Journal of the American Medical Directors Association
EditorialConcrete Steps Toward Academic Medicine in Long Term Care
Section snippets
NH Physician Specialist
Working in NHs makes unique demands on (1) problem-oriented working methods; (2) medical knowledge of chronic diseases and the presentation of illness in frail elderly; (3) communication skills, multidisciplinary cooperation, and organization; and (4) the competency to deal with complex medical-ethical dilemmas. Against this background, the new specialist elderly care physician (ECP) has arisen in the Netherlands.11 The ECP combines the competencies of a general practitioner (GP) with those of
The Training Program
The first and only specialist training program for NH physicians in the world started in 1989.15, 16 The current 3-year training program consists of 4 days of practical training and a 1-day-a-week theoretical course at the university. The program is based on competencies according to the Canadian Medical Education Directions for Specialists (CANMEDS) framework. The entrustable professional activities are categorized into 6 themes: acute care, chronic somatic care, rehabilitation, palliative
Academic Networks
Dutch Elderly Care Medicine has a long academic tradition. The first professor in NH medicine in the world, Prof. dr. J. Michels, was appointed in Nijmegen in 1980. To date, 4 ECPs have a chair in Elderly Care Medicine, and there are 3 emeriti. The universities of Nijmegen, Leiden, Amsterdam, and Maastricht have established academic networks and the University of Groningen is setting up such a network.
Basically, the network is a close cooperation between NH organizations and a university
Teaching
One of the strengths of the close collaboration between the university and NHs is that parts of the curriculum of medical school take place in NHs. The Radboud University Nijmegen Medical Centre, for instance, offers students a year 1 nursing attachment and a year 5 mandatory internship, both in NHs.18, 19 Our own research revealed that NHs and hospitals were found to be equally suitable for the enhancement of students’ early professional development.20 Students reported similar educational
Research
The academic networks provide an excellent infrastructure to perform multicenter research projects. Projects are presented in a steering committee that consists of the chairs of the local, multidisciplinary, academic network committees. Every NH organization decides whether or not to participate in a particular study. Over the past years in Nijmegen, studies on several issues like neuropsychiatric symptoms in patients with dementia,23, 24 geriatric rehabilitation,25 patient safety,26 people
Best Practices
The ultimate goal of the academic networks is to develop best practices with best evidence-based care with measurable high quality of care and high quality of life of the residents. Developing best-practices is facilitated by the fact that Dutch NHs have a long tradition of grouping patients in units with specialized care covering, for instance, (young-onset) dementia, Huntington and Korsakow disease, geriatric rehabilitation, palliative care, and patients with mental-physical multimorbidity.
In Conclusion
The Netherlands has developed a roadmap toward academic medicine in long term care. Key elements are a significant contribution in the medical curriculum, a specialty with a 3-year specialist training program, and academic networks that provide an infrastructure for teaching, research, and best practices. Maybe this can inspire other countries that deal with the same challenges to set these steps too.
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Cited by (33)
Dutch Long-Term Care in Transition: A Guide for Other Countries
2022, Journal of the American Medical Directors AssociationThe Course of Quality of Life and Its Predictors in Nursing Home Residents With Young-Onset Dementia
2021, Journal of the American Medical Directors AssociationTwo-Year Course of Quality of Life in Nursing Home Residents with Dementia
2018, American Journal of Geriatric PsychiatryCitation Excerpt :We performed analysis on data from a longitudinal, multicenter, observational cohort study in which residents with dementia living in 14 dementia special care units in nine nursing homes in the Netherlands participated. The nine nursing homes participated in an academic network of nursing homes.15,16 They were part of public organizations, in which most nursing home residents in the Netherlands live.
Is late-life dependency increasing or not? A comparison of the Cognitive Function and Ageing Studies (CFAS)
2017, The LancetCitation Excerpt :The workforce must be competent and adequately skilled to care for an ageing population.31 For care home residents with complex needs, a new specialty—a nursing home physician—has been developed in the Netherlands;32 however, high-quality evidence is unavailable to facilitate wider implementation of such new innovative service models. For older people with low dependency living at home, family physicians and their community care teams are the first point of contact for care, and they are increasingly undertaking the majority of chronic illness management.31
The Dutch Move Beyond the Concept of Nursing Home Physician Specialists
2017, Journal of the American Medical Directors AssociationStructured scoring of supporting nursing tasks to enhance early discharge in geriatric rehabilitation: The BACK-HOME quasi-experimental study
2016, International Journal of Nursing StudiesCitation Excerpt :It provides a good example of bottom-up research, initiated by a care professional (physiotherapist) and supported by researchers. ( Achterberg et al., 2015; Koopmans et al., 2013) Within this context, the scorecard was easy to implement in the total population receiving geriatric rehabilitation in the skilled nursing facility. However, in a quasi-experimental design there is a risk of low internal validity due to potential differences between the cohorts due to non-randomization.
The authors declare no conflict of interest.