon EAMA catalogue as board members had the feeling the suggestions 1 3 402 European Geriatric Medicine (2018) 9:399–406 Table 2 Learning objectives for a full 2-year course of the European Academy of Medicine of Ageing (EAMA) Knowledge EAMA graduates will be able to… … plan care based on competent critical appraisal of evidence on micro (individual patient), meso (service) and macro (societal, public health) levels … synthesize an approach drawing upon the evidence base and adapting to complex patients … develop and apply a bio-psycho-social approach to relevant geriatric and gerontological topics informed by key international leaders … understand and translate basic or clinical research as an expert in geriatric medicine … compare and contrast the general structure of geriatric care from different European perspectives Skills Communication EAMA graduates will be able to… … review and select different established and emerging communication techniques, in order to improve communication with the target audience … interact effectively in different roles such as participant, chair or moderator in group discussions, giving feedback, etc. … successfully impart topics of geriatric medicine to different audiences, e.g. lay people, politicians, hospital administrators, allied health care professionals and colleagues in other disciplines to promote geriatric medicine …reflect the influence of sociocultural differences in communication and interaction and adapt own strategies accordingly …recognise, prevent and manage conflicts and crises (patient/family, colleagues, administrators …) Skills Leadership/leadership competence at microlevel EAMA graduates will be able to… …analyse personal strengths to be integrated into individuals’ leadership profiles …develop leadership competences in geriatric medicine including coaching, delegating, team building, etc. … analyse personal profile and strength within the interdisciplinary team … critically reflect upon personal career development, plans and strategies and to identify specific objectives leading towards a career plan for him/herself as well as mentees Skills Leadership competence at mesolevel EAMA graduates will be able to… … synthesize various inter- and multi-professional aspects of a geriatric team towards a common therapeutic plan of care reflecting patient- centred outcomes … coach change management in geriatric medicine based on evidence, lead and broaden implementation processes to scale up .. develop new geriatric services or adapt geriatric services to new situations, considering both, scientific advances and local requirements and needs … improve quality in daily practice by critical use of elements of quality management, e.g. development of a quality improvement (PDSA) cycle, etc. Skills Leadership competence at macrolevel EAMA graduates will be able to… …establish and maintain active networks across Europe and the rest of the world Skills Research EAMA graduates will be able to… … identify clinical problems, critically appraise evidence for solutions and generate new research questions (innovation cycle) … exploit research questions into sustainable networks and funding structures (including project management, formation of consortia and others) Skills Education and teaching EAMA graduates will be able to… … create and adapt learning objectives and teaching strategies to target groups and in order to transfer knowledge and understanding … improve personal teaching competences by critical analysis of board members’ performances, expert and student speakers … create a network to European organisations linked with geriatric medicine and care in order to contribute to trans-national teaching or research activities … choose and develop learning action sets and teaching strategies (communication, considering communication towards target groups) Skills Advocacy EAMA graduates will be able to… … demonstrate behaviours as an ambassador of geriatric medicine and the needs of older people locally and globally (e.g. influence decision makers, create lobbying partnership with EU/WHO) … critically appraise the policy of establishments and influence those by using tools acquired in EAMA 1 3 European Geriatric Medicine (2018) 9:399–406 403 Table 2 (continued) Attitudes EAMA graduates will be able to… …develop a reflective, ethically reasoned attitude on health and life in old age and implement it into daily practice, research and teaching activi- ties … develop a personal behaviour to positively contribute to social innovation, e.g. care giver and patient empowerment … develop coping strategies towards criticism and negative impact. … critically appraise personal activity levels and potential as well as to modulate daily business efficiently (improvement of work-life balance, time management, etc.) to maintain the utmost personal resilience were very specific and covered by the final version of the 1. Problem Identification- catalogue anyway. General Needs Assessment Discussion 2. Targeted Needs 6. Evaluation and Assessment Feedback The European Academy for Medicine of Ageing has a long standing tradition in training of future key opinion leaders in the field of geriatric medicine. Programme evaluation has been the key ever since EAMA has been established. Due 5. Implementation 3. Goals andObjectives to evaluation reports of the programme as well as changing demands for geriatricians in the light of changes in European health care systems, the advancement of the EAMA curricu- lum became mandatory. 4. Educational Strategies Therefore, EAMA has gone through substantial curricular changes over the past 5 years. The current paper describes the development of the latest version of the EAMA learning Fig. 2 Kern’s six step approach for curricular development [10]. Each general needs assessment for development is followed by a detailed objectives catalogue. All steps described in this publication needs analysis to develop targeted programme goals and objectives. have been planned according to Kern’s six step approach Learning environment and methodology have to be tailored accord- [10] (see Fig. 2). ing to the competence-based learning objectives developed within the Students and teachers were involved into the needs assess- Kern cycle and implementation of changes has to be monitored by evaluation closely to ensure a goal oriented programme design ment process in an inclusive fashion and over a 12-month period, building a comprehensive mind map of all seman- tic and unstructured feedbacks collected during the EAMA the core content of the EAMA programme currently seems courses. to address the needs of young expert geriatricians in daily The board chose to use an open focus group (expert work and competition within various health care systems panel) approach to develop a core set of learning objectives across Europe and also abroad. The new LOs Catalogue is, to be covered during the 4-week courses. Doing so, the therefore, in line with WHO recommendations on workforce board finally agreed upon an LOs catalogue, which is out- development published in 2013 [11]. lined in Table 2. As may be seen from the table, the majority An additional strength of our approach is the align- of LOs is attributed to skills. Communication, leadership ment with other recent educational developments in the competencies at all levels of the public health care system field of geriatric medicine such as European undergradu- for older people are the main domains covered by the new ate curriculum for geriatric competences in undergradu- LOs catalogue of EAMA. These skills shall be carried by a ate medical education [12]. 7/10 EAMA board members set of attitudes supporting innovation and research and advo- are also members of the core group development of the cacy for older people. Only few LOs encounter knowledge undergraduate and/or postgraduate curriculum in geriatric and the skill to critically appraise research, innovation and medicine. It may be seen from the objectives developed for evidence gathered in the care of older patients. undergraduate students that they clearly differ in terms of One major strength of the data presented here is the high competence and domains covered [12]. Similarly, recom- internal consistency of feedbacks during the focus groups mendations for core competences in postgraduate train- among the board members (higher than 90% for all items). ing of future geriatricians in Europe are under develop- Comments by former students underlined the need for a ment by the European Union Geriatric Medicine Society strong focus on leadership skills as outlined. Therefore, 1 3 404 European Geriatric Medicine (2018) 9:399–406 (EuGMS), Union European Medicine Societe-Geriatric of reflections received from end users as well as experts on Medicine Section (UEMS-GMS), European Academy for top of their career in the field of geriatric medicine. Medicine of Ageing (EAMA) and the International Asso- Furthermore, goal orientation of the new objectives ciation of Geriatrics and Gerontology European Region was the key for the EAMA board, following the six-step (IAGG-EUR). This joint effort of geriatricians from many approach by Kern [10]. The high degree of consensus among European Member States tries to align content with under- EAMA board members during the focus groups (internal graduate as well as leadership programmes, designing an consistency) and final feedbacks from EAMA network mem- integrated spiral curriculum for career development in ger- bers also reflect the comprehensiveness of the process as a iatric medicine as first described by Jerome Bruner in 1960 whole. and developed by colleges over the past decades [13, 14]. The new EAMA learning objectives catalogue has impli- Using this “harmonising approach” it is to be expected cations for practice during the courses. Learners’ experi- that a well-defined programme for geriatric education fos- ences within the EAMA course differ in their level of exper - tering entrepreneurship in geriatric training will be avail- tise, individual constraints and preferences when starting able by the end of 2018 ( h tt p: // e c. e ur op a .e u /e d uc a t io n/ the programme. It is, therefore, EAMA’s task to provide an polic y/s tr at egic-fr ame w or k/entr e pr ene urshi p_en). This environment and the resources in which each learner can development of a comprehensive career model in geriatric develop according to their own learning style, pace and level medicine will strengthen geriatric training across Europe of experience [15]. The EAMA board members have, there- [11]. fore, started to cluster learning objectives for the training The recently developed LOs catalogue of EAMA pre- weeks and to design the programme accordingly. Teaching sented within this publication reflects a clear shift from methods introduced to the programme have shifted towards knowledge-based education and training towards a compre- a proactive role of students and putting the teachers in a role hensive programme design for leadership development. This of coaches. Going through the literature, it becomes clear may be seen as another strength of this work. As a conse- that the capability of faculty members as role models has quence, EAMA has changed its teaching methods towards an impact on the success and sustainability of continuous a more and more interactive and self-reflecting teaching educational programs teaching content on professionalism. environment with active students’ involvement. Students A role model faculty member is additionally effective in are given tasks to be solved in groups with predefined roles transferring hidden curriculum that includes all activities within the groups. This concept aims to strengthen the learn- and teachings that happen outside the formal curriculum ers’ self-concept (“I am responsible for my own decisions, and is learnt through behaviours and attitudes of faculty however, contributing to the group’s success”). Changing members [16]. environments unexpectedly during tasks aims to improve The development of the new EAMA learning objectives students’ readiness to learn and to provide them with neces- catalogue and introducing elements of modern adult educa- sary responsibility to adapt to changing situations. tion theories in the recent development poses the European The role of the teachers and board members in the EAMA Academy of Medicine of Ageing upfront all postgraduate more and more shifts towards a coaching position, providing life educational programmes currently provided. Training mentorship and improving motivation and orientation dur- future key opinion leaders in the field of geriatric medicine ing the learning experience. This approach has been proven brings EAMA into focus of future educational develop- effective and sustainable in adult education elsewhere in the ments. Especially, the need for high stakes multi-profes- literature [15]. As programme evaluation reports from stu- sional education will be in the focus of EAMA. Reaching dents in EAMA show (data not shown in this publication) out the programme towards changes and needs of health the new model of teaching is well perceived and EAMA care systems, to better scope with the needs of the older trainees feel a clear benefit from EAMA for their profes- population in the context of multi-disciplinary services, will sional lives at their home working places [16]. be one of the future directions to go. The current EAMA One of the major drawbacks of the work described is educational programme, built on the new learning objectives the small group of board members involved in the content catalogue and training environment, is the core to face these development. At first sight, the LOs catalogue outlined in future challenges. this paper was built on the experience and view of only 10 Acknowledgements Open access funding provided by Medical Uni- EAMA board members currently running the EAMA pro- versity of Graz. The authors wish to thank all former board members gramme. However, to address this shortcoming two steps for their continuous support of this programme. Furthermore, the were implemented during the process as outlined in the authors wish to thank Mieke Laforce and Janet Weinberger for the methods section: focus groups of board members with needs office support. assessment derived from students’ feedback and evaluation reports and professors’ interviews. This led to the inclusion 1 3 European Geriatric Medicine (2018) 9:399–406 405 Funding This research did not receive any specific grant from funding the future teachers in geriatrics: the 10-year success story of the agencies in the public, commercial, or not-for-profit sectors. European Academy for Medicine of Aging. Geriatr Gerontol Int 5(2):82–88. https ://doi.org/10.1111/j.1447-0594.2005.00287 .x 5. Roller RE, Petermans J (2015) Education and training in geriatrics Compliance with ethical standards in the 21st century—where do we come from—where do we go? Eur Geriatr Med 6(3):205–207. https ://doi.org/10.1016/j.eurge Conflict of interest The authors have no financial conflict of interest r.2014.12.001 developing the programme. They teach out of pleasure. 6. Moreau KA (2017) Has the new Kirkpatrick generation built a better hammer for our evaluation toolbox? Med Teach 39(9):999– Ethical approval This article does not contain any studies with human 1001. https ://doi.org/10.1080/01421 59X.2017.13378 74 participants or animals performed by any of the authors. 7. Frank JR, Snell L, Sherbino J (eds) (2015) CanMEDS 2015 phy- sician competency framework. Royal College of Physicians and Informed consent For this type of study formal consent is not required. Surgeons of Canada, Ottawa 8. Krathwohl DR (2002) A revision of Bloom’s taxonomy: an over- view. Theory Pract 41(4):212–218. https: //doi.org/10.1207/s1543 Open Access This article is distributed under the terms of the Crea- 0421t ip410 4_2 tive Commons Attribution 4.0 International License (http://creat iveco 9. Miller GE (1990) The assessment of clinical skills/competence/ mmons.or g/licenses/b y/4.0/), which permits unrestricted use, distribu- performance. Acad Med 65(9 Suppl):S63–S67 tion, and reproduction in any medium, provided you give appropriate 10. Thomas PA, Kern DE, Hughes MT, Chen BY (2015) Curriculum credit to the original author(s) and the source, provide a link to the development for medical education: a six step approach. 3rd edn. Creative Commons license, and indicate if changes were made. The John’s Hopkins Development Program. The John’s Hopkins University Schoool of Medicine, Baltimore, Maryland 11. World Health Organisation (2013) Transforming and scaling up health professionals’ education and training: world health organi- References zation guidelines 2013. World Health Organization, Geneva 12. Masud T, Blundell A, Gordon AL, Mulpeter K, Roller R, Singler 1. Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Har- K, Goeldlin A, Stuck A (2014) European undergraduate curricu- wood RH, Conroy SP, Kircher T, Somme D, Saltvedt I, Wald H, lum in geriatric medicine developed using an international modi- O’Neill D, Robinson D, Shepperd S (2017) Comprehensive geri- fied Delphi technique. Age Ageing 43(5):695–702. https ://doi. atric assessment for older adults admitted to hospital. Cochrane org/10.1093/agein g/afu01 9 Database Syst Rev 9:Cd006211. https ://doi.org/10.1002/14651 13. Bruner JS (1977) The process of education. Harvard University 858.cd006 211.pub3 Press, Oxford 2. Singler K, Sieber CC, Biber R, Roller RE (2013) Considera- 14. Harden RM (1999) What is a spiral curriculum? Med Teach tions for the development of an undergraduate curriculum in 21(2):141–143. https ://doi.org/10.1080/01421 59997 9752 geriatric medicine. Gerontology 59(5):385–391. https ://doi. 15. Taylor DC, Hamdy H (2013) Adult learning theories: implica- org/10.1159/00034 6511 tions for learning and teaching in medical education: AMEE 3. Swine C, Michel JP, Duursma S, Grimley Evans J, Staehelin guide no. 83. Med Teach 35(11):e1561–e1572. https ://doi. HB (2004) Evaluation of the European Academy for Medicine org/10.3109/01421 59x.2013.82815 3 of Ageing “Teaching the Teachers” program (EAMA course II 16. Knowles MS, Holton EF, Swanson RA (2012) The adult learner: 1997–1998). J Nutr Health Aging 8(3):181–186 the definitive classic in adult education and human resource devel- 4. Bonin-Guillaume S, Kressig RW, Gavazzi G, Jacques MC, Cheval- opment, 7th edn. Routlege, New York ley T, Pautex S, Vischer U, Zekry D, Michel JP (2005) Teaching Affiliations 1,2 1,3 1,4 Regina Elisabeth RollerW ‑ irnsberger  · Nele van den Noortgate  · Sylvie Bonin‑Guillaume  · 1,5 1,6 1,7,8 1,9 1,10 Karen Andersen‑Ranberg  · Anette Hylen Ranhoff  · Thomas Münzer  · Tomasz Grodzicki  · Simon Conroy  · 1,11 12 13,14 15 16 Francesco Landi  · Louis Mieiro  · Ulrike Dapp  · Robertus van Deelen  · Rannveig Sakshaug Eldholm  · 17 1,18,19 Nicolas Martinez‑Velilla  · Katrin Singler 1 7 Board of the European Academy for Medicine of Ageing Geriatrische Klinik, St. Gallen, Switzerland (EAMA), Ghent, Belgium Department of Geriatrics, University of Zürich, Zürich, Department of Internal Medicine, Medical University Switzerland of Graz, Auenbruggerplatz 15, 8036 Graz, Austria Department of Internal Medicine and Geriatrics, Jagiellonian Department of Geriatric Medicine, Ghent University, Ghent, University Medical College, Kraków, Poland Belgium Department of Health Science, University of Leicester, Department of Geriatric Medicine, Aix Marseille University, Leicester, UK Marseille, France Department of Geriatrics and Rehabilitation, Catholic Department of Geriatrics, Odense University Hospital, University of Sacred Heart, Rome, Italy Odense, Denmark MRC Unit for Lifelong Health and Ageing, University University of Bergen, Bergen, Norway College London, London, UK 1 3 406 European Geriatric Medicine (2018) 9:399–406 13 17 Department of Geriatrics, Albertinen-Haus Hamburg, Servicio de Geriatría, Complejo Hospitalario de Navarra, Hamburg, Germany Pamplona, Spain 14 18 Scientific Department, University of Hamburg, Hamburg, Institute of Biomedicine of Ageing, Friedrich Alexander Germany University Erlangen-Nürnberg, Erlangen, Germany 15 19 Department of Geriatrics, Spaarne Gasthuis, Haarlem, Department of Geriatrics, Klinikum Nürnberg, Paracelsus The Netherlands Private Medical University, Nuremberg, Germany Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway 1 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Geriatric Medicine Springer Journals

Setting competencies and standards for a European Leadership Program in Geriatric Medicine: “The European Academy for Medicine of Ageing (EAMA) reloaded”

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Abstract

Background The European Academy for Medicine of Ageing (EAMA) was founded in 1995 as an “Advanced Postgradu- ate Course in Geriatric Medicine”, in order to train future key opinion leaders in geriatric medicine. Recent changes across European Healthcare systems have changed the needs for leadership competences for geriatricians. Therefore, it became mandatory to further develop EAMA’s learning objectives catalogue. Materials and methods Following a comprehensive needs assessment among students and visiting professors of the EAMA, a template containing seven key domains derived from the needs assessment was developed. EAMA professors had the chance to feedback learning objectives aligned with the seven domains. Feedbacks were transcribed into a first draft of a learning objectives catalogue during this meeting. This first draft was reflected with EAMA network members (former EAMA stu - dents) and finalized following a second focus group among board members. Results 24 learning objectives which cover the spectrum of knowledge, skills and attitudes necessary to develop leadership roles in geriatric medicine are included in the new EAMA learning objectives catalogue. Rate of agreement achieved in open ratings was > 90% for all selected items among the board members. Conclusions The recently developed learning objectives catalogue of EAMA presented within this publication reflects a clear shift from knowledge-based education and training towards a comprehensive programme design for leadership development. Keywords European Academy for Medicine of Ageing · Learning objectives · Leadership programme · Competence based programme · Kirkpatrick evaluation Background leaders in the field to support professional development in all countries of Europe is strong. The concept of geriatric medicine has been proven ee ff ctive: The European Academy for Medicine of Ageing (EAMA) nowadays, the Comprehensive Geriatric Assessment repre- was founded in 1992 as an Advanced Postgraduate Course sents the gold standard for effective care of frail older peo - in Geriatric Medicine and addresses the demand for leader- ple, who are prone to functional decline [1]. However, post- ship in geriatric medicine across Europe [3]. Most of the graduate training in geriatric medicine varies across Europe, professors teaching in EAMA are former EAMA students. and consistent undergraduate teaching is still uncommon in Selections of students follow structured criteria of workforce this field [ 2]. Therefore, the demand to train trainers and experience and academic background. Since its inception the major objective has been to improve knowledge and skills in geriatric medicine for emerging leaders in geriatrics and to establish a network among those doctors responsible for the care of older people across Europe [4]. The 2 years course * Regina Elisabeth Roller-Wirnsberger Regina.Roller-Wirnsberger@medunigraz.at (provided as four 1-week life educational events) has out- lined clear learning objectives since then. Teaching methods Extended author information available on the last page of the article Vol.:(0123456789) 1 3 400 European Geriatric Medicine (2018) 9:399–406 included traditional class room teaching and learning sets aligned with Kirkpatrick’ evaluation criteria [6] of recent using interactive discussions and presentations, also given courses. by students. Both the teachers’ and students’ activities were In addition, informal and non-structured interviews with evaluated by students. expert teachers during their stay in EAMA, reflecting the Given the changes in public health due to ageing across current goals and learning objectives were performed. Con- Europe, the demand for progressive development of the tent was elaborated and extracted and, if possible, translated established EAMA program became evident [5]. The current into overarching domains. publication describes the process and results of the devel- Additionally, a structured focus group with participation of opment of a new learning objectives catalogue (LOC) for all EAMA board members was held. Like in the interviews attendees of EAMA. with expert teachers before, all domains to be covered due to board members’ opinion were collected. Domains were than clustered according to competence levels [7]. The objectives Methods detected were than transcribed into a template of learning objectives structured to Bloom’s taxonomy [8] and transfer- Needs assessment rable to Miller’s pyramid of competence [9] (see Fig. 1). Using this concept, it was possible to align learning con- To determine the needs for new learning objectives, authors tent with needs expressed by EAMA students. chose a multidimensional approach. The first draft of a learning objectives catalogue was A general needs assessment for leadership knowledge, than presented to board members of EAMA for further skills and attitudes was performed using feedback evaluation evaluation. Focus group of EAMA board members The first draft of learning objectives created upon student’s feedbacks and on written programme evaluation feedbacks from 2014 to 2016 and interviews is shown in Table 1. The draft included seven domains aligned with the Can- MedRoles [7]. EAMA Board members were given the opportunity to reflect upon these domains and to introduce possible learning objectives according to their individual experience. In a next step, the two coordinating board mem- bers (RRW, KS) transcribed the raw data into a learning cat- alogue format aligned with Miller’s pyramid of competence [10] (see Fig.  1) and used semantic background aligned with Bloom’s taxonomy [8]. The taxonomy describes a set Fig. 1 The concept of Miller’s pyramid of competences and how the of three hierarchical models used to classify educational level of learning objectives is aligned with educational levels [9] Table 1 The first draft of domains possibly to be covered in a new among EAMA students and visiting professors and built upon EAMA EAMA learning objectives catalogue. The domains were developed evaluation feedbacks from courses held from 2014 to 2016 according to the results obtained from an open needs assessment Domain Function as medical experts, integrating all roles of an expert to provide optimal, ethical and patient-centred medical care (e.g. basic and clinical research, profound competencies on knowledge and skills in all fields of geriatric medicine) Interpersonal and communication skills (e.g. presentation techniques, etc.) Development of geriatric services/administrative duties (e.g. project management, training on leadership, quality control, etc.) Interdisciplinary team management (including communication skills, etc.) Creation, dissemination, application and translation of medical knowledge (including educational skills, etc.) Advocacy of well-being of individual patients, communities, and populations (including advocacy of the specialisation of geriatric medicine, etc.) Self-management, self-resilience 1 3 European Geriatric Medicine (2018) 9:399–406 401 learning objectives into levels of complexity and specific- with its long standing tradition, however, could not contrib- ity. The three lists primary developed by Benjamin Bloom ute to the whole programme development as their visits usu- cover the learning objectives in cognitive, affective and sen - ally did not last longer than 2 days of a programme week. sory domains. The cognitive domain has mainly been used to structure curriculum learning objectives in the past [8]. Results from focus groups with EAMA board The first “raw version” of learning objectives was summa - members rised by the two coordinating board members. All 10 board members were then invited to rate the new learning objec- In a first raw version of the new learning objectives cata- tives catalogue in an open focus group format during one of logue, each of the seven domains (see Table  1) included the EAMA courses. detailed learning objectives created and suggested by board members. In total professors developed eleven up to 28 new Student’s feedback on preliminary draft of LOS learning objectives per domain (data not shown). catalogue The transcription of the LOs consented by the whole EAMA board finally contained overall 24 items which cover The preliminary version of the new learning objectives cata- the spectrum of knowledge, skills and attitudes necessary to logue was sent to five randomly assigned former EAMA develop leadership roles in geriatric medicine. Rate of agree- students (EAMA network members at advanced stage of ment achieved in open ratings was > 90% for all selected academic career and geographically distributed across the items among the board members. European Union) asking for feedback on the following Knowledge domains of the new EAMA curriculum parameters: relevance for further career planning, options mainly cover topics related to professional work of geriatri- for migration within the European Union, need for rephras- cians, critically reflecting daily business towards evidence, ing of learning objectives (LOs) for better understanding. but also considering strength of bottom-up approaches of Feedback was evaluated by the EAMA board members best practice models or eminence delivered by experts in independently, rated and transcribed and introduced in the the field (see Table  2). final draft of the learning objectives catalogue afterwards. Skills to be developed during the course were structured according to CanMed Roles [7], an educational framework Final focus group of experts developed by the Canadian Royal College in the 1990s. It describes the abilities that physicians require to effectively The final consensus building for LOs catalogue presented meet the health care needs of the people they serve. The in this paper was achieved by a teleconference call held on framework is organized into seven thematic groups of com- February 2017 among board members of EAMA. All board petencies, which are expressed as CanMed roles. members had been sent out the final proposal for the LOs The four domains developed for attitudes to be achieved catalogue including former students’ comments and board during the EAMA courses were strengthened by adding members’ reflections upon. All comments were discussed leadership competences (including service development) to and evaluated towards current training standards of the develop geriatric medicine at the national and international EAMA course and transferability to the future course outline level and to contribute to innovation and research. of EAMA as planned by the board. Results from EAMA network feedbacks Results Feedback from EAMA network members did not reveal any deletion or addition of new items in the list. Two stu- Results from needs assessment dents commented on the wording of communication and management competences learning objectives. One student The biggest strength of the EAMA programme outlined by requested to introduce “cultural differences in Europe” to be students was the network building. However, many students included in the wording of any of the learning objectives. A expressed their wish to change venue for the meetings. Stu- second comment pointed towards lobbying for partnerships dents felt that gain of knowledge was high. However, the exist- between the EAMA network members. ing learning style did not seem to support their personal learn- ing styles. Furthermore, the wish for extended training for Results from final focus group of the EAMA board leadership skills became obvious from the students’ feedback. Results from interviews with visiting professors in The board discussed openly and decided not to include the EAMA did not have high impact on the development of the two comments in the final version of the learning objectives primary LOs list. Visiting professors reflected upon EAMA catalogue as board members had the feeling the suggestions 1 3 402 European Geriatric Medicine (2018) 9:399–406 Table 2 Learning objectives for a full 2-year course of the European Academy of Medicine of Ageing (EAMA) Knowledge EAMA graduates will be able to… … plan care based on competent critical appraisal of evidence on micro (individual patient), meso (service) and macro (societal, public health) levels … synthesize an approach drawing upon the evidence base and adapting to complex patients … develop and apply a bio-psycho-social approach to relevant geriatric and gerontological topics informed by key international leaders … understand and translate basic or clinical research as an expert in geriatric medicine … compare and contrast the general structure of geriatric care from different European perspectives Skills Communication EAMA graduates will be able to… … review and select different established and emerging communication techniques, in order to improve communication with the target audience … interact effectively in different roles such as participant, chair or moderator in group discussions, giving feedback, etc. … successfully impart topics of geriatric medicine to different audiences, e.g. lay people, politicians, hospital administrators, allied health care professionals and colleagues in other disciplines to promote geriatric medicine …reflect the influence of sociocultural differences in communication and interaction and adapt own strategies accordingly …recognise, prevent and manage conflicts and crises (patient/family, colleagues, administrators …) Skills Leadership/leadership competence at microlevel EAMA graduates will be able to… …analyse personal strengths to be integrated into individuals’ leadership profiles …develop leadership competences in geriatric medicine including coaching, delegating, team building, etc. … analyse personal profile and strength within the interdisciplinary team … critically reflect upon personal career development, plans and strategies and to identify specific objectives leading towards a career plan for him/herself as well as mentees Skills Leadership competence at mesolevel EAMA graduates will be able to… … synthesize various inter- and multi-professional aspects of a geriatric team towards a common therapeutic plan of care reflecting patient- centred outcomes … coach change management in geriatric medicine based on evidence, lead and broaden implementation processes to scale up .. develop new geriatric services or adapt geriatric services to new situations, considering both, scientific advances and local requirements and needs … improve quality in daily practice by critical use of elements of quality management, e.g. development of a quality improvement (PDSA) cycle, etc. Skills Leadership competence at macrolevel EAMA graduates will be able to… …establish and maintain active networks across Europe and the rest of the world Skills Research EAMA graduates will be able to… … identify clinical problems, critically appraise evidence for solutions and generate new research questions (innovation cycle) … exploit research questions into sustainable networks and funding structures (including project management, formation of consortia and others) Skills Education and teaching EAMA graduates will be able to… … create and adapt learning objectives and teaching strategies to target groups and in order to transfer knowledge and understanding … improve personal teaching competences by critical analysis of board members’ performances, expert and student speakers … create a network to European organisations linked with geriatric medicine and care in order to contribute to trans-national teaching or research activities … choose and develop learning action sets and teaching strategies (communication, considering communication towards target groups) Skills Advocacy EAMA graduates will be able to… … demonstrate behaviours as an ambassador of geriatric medicine and the needs of older people locally and globally (e.g. influence decision makers, create lobbying partnership with EU/WHO) … critically appraise the policy of establishments and influence those by using tools acquired in EAMA 1 3 European Geriatric Medicine (2018) 9:399–406 403 Table 2 (continued) Attitudes EAMA graduates will be able to… …develop a reflective, ethically reasoned attitude on health and life in old age and implement it into daily practice, research and teaching activi- ties … develop a personal behaviour to positively contribute to social innovation, e.g. care giver and patient empowerment … develop coping strategies towards criticism and negative impact. … critically appraise personal activity levels and potential as well as to modulate daily business efficiently (improvement of work-life balance, time management, etc.) to maintain the utmost personal resilience were very specific and covered by the final version of the 1. Problem Identification- catalogue anyway. General Needs Assessment Discussion 2. Targeted Needs 6. Evaluation and Assessment Feedback The European Academy for Medicine of Ageing has a long standing tradition in training of future key opinion leaders in the field of geriatric medicine. Programme evaluation has been the key ever since EAMA has been established. Due 5. Implementation 3. Goals andObjectives to evaluation reports of the programme as well as changing demands for geriatricians in the light of changes in European health care systems, the advancement of the EAMA curricu- lum became mandatory. 4. Educational Strategies Therefore, EAMA has gone through substantial curricular changes over the past 5 years. The current paper describes the development of the latest version of the EAMA learning Fig. 2 Kern’s six step approach for curricular development [10]. Each general needs assessment for development is followed by a detailed objectives catalogue. All steps described in this publication needs analysis to develop targeted programme goals and objectives. have been planned according to Kern’s six step approach Learning environment and methodology have to be tailored accord- [10] (see Fig. 2). ing to the competence-based learning objectives developed within the Students and teachers were involved into the needs assess- Kern cycle and implementation of changes has to be monitored by evaluation closely to ensure a goal oriented programme design ment process in an inclusive fashion and over a 12-month period, building a comprehensive mind map of all seman- tic and unstructured feedbacks collected during the EAMA the core content of the EAMA programme currently seems courses. to address the needs of young expert geriatricians in daily The board chose to use an open focus group (expert work and competition within various health care systems panel) approach to develop a core set of learning objectives across Europe and also abroad. The new LOs Catalogue is, to be covered during the 4-week courses. Doing so, the therefore, in line with WHO recommendations on workforce board finally agreed upon an LOs catalogue, which is out- development published in 2013 [11]. lined in Table 2. As may be seen from the table, the majority An additional strength of our approach is the align- of LOs is attributed to skills. Communication, leadership ment with other recent educational developments in the competencies at all levels of the public health care system field of geriatric medicine such as European undergradu- for older people are the main domains covered by the new ate curriculum for geriatric competences in undergradu- LOs catalogue of EAMA. These skills shall be carried by a ate medical education [12]. 7/10 EAMA board members set of attitudes supporting innovation and research and advo- are also members of the core group development of the cacy for older people. Only few LOs encounter knowledge undergraduate and/or postgraduate curriculum in geriatric and the skill to critically appraise research, innovation and medicine. It may be seen from the objectives developed for evidence gathered in the care of older patients. undergraduate students that they clearly differ in terms of One major strength of the data presented here is the high competence and domains covered [12]. Similarly, recom- internal consistency of feedbacks during the focus groups mendations for core competences in postgraduate train- among the board members (higher than 90% for all items). ing of future geriatricians in Europe are under develop- Comments by former students underlined the need for a ment by the European Union Geriatric Medicine Society strong focus on leadership skills as outlined. Therefore, 1 3 404 European Geriatric Medicine (2018) 9:399–406 (EuGMS), Union European Medicine Societe-Geriatric of reflections received from end users as well as experts on Medicine Section (UEMS-GMS), European Academy for top of their career in the field of geriatric medicine. Medicine of Ageing (EAMA) and the International Asso- Furthermore, goal orientation of the new objectives ciation of Geriatrics and Gerontology European Region was the key for the EAMA board, following the six-step (IAGG-EUR). This joint effort of geriatricians from many approach by Kern [10]. The high degree of consensus among European Member States tries to align content with under- EAMA board members during the focus groups (internal graduate as well as leadership programmes, designing an consistency) and final feedbacks from EAMA network mem- integrated spiral curriculum for career development in ger- bers also reflect the comprehensiveness of the process as a iatric medicine as first described by Jerome Bruner in 1960 whole. and developed by colleges over the past decades [13, 14]. The new EAMA learning objectives catalogue has impli- Using this “harmonising approach” it is to be expected cations for practice during the courses. Learners’ experi- that a well-defined programme for geriatric education fos- ences within the EAMA course differ in their level of exper - tering entrepreneurship in geriatric training will be avail- tise, individual constraints and preferences when starting able by the end of 2018 ( h tt p: // e c. e ur op a .e u /e d uc a t io n/ the programme. It is, therefore, EAMA’s task to provide an polic y/s tr at egic-fr ame w or k/entr e pr ene urshi p_en). This environment and the resources in which each learner can development of a comprehensive career model in geriatric develop according to their own learning style, pace and level medicine will strengthen geriatric training across Europe of experience [15]. The EAMA board members have, there- [11]. fore, started to cluster learning objectives for the training The recently developed LOs catalogue of EAMA pre- weeks and to design the programme accordingly. Teaching sented within this publication reflects a clear shift from methods introduced to the programme have shifted towards knowledge-based education and training towards a compre- a proactive role of students and putting the teachers in a role hensive programme design for leadership development. This of coaches. Going through the literature, it becomes clear may be seen as another strength of this work. As a conse- that the capability of faculty members as role models has quence, EAMA has changed its teaching methods towards an impact on the success and sustainability of continuous a more and more interactive and self-reflecting teaching educational programs teaching content on professionalism. environment with active students’ involvement. Students A role model faculty member is additionally effective in are given tasks to be solved in groups with predefined roles transferring hidden curriculum that includes all activities within the groups. This concept aims to strengthen the learn- and teachings that happen outside the formal curriculum ers’ self-concept (“I am responsible for my own decisions, and is learnt through behaviours and attitudes of faculty however, contributing to the group’s success”). Changing members [16]. environments unexpectedly during tasks aims to improve The development of the new EAMA learning objectives students’ readiness to learn and to provide them with neces- catalogue and introducing elements of modern adult educa- sary responsibility to adapt to changing situations. tion theories in the recent development poses the European The role of the teachers and board members in the EAMA Academy of Medicine of Ageing upfront all postgraduate more and more shifts towards a coaching position, providing life educational programmes currently provided. Training mentorship and improving motivation and orientation dur- future key opinion leaders in the field of geriatric medicine ing the learning experience. This approach has been proven brings EAMA into focus of future educational develop- effective and sustainable in adult education elsewhere in the ments. Especially, the need for high stakes multi-profes- literature [15]. As programme evaluation reports from stu- sional education will be in the focus of EAMA. Reaching dents in EAMA show (data not shown in this publication) out the programme towards changes and needs of health the new model of teaching is well perceived and EAMA care systems, to better scope with the needs of the older trainees feel a clear benefit from EAMA for their profes- population in the context of multi-disciplinary services, will sional lives at their home working places [16]. be one of the future directions to go. The current EAMA One of the major drawbacks of the work described is educational programme, built on the new learning objectives the small group of board members involved in the content catalogue and training environment, is the core to face these development. At first sight, the LOs catalogue outlined in future challenges. this paper was built on the experience and view of only 10 Acknowledgements Open access funding provided by Medical Uni- EAMA board members currently running the EAMA pro- versity of Graz. The authors wish to thank all former board members gramme. However, to address this shortcoming two steps for their continuous support of this programme. Furthermore, the were implemented during the process as outlined in the authors wish to thank Mieke Laforce and Janet Weinberger for the methods section: focus groups of board members with needs office support. assessment derived from students’ feedback and evaluation reports and professors’ interviews. This led to the inclusion 1 3 European Geriatric Medicine (2018) 9:399–406 405 Funding This research did not receive any specific grant from funding the future teachers in geriatrics: the 10-year success story of the agencies in the public, commercial, or not-for-profit sectors. European Academy for Medicine of Aging. Geriatr Gerontol Int 5(2):82–88. https ://doi.org/10.1111/j.1447-0594.2005.00287 .x 5. Roller RE, Petermans J (2015) Education and training in geriatrics Compliance with ethical standards in the 21st century—where do we come from—where do we go? Eur Geriatr Med 6(3):205–207. https ://doi.org/10.1016/j.eurge Conflict of interest The authors have no financial conflict of interest r.2014.12.001 developing the programme. They teach out of pleasure. 6. Moreau KA (2017) Has the new Kirkpatrick generation built a better hammer for our evaluation toolbox? Med Teach 39(9):999– Ethical approval This article does not contain any studies with human 1001. https ://doi.org/10.1080/01421 59X.2017.13378 74 participants or animals performed by any of the authors. 7. Frank JR, Snell L, Sherbino J (eds) (2015) CanMEDS 2015 phy- sician competency framework. Royal College of Physicians and Informed consent For this type of study formal consent is not required. Surgeons of Canada, Ottawa 8. Krathwohl DR (2002) A revision of Bloom’s taxonomy: an over- view. Theory Pract 41(4):212–218. https: //doi.org/10.1207/s1543 Open Access This article is distributed under the terms of the Crea- 0421t ip410 4_2 tive Commons Attribution 4.0 International License (http://creat iveco 9. Miller GE (1990) The assessment of clinical skills/competence/ mmons.or g/licenses/b y/4.0/), which permits unrestricted use, distribu- performance. Acad Med 65(9 Suppl):S63–S67 tion, and reproduction in any medium, provided you give appropriate 10. Thomas PA, Kern DE, Hughes MT, Chen BY (2015) Curriculum credit to the original author(s) and the source, provide a link to the development for medical education: a six step approach. 3rd edn. Creative Commons license, and indicate if changes were made. The John’s Hopkins Development Program. The John’s Hopkins University Schoool of Medicine, Baltimore, Maryland 11. World Health Organisation (2013) Transforming and scaling up health professionals’ education and training: world health organi- References zation guidelines 2013. World Health Organization, Geneva 12. Masud T, Blundell A, Gordon AL, Mulpeter K, Roller R, Singler 1. Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Har- K, Goeldlin A, Stuck A (2014) European undergraduate curricu- wood RH, Conroy SP, Kircher T, Somme D, Saltvedt I, Wald H, lum in geriatric medicine developed using an international modi- O’Neill D, Robinson D, Shepperd S (2017) Comprehensive geri- fied Delphi technique. Age Ageing 43(5):695–702. https ://doi. atric assessment for older adults admitted to hospital. Cochrane org/10.1093/agein g/afu01 9 Database Syst Rev 9:Cd006211. https ://doi.org/10.1002/14651 13. Bruner JS (1977) The process of education. Harvard University 858.cd006 211.pub3 Press, Oxford 2. Singler K, Sieber CC, Biber R, Roller RE (2013) Considera- 14. Harden RM (1999) What is a spiral curriculum? Med Teach tions for the development of an undergraduate curriculum in 21(2):141–143. https ://doi.org/10.1080/01421 59997 9752 geriatric medicine. Gerontology 59(5):385–391. https ://doi. 15. Taylor DC, Hamdy H (2013) Adult learning theories: implica- org/10.1159/00034 6511 tions for learning and teaching in medical education: AMEE 3. Swine C, Michel JP, Duursma S, Grimley Evans J, Staehelin guide no. 83. Med Teach 35(11):e1561–e1572. https ://doi. HB (2004) Evaluation of the European Academy for Medicine org/10.3109/01421 59x.2013.82815 3 of Ageing “Teaching the Teachers” program (EAMA course II 16. Knowles MS, Holton EF, Swanson RA (2012) The adult learner: 1997–1998). J Nutr Health Aging 8(3):181–186 the definitive classic in adult education and human resource devel- 4. Bonin-Guillaume S, Kressig RW, Gavazzi G, Jacques MC, Cheval- opment, 7th edn. Routlege, New York ley T, Pautex S, Vischer U, Zekry D, Michel JP (2005) Teaching Affiliations 1,2 1,3 1,4 Regina Elisabeth RollerW ‑ irnsberger  · Nele van den Noortgate  · Sylvie Bonin‑Guillaume  · 1,5 1,6 1,7,8 1,9 1,10 Karen Andersen‑Ranberg  · Anette Hylen Ranhoff  · Thomas Münzer  · Tomasz Grodzicki  · Simon Conroy  · 1,11 12 13,14 15 16 Francesco Landi  · Louis Mieiro  · Ulrike Dapp  · Robertus van Deelen  · Rannveig Sakshaug Eldholm  · 17 1,18,19 Nicolas Martinez‑Velilla  · Katrin Singler 1 7 Board of the European Academy for Medicine of Ageing Geriatrische Klinik, St. Gallen, Switzerland (EAMA), Ghent, Belgium Department of Geriatrics, University of Zürich, Zürich, Department of Internal Medicine, Medical University Switzerland of Graz, Auenbruggerplatz 15, 8036 Graz, Austria Department of Internal Medicine and Geriatrics, Jagiellonian Department of Geriatric Medicine, Ghent University, Ghent, University Medical College, Kraków, Poland Belgium Department of Health Science, University of Leicester, Department of Geriatric Medicine, Aix Marseille University, Leicester, UK Marseille, France Department of Geriatrics and Rehabilitation, Catholic Department of Geriatrics, Odense University Hospital, University of Sacred Heart, Rome, Italy Odense, Denmark MRC Unit for Lifelong Health and Ageing, University University of Bergen, Bergen, Norway College London, London, UK 1 3 406 European Geriatric Medicine (2018) 9:399–406 13 17 Department of Geriatrics, Albertinen-Haus Hamburg, Servicio de Geriatría, Complejo Hospitalario de Navarra, Hamburg, Germany Pamplona, Spain 14 18 Scientific Department, University of Hamburg, Hamburg, Institute of Biomedicine of Ageing, Friedrich Alexander Germany University Erlangen-Nürnberg, Erlangen, Germany 15 19 Department of Geriatrics, Spaarne Gasthuis, Haarlem, Department of Geriatrics, Klinikum Nürnberg, Paracelsus The Netherlands Private Medical University, Nuremberg, Germany Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway 1 3

Journal

European Geriatric MedicineSpringer Journals

Published: May 8, 2018

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