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Health Workforce Education Needs for Seniors Care –
Continuing Professional Development
Final Report
Prepared for
The Office of Health Sciences – Council of Ontario Universities
August 2014
Haig Baronikian, PhD, PMP, PEng and May Halsam, BA, BEd
eFuel Partners Inc. 186 Wright Ave., Suite 200
Toronto, Ontario M6R 1L2
Contact:
E [email protected] T 416.530.4877 F 416.530.4878 W www.eFuel.ca
Acknowledgement
This needs assessment was commissioned by the Council of Ontario Universities (COU), who were funded by the Government of Ontario.
Notice
The views expressed are those of eFuel Partners Inc. and do not necessarily reflect those of COU or the Province.
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Table of Contents
Executive Summary ........................................................................................................................ 4
Introduction .............................................................................................................................. 9 1.1.1. Background .................................................................................................................. 9
1.2. Methodology ................................................................................................................ 9
1.3. Literature Review ....................................................................................................... 10
1.4. Open Enrollment CPD Programs ............................................................................... 12
1.5. Better Aging: Ontario Education Summit .................................................................. 13
1.6. General Observations ................................................................................................. 14
Findings – Medicine .............................................................................................................. 15 2. Findings – Nursing (Baccalaureate/Registered) .................................................................... 19 3. Findings – Social Work ......................................................................................................... 22 4. Findings – Practical Nursing.................................................................................................. 25 5. Findings – Personal Support Work ........................................................................................ 27 6. Findings – General ................................................................................................................. 30 7. Modes of Education Delivery ................................................................................................ 32 8. Better Aging Summit – Commentary from Break-Out Group Discussions .......................... 34 9.
Analysis and Priorities for Moving Forward ......................................................................... 35 10.10.1 Discipline-Specific Priorities ..................................................................................... 36
10.2 General Priorities ....................................................................................................... 37
Appendix A: Interview Questionnaire .......................................................................................... 42
Appendix B: Organizations Interviewed ...................................................................................... 43
Appendix C: Open Enrollment Gerontology CPD Programs ....................................................... 44
Appendix D: Inventory of CPD Programs Relating to Seniors Care for Medicine ...................... 48
Appendix E: Inventory of CPD Programs Relating to Seniors Care for Nursing (Registered/Baccalaureate), Practical Nursing and Personal Support Work ................................ 51
Appendix F: Inventory of CPD Programs Relating to Seniors Care for Social Work ................. 62
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Executive Summary
This needs assessment focuses on continuing professional development (CPD) in the context of health workforce education for seniors care. It is one of five needs assessments commissioned by the Council of Ontario Universities in November, 2013, with funding from Government of Ontario, in order to help identify priority areas for implementing the educational recommendations in Dr. Sinha’s Living Longer, Living Well. Interim results of the needs assessments also supported stakeholder discussions at the “Better Aging: Ontario Education Summit” held on February 13, 2014.1
This needs assessment identifies priority areas for specifically supporting continuing professional development.
The assessment looks at existing continuing professional development offerings related to seniors care, including strengths, gaps, competency models, and modes of delivery. It focuses on five health and social care professions—Medicine, Registered Nursing, Social Work, Practical Nursing, and Personal Support Work (PSW)—and identifies areas where future work to develop CPD in seniors care should be focused.
Medicine
While Medicine is quite strong in CPD related to seniors care, few CPD offerings were identified as available for the general practitioner. Offerings for general practitioners and possibly specialists other than those in geriatric medicine are in need of attention, particularly in the areas of:
Frailty and mobility
Mental health
Falls
Co-morbidity
Collaborative care plans
Medication management and polypharmacy
Health promotion
Atypical presentations of medical illness
Geriatric assessment
Navigation of support systems to guide the elderly and their families
1 Dr. Sinha is the Provincial Expert Lead for the Ontario Seniors Strategy. Dr. Sinha identified enhanced education and training of health and social care professionals who work with older adults as a key enabler of a seniors-friendly Ontario.
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Registered Nursing
Registered Nursing is in an excellent position overall regarding CPD programs for seniors care. Specific topics that were identified as gaps include:
Mental health/psychiatric (including needs beyond dementia)
Complex needs
Chronic disease management
Responsive behaviours and behavioural supports; dealing with aggression, violence
Supporting self-management, wellness promotion and health protection (supporting seniors to remain at home)
Transitions between care settings]
Post-acute care, including rehabilitation supports
Incontinence management
Falls management
Wound care
Understanding of scopes of practice and interprofessional collaboration, within patient-centred perspective and good communication
Leadership training
Ethical issues
End-of-life care
Evidence-based knowledge and practice
Leadership
Social Work
The profession is currently in quite a weak position regarding CPD for seniors care. There is no competency model in use related to CPD and seniors care, and few CPD offerings appear to be available. Specific topics in need of attention include:
Cognitive decline and dementia
Depression
Anxiety
Bullying
Grief
Housing
Financial
Chronic disease
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Dying and death
Community and home care
Living in poverty
Multiplicity of family forms
People living longer and with disabilities
Training the caregivers
Practical Nursing
Practical nursing is in quite a good position overall regarding seniors care insofar as there are some programs available. Specific topics have been raised as being in need of attention:
More programs needed for community care and home settings
Mental health assessment and treatment (often complicated by medications and other physical ailments)
Behavioural supports
Some clinical/technical skills (e.g. starting an IV)
Palliative care
Educating RPNs to, in turn, educate caregivers
Health promotion
Leadership
Delegation, conflict resolution and other soft skills
Personal Support Workers
PSWs are in a reasonably good position overall regarding seniors care insofar as there are some programs available. Further development is likely to be dependent on the standardization of the entry-to-practice curriculum. Through this work, a competency model may also emerge for PSWs. Specific topics have been raised as being in need of attention:
Leadership, communication, negotiation, teamwork and related soft skills (much of such training would depend upon and be aided by the inclusion of other professions working closely with PSWs, such as registered and practical nurses)
Depression
Anxiety
Bullying
Grief
Dementia, cognitive impairments, acquired brain injuries
Dying and death
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Orientation to the utilization of best practices guidelines and other evidence-based knowledge
General topics, not specific to any particular profession, that are in need of attention:
Complex care needs of seniors, including for dementia, bone health, frailty, incontinence and various combinations
Working in integrated health teams
Cultural competence to address diversity amongst older adults.
Tools (including for geriatric assessments), guides, knowledge brokers, communities of practice
Catheters, skin care
Wound care expertise in long-term care facilities
Diabetes training
Palliative care, pain management.
Person-directed care
Communication
Tools to assess skills and competencies of staff
The importance of physical activity, spiritual care and dealing with social isolation issues
Potential Priority Areas:
1. A web-based portal, directory or database function to facilitate navigation of CPD opportunities related to seniors care, minimize duplication and highlight gaps which should be addressed.
2. Creation of competency models for those disciplines lacking them for CPD, in order to guide the development of suitably informed programs.
3. More coordinated funding approach between MOHLTC, MTCU and MCSS to prevent ‘silo-ing’ of educational programs, with particular attention to community and home-based care and social services which are not adequately attended to.
4. Expansion of role of OTN (or similar organization) to host and support online learning and removal of barriers to this use across professions, including social work.
5. Identify and exploit opportunities for replication or extension of particular programs across the province.
6. Disciplines should work together to develop programs or modules for common topics such as leadership; mental health; teamwork; consent, capacity and substitute decision-making; and, collaborative care planning, and to disseminate these broadly.
7. More partnering between educational institutions, clinical sites and/or professional associations to exploit the expertise, content and educational capabilities of the partners.
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8. Ensure continuity of learning between entry-to-practice and CPD.
9. Seek opportunities to integrate learning within the workplace, including at the point of care.
10. Complement education with superior toolkits, which translate evidence-based, high quality information into a format that can be readily applied by practitioners and, in some instances, by informal caregivers.
11. Update perspectives on aging, by making at least some aspects of CPD about wellness management and health protection.
12. Further discipline-specific research should be carried out within those disciplines not covered here and which work in seniors care.
13. Establish a guiding coalition to provide direction and monitor ongoing activities and areas of need.
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Introduction 1.
1.1. Background
This needs assessment focuses on continuing professional development (CPD) in the context of health workforce education for seniors care. It is one of five needs assessments commissioned by the Council of Ontario Universities in December, 2013, with funding from the Ministry of Health and Long-Term Care, in order to help identify priority areas for implementing the educational recommendations in Dr. Sinha’s Report Living Longer, Living Well [December 20, 2012], and to support the “Better Aging: Ontario Education Summit” held on February 13, 2014.
In particular, this needs assessment is intended to identify priority areas within Recommendation 133 in Living Longer, Living Well, which states:
The Ministry of Health and Long-Term Care, in collaboration with the Ministry of Training, Colleges and Universities and the Ministry of Community and Social Services, should support the preparedness of all current health and social care providers by encouraging the development of continuing professional educational activities and certification programs focused on care of the older adult, and encouraging that a proportion of continuing education for health and social care providers be focused around the care of older adults. [p. 203]
The assessment looks at CPD in seniors care across five health and social care workers, and identifies current strengths, gaps, available competency models, and optimal modes of delivery.
Note: Seniors care, geriatrics and gerontology are used interchangeably in this document.
1.2. Methodology
There are over 20 regulated health professions in Ontario and several health disciplines which are unregulated. Additionally, there are a number of regulated social service professions, such as social work. This project covers five professions, one of which – Personal Support Work – is unregulated. It would not be feasible to survey every profession, thus necessitating this scope of work. Those covered were:
Medicine
Baccalaureate/Registered Nursing
Social Work
Practical Nursing
Personal Support Work (PSW)
These were selected as a sample for their representativeness of different care settings for seniors, individual practitioner support of patients or clients versus team-based support and casework, as well as to address the spectrum of interactions between healthcare and social services.
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While acknowledging that there are many approaches to providing continuing professional development, this needs assessment was chiefly concerned with structured educational programs (as opposed to less formal or ad hoc continuing education opportunities such as speakers, webinars, rounds, conferences, etc.). The intended scope is programs which take place following entry-to-practice education and does not include postgraduate degree or diploma programs. Typically, these CPD programs would also feature a formal credential of some kind upon successful completion. The program inventories developed reflect this approach.
The interview questionnaire is provided in Appendix A. The organizations interviewed are listed in Appendix B.
The techniques used for information gathering were:
a. Conduct interviews with selected representatives from a range of organizations involved with continuing professional development for the above sample set of professions.
The interviews were of a semi-structured nature, lasting up to 90 minutes. More than 25 interviews were conducted, most via telephone and a few in person. Among other elements, they were used to:
• Identify major, anticipated trends and needs
• Document available or planned educational offerings
• Understand modes of delivery
• Note barriers and gaps
b. Development of an inventory of CPD programs from various educational and other organizations, primarily through Web research
c. Review of pertinent competency models d. Review of different modes of delivery and possible platforms
e. Background literature review
1.3. Literature Review
Results from the literature review were quite limited. The relatively few papers having high relevance are discussed here. They are predominantly oriented to medicine. One extensive review, covering continuing education for both medicine and nursing, is that of the Macy Foundation-supported report: Lifelong Learning in Medicine and Nursing.2 Beyond the more traditional view of continuing education being driven solely by an individual’s practice or performance change, the Expert Panel emphasized the role of continuing education in:
1. Validating individual practice and competence;
2. Engaging learners in new knowledge and skill acquisition for practice setting application;
2 Lifelong Learning in Medicine and Nursing, Final Conference Report. American Association of Colleges of Nursing and Association of American Medical Colleges. 2010.
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3. Reducing or closing practitioner-identified performance gaps;
4. Improving patient care outcomes;
5. Affording the opportunity to integrate knowledge, performance, competence and judgment; and
6. Generating professional satisfaction and identity, potentially preventing or decreasing burnout. [p. 16].
Four main areas were addressed in the analysis and recommendations: continuing education methods, interprofessional education, lifelong learning and workplace learning (including point of care learning). The recommendations are directed to educators, regulators and to those organizations involved in practice. Though not specific to seniors care, and accounting for some differences between the American and Canadian healthcare systems, many of the recommendations would be applicable.
A paper entitled Caring for Older Americans: The Future of Geriatric Medicine describes key goals to achieve the highest possible quality of care for every senior.3 A set of Geriatrics Core Values – Attributes and Competencies are described, centred on medicine, and including ‘Lifelong learning and continuous professional growth’ and ‘Education of a health professions workforce to care for older persons’. In order to improve the health and well-being of seniors, they propose five goals, several of which speak directly to educational needs:
To ensure that every older person receives high-quality, patient-centered health care
To expand the geriatrics knowledge base
To increase the number of healthcare professionals who employ the principles of geriatric medicine in caring for older persons
To recruit physicians and other healthcare professionals into careers in geriatric medicine
To unite professional and lay groups in the effort to influence public policy to continually improve the health and health care of seniors [p. S248]
The authors discuss the requisites, obstacles and recommendations for each.
Thomas et al provide a systematic review of CPD in relation to seniors care and practicing physicians.4 They argue for ‘active-mode’ learning to achieve high effectiveness knowledge translation and practice improvement. This form of learning is highly accessible and relies on interactive, targeted, and multifaceted techniques for reinforcement. They offer a set of lessons learned in the areas of program development, participant recruitment, implementation and train-the-trainer programs.
3 American Geriatrics Society Core Writing Group of the Task Force on the Future of Geriatric Medicine. Caring for Older Americans: The Future of Geriatric Medicine. Journal of the American Geriatrics Society. 2005; 53: S245–S256 4 Thomas, D.C. et al. Continuing Medical Education, Continuing Professional Development, and Knowledge Translation: Improving Care of Older Patients by Practicing Physicians. Journal of the American Geriatrics Society. 2006; 54: 1610–1618.
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Educational approaches aimed at community physicians working with seniors are addressed in a paper by Warshaw et al.5 A program, based on the Assessing the Care of Vulnerable Elders model was implemented and studied with a large, multisite primary care group based in Cincinnati. It was designed to increase physicians' clinical skills and system strategies to improve the quality of care for their older patients in four areas: medication management, falls and mobility, urinary incontinence and dementia. A multifaceted physician education program was developed for each topic area, with lunch‐time, in‐office and geriatrician‐led presentations as components. During the teaching sessions, participants were provided with screening tools to identify “at risk” patients, assessment chart templates, as well as community resource and patient education materials. Between 80% and 92% of these primary care physicians planned to make a change in their practice behavior as a result of the training.
1.4. Open Enrollment CPD Programs
It is worth noting that outside of profession-specific CPD programs, there are many open enrollment programs which allow individuals from a wide range of disciplines and backgrounds to obtain education in seniors care and gerontology. An example from the university sector is that of Ryerson University’s Certificate in Gerontology6, detailed in Appendix C. It consists of four core courses plus two electives from a designated set. Many of the courses are also available online. Appendix C also lists a variety of other open enrollment programs.
An example from the college sector is Algonquin College’s Certificate in Gerontology – Multidiscipline7. It consists of five core courses plus an elective from a designated set. A clinical placement is also included in the program.
There are also more subject-specific programs, such as the dementia care education series from the University of Waterloo’s Murray Alzheimer Research and Education Program (MAREP) at the Faculty of Applied Health Sciences.8 This 10-module program is delivered via CD-ROM and may be facilitator-led or self-paced. Another example is the Learning Essential Approaches to Palliative and End-of-Life Care in Long Term Care (LEAP in LTC) Program offered at Lakehead University.9 It is intended for physicians, nurses, pharmacists and other licensed health care professionals working in long-term care. It is based on the Canadian Hospice Palliative Care Association model and consists of 11 modules (13 hours in total).
An innovative approach, which might be called a Virtual Certificate in Geriatrics, has been developed by the Regional Geriatric Program of Hamilton, in collaboration with the Hamilton Health Sciences Centre and McMaster University. The program is ‘virtual’ in the sense that it draws on and combines existing, best-in-class educational material. The courses have been sourced from multiple, leading educational partners and the whole is informed by a set of core
5 Warshaw, G.A. et al. Community Physician Education in Geriatrics: Applying the Assessing Care of Vulnerable Elders Model with a Multisite Primary Care Group. Journal of the American Geriatrics Society. 2010; 58: 1780-1785. 6 http://ce-online.ryerson.ca/ce/default.aspx?id=3129 [accessed March 18, 2014] 7 http://extraweb.algonquincollege.com/ce_programs/pdfs/0642X02PWO.pdf [accessed March 18, 2014] 8 https://uwaterloo.ca/murray-alzheimer-research-and-education-program/education-and-knowledge-translation/products-education-tools/dementia-care-education-series [accessed March 18, 2014] 9 http://cerah.lakeheadu.ca/learning-essential-approaches-to-palliative-and-end-of-life-care-in-long-term-care-leap-in-ltc/ [accessed March 18, 2014]
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competencies.10 Approximately 100 learners are currently in the program. Most are nurses, but other disciplines are also represented. Plans call for having intact teams from different organizations attend the program for greater impact when they return to their respective organizations. A mix of classroom-based and e-learning approaches are used. A certificate is awarded upon successful completion by the Division of Geriatric Medicine, McMaster University.
Lastly, Bridges to Care is an example of an interprofessional CPD program.11 It consists of both online, evidence-based, practice-oriented resources and implementation within a context of committed teams and employer involvement at a care site, over a period of 6 – 12 weeks. It has been piloted in hospital, long-term care and community (with public health agency participation) settings and has been demonstrated to lead to sustained change. Typically, 3 – 5 champions are needed to make it work. The PARIHS12 model is used, with modifications for the quality improvement aspects of the process.
Through the broad-based Bridges to Care approach, multiple health disciplines and even informal caregivers are engaged; much of the work is driven by front-line workers. A Project Resource Consultant from the Bridges to Care operation, with quality improvement training and expertise in gerontology and knowledge-sharing, facilitates the project. The process creates leadership within the group and is intended to bring about sustained change. The approach, which has now been piloted at six sites across Ontario, has been successful in terms of engaging and empowering team members, supporting practical implementation of quality improvement plans and creating an environment supportive of adult learning and collaborative practice. It has been applied toward pneumonia, dementia, falls and other areas of care. Various toolkits are available to support the effort.13 The program has been developed through a collaborative effort between the Seniors Health Knowledge Network, Queen’s University and others, with some funding support from HealthForceOntario. Plans call for a gradual roll-out over the next 18 – 24 months, subject to funding.
1.5. Better Aging: Ontario Education Summit
In support of Ontario’s health workforce seniors-related education needs, a summit was organized for stakeholders in seniors care across the province. It was held on February 13, 2014 at Baycrest Health Sciences in Toronto. Among the objectives of the day was to share interim findings from the five needs assessments, including this one, with the audience.
Information about the summit and copies of the presentations are available at:
http://betteragingsummit.ca
The presentation for this needs assessment may be found at:
http://betteragingsummit.ca/documents/papers/ResearchPresentation5-CP%20forSeniorsCare.pdf
10 https://www.geriatriccp.ca [accessed March 18, 2014] 11 http://ns1.dragonflyit.net/sites/default/files/article-resources/Bridges%20to%20Care.pdf [accessed March 18, 2014] 12 http://basale-stimulation.be/Pflege/pflege-ol/PARIHS.pdf [accessed March 18, 2014] 13 http://www.sagelink.ca/content/bridges-care-long-term-care-toolkits [accessed March 18, 2014]
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Comments gathered from the break-out discussions and distilled by the facilitators are documented in Section 8.
1.6. General Observations
By way of introduction, we begin here with a set of general observations based on our inquiry in connection with the five disciplines addressed. Discipline-specific commentary follows in the next section. The general observations are:
Discipline-specific CPD program offerings are quite fragmented and vary considerably by discipline; no discipline appears to have an extensive, targeted set of CPD offerings for seniors care.
There are a multiplicity of educational providers: Universities, colleges, professional associations, regional geriatric programs, others.
A large number of open enrollment/multidisciplinary programs are available, predominantly at colleges (examples noted above).
Some disciplines do not have any competency models in use to guide CPD educational offerings or practice.
A wide range of short-form, less formal or ad hoc education is utilized in every discipline, including webinars, conferences, self-study groups, occasional speakers, rounds, online resources (as appropriate).
Mental health is a major, consistently highlighted educational need across all disciplines; leadership and other soft skills are also frequently cited.
There is generally a desire to do more in terms of education but limited, among other factors, by funding, coordination, and need for cultural change within the discipline concerning the appeal of seniors care as a career option.
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Findings – Medicine 2.
Medicine plays a substantial role in seniors care, both through primary care and through specialists (notably geriatric medicine), and in a variety of care settings. There is broad recognition in the profession of the continuing importance and relevance of medical expertise and leadership in seniors care. The existence of Divisions of Geriatric Medicine at Ontario medical schools, the Canadian Geriatrics Society and other organizations, helps to bring strong focus and recognition to the field of seniors care.
Inventory of CPD Programs
The intent of the survey was to capture CPD educational opportunities for general practitioners in primary care, long-term care, community care or emergency care. Based on our survey of the principle organizations offering such education in Ontario, a range of CPD offerings were found relating to seniors care or gerontology at universities, through hospitals and via other organizations.
No needs assessments for CPD with respect to medicine in seniors care were uncovered at the organizations interviewed.
It appears that there are no CPD programs available in French.
Three programs, demonstrating the range of educational offerings, are briefly described below:
e-Learning program for emergency physicians provided by Geri-EM14. It has been accredited for continuing education by the College of Family Physicians of Canada and Royal College of Physicians and Surgeons of Canada. The topics covered are medication management, trauma and falls, atypical presentations, cognitive impairment, functional assessment, and end-of-life care. Each module is about 45 minutes long. Included with each module are:
• Videos of simulated patient encounters
• Recommended readings
• Pre- and post-tests with immediate feedback
• In-page questions and answers with immediate feedback
• Chat and blog features
• Resources for use in the Emergency Department
Training program for Medical Directors for long-term care facilities.15 While the Ontario Long-term Care Homes Act requires that there is a medical director associated with each facility, there has been no formal preparation of physicians for this role. The lead
14 http://geri-em.com [accessed March 18, 2014] 15 http://oltcp.ca/storage/2-education-program/2014/2014%20CMD%20COURSE%20REGISTRATION%20%20%20INFORMATION%20R1.pdf [accessed March 18, 2014]
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organization is Ontario Long-Term Care Physicians, with curriculum development leadership from researchers at Baycrest and Sunnybrook. The format is in-person, case-based learning in small groups, with pre- and post-work. The program consists of three 2-day blocks of education:
• Regulatory, staff management, documentation
• Quality improvement
• Leadership, risk and safety management, ethics
The intent is to develop e-learning modules and have small group interaction opportunities in different centres. Formal international certification is possible in future through the American Medical Directors Association.
Care of the Elderly Certificate Course operated by University Health Network and the University of Toronto’s Department of Family and Community Medicine.16 It is held over five weekends. The following topics are covered:
• Weekend One: Diagnosis and Management of Mild Cognitive Impairment and Dementia
• Weekend Two: Approach to Physically Frail Elderly Patients with Falls
• Weekend Three: Mental Health and Chronic Pain Management
• Weekend Four: Management of Common Medical Problems in the Elderly
• Weekend Five: Approach to Elderly Patients with Failure to Thrive
This program meets the accreditation criteria of The College of Family Physicians of Canada for continuing education.
Please refer to Appendix D for an inventory of relevant CPD programs for medicine in Ontario.
Identified Needs
In no particular order, the following topics were cited as needing attention for CPD:
Frailty and mobility
Mental health
Falls
Co-morbidity
Collaborative care plans
Medication management and polypharmacy
Health promotion
16 http://www.dfcm.utoronto.ca/about/newsevents/DFCMNEWS/news/121412-2.htm [accessed March 18, 2014]
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Atypical presentations of medical illness
Geriatric assessment
Navigation of support systems to guide the elderly and their families
Competency Model
There is one relevant competency model found to be in use, providing support for continuing professional development related to seniors care17:
College of Family Physicians of Canada – Triple C Competency-based Curriculum – Adapted for elderly patients by the University of Ottawa
Other Resources
Beyond the more formal CPD programs cited, the profession also utilizes occasional speakers, conferences, webinars, rounds, self-study groups and other approaches to support continuing education. A wide range of web resources are available. Of course, useful resources may also be found elsewhere outside Ontario and even outside Canada. These types of resources are not included in the inventory.
Platforms
Education is delivered predominantly in face-to-face/classroom settings. Though there is a high level of interest, for example with the medical directors program, to provide more educational programming via e-learning, funding is required to support the design and development of such programs. Operational support is also needed to run e-learning programs once developed.
Tullo, Newton and Clapp, in a 2012 paper18, review the pertinent literature on e-learning and discuss its merits toward the various stages of medical education, including CPD. They make the following key points:
Geriatric medicine has already adopted examples of e-learning for the education of medical students, specialty trainees, consultants and multidisciplinary healthcare professionals
Advantages of e-learning include provision of a constructivist learning environment, flexibility for learners and teachers, ease of dissemination and cost savings. Potential problems relate to quality control, technical problems and learner isolation
There is a growing evidence base that e-learning interventions, including examples within geriatric medicine, are well received by students, and are associated with enhanced learning compared with traditional methods
17 There is a competency model also, for entry-to-practice for medicine, co-developed by the Canadian Geriatrics Society and NICE. http://www.nicenet.ca/files/CGS_Competencies.pdf [accessed March 21, 2014] 18 Tullo, E., Newton, J. and Clapp, A. What can e-learning offer geriatric medicine in the UK? Reviews in Clinical Gerontology. 2012; 22: 235–242
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To improve the quality of e-learning materials for geriatric medical education and training, peer-review of learning materials and on-going research on educational impact should be encouraged
There is considerable scope to improve geriatric medical education and training, and to extend it to a wider range of healthcare professionals caring for older people, via e-learning [p. 240]
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Findings – Nursing (Baccalaureate/Registered) 3.
Baccalaureate/registered nurses play a major role in seniors care, in a variety of settings. There is broad recognition in the profession of the increasing importance and relevance of nursing expertise and nursing leadership in seniors care. The existence of Gerontological Nurses Associations in Ontario (with approximately 1,200 members)19, in other provinces and at the national level, helps to bring strong focus and recognition to the field of seniors care.
Inventory of CPD Programs
Based on our survey of the principle organizations offering nursing education in Ontario, numerous CPD offerings were found relating to seniors care or gerontology, both at universities and colleges.
RNAO has done needs assessment surveys in 2008 and 2011 in relation to priorities at long-term care facilities (not limited to CPD).
There is a national level specialist designation and corresponding certification examination for gerontological nursing. These are managed by the Canadian Nurses Association (CNA).20 Successful completion of the examination leads to the GNC(C) designation – Gerontological Nurse Certified (C)anada. Preparation programs and study groups are available for the examination.
It appears that there are no CPD programs available in French.
Please refer to Appendix E for an inventory of relevant CPD programs for baccalaureate /registered nursing in Ontario (this Appendix also includes CPD programs for practical nursing and PSWs).
Identified Needs
In no particular order, the following topics were cited as needing attention for CPD:
Mental health/psychiatric (including needs beyond dementia)
Complex needs
Chronic disease management [RNAO has Best Practice Guidelines (BPGs)]
Responsive behaviours and behavioural supports; dealing with aggression, violence
Supporting self-management, wellness promotion and health protection (supporting seniors to remain at home)
Transitions between care settings [RNAO has BPGs]
Post-acute care, including rehabilitation supports
Incontinence management
19 http://gnaontario.org [accessed March 21, 2014] 20 CNA also has other relevant specialist programs, such as one for palliative care.
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Falls management
Wound care
Understanding of scopes of practice and interprofessional collaboration, within patient-centred perspective and good communication [RNAO has BPGs]
Leadership training
Ethical issues
End-of-life care
• Evidence-based knowledge and practice Leadership
Competency Model
There are two relevant competency models in use, providing strong support for continuing professional development related to seniors care:
CNA has documented competencies for the GNC(C) designation21 and these are used as the foundation for the examination.
The Canadian Gerontological Nurses Association has also established a set of competencies for gerontological nursing22, entitled Gerontological Nursing Competencies and Standards of Practice 2010.
Other Resources
Beyond the CPD programs cited, the profession also utilizes occasional speakers, conferences, webinars, rounds and other events to support continuing education. A wide range of web resources are also available. Of course, useful resources may also be found elsewhere outside Ontario and even outside Canada. These types of resources are not included in the inventory, but some selected resources are briefly described below.
The Registered Nurses Association of Ontario (RNAO) operates the Advanced Clinical Practice Fellowships program23. This is a CPD program for experienced nurses and provides opportunities in advanced clinical practice, research, leadership and other roles. The individual is supported by a mentor and is required to commit 450 hours to the fellowship. Typically, there are a few fellowships focusing on gerontology each year.
RNAO has run the Spotlight Program for some time to embed their Best Practices Guidelines into nursing practice. They have launched a new call focusing on long-term care facilities. Each chosen facility must make a three-year commitment and will be linked to a mentor organization. RNAO promotes an interdisciplinary approach and the effort will be led by the facility’s best practices coordinator. One facility per Local Health Integration Network (LHIN) is expected to
21 http://www.nurseone.ca/docs/NurseOne/Certification/Gerontology_Summary_2010_en.pdf#page=9 [accessed March 18, 2014] 22 http://www.cgna.net/uploads/CGNAStandardsOfPractice_English.pdf [accessed March 18, 2014] 23 http://rnao.ca/bpg/get-involved/acpf [accessed March 18, 2014]
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be accepted initially into the program. The training and mentoring will lead to a special Spotlight designation, contingent upon maintaining performance expectations.
The Gerontological Nurses Association of British Columbia24 has published a handbook for seniors care which has been used in Ontario. It covers practice guidelines for, among other topics, falls, cognition, nutrition, incontinence and skin care. They have also produced ‘pocket dockets’ for quick reference. Combined, these describe competencies, assessment processes and decision-making trees to assist nurses with basic interventions.
Behavioural Supports Ontario has developed an extensive toolkit and an educational program which may be utilized by nurses and other practitioners to deal with responsive behaviours in seniors care.25
Platforms
Education is delivered predominantly in face-to-face/classroom settings. Bedside teaching remains an important model for integration of learning into practice. RNAO does utilize webinars and e-learning for such topics as delirium, depression and falls. More educational programming via e-learning is anticipated. The Ontario Association of Non-Profit Homes & Services for Seniors26 also provides webinars and workshops for nurse leaders. The costs associated with designing, developing and operating e-learning courses have been noted to be a barrier.
24 http://gnabc.com [accessed March 18, 2014] 25 http://www.akeresourcecentre.org/Behaviour and http://www.akeresourcecentre.org/files/BSOResources/BETSI%20Full%20Version%20Updated%20191212.pdf [accessed March 18, 2014] 26 http://www.oanhss.org [accessed March 18, 2014]
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Findings – Social Work 4.
In the field of social work, there is certainly broad recognition of the increasing importance and relevance of social work expertise in seniors care. There are more than 4,500 social workers in Ontario and greater than 60% of social workers practice in healthcare settings, according to the Ontario Association of Social Workers (OASW).
Regarding CPD, one interviewee stated: “A tremendous amount is required… and practitioners would be open to it.”
Inventory of CPD Programs
Based on our survey of the principle organizations offering social work education in Ontario, few CPD offerings were found relating to seniors care or gerontology and these were of a more general nature (i.e. applicable to any population, not specifically seniors). For example, the University of Toronto offers a certificate in bereavement education.
No needs assessments for CPD in connection with seniors care were uncovered at the organizations interviewed.
Of note, gerontology specialization is available at the entry-to-practice level at the University of Toronto and at the entry-to-practice and Master’s levels at Lakehead University.
It appears that there are no CPD programs available in French.
There is interest in applying simulations in the CPD context.
It seems that social work is unable to draw on funding for professional development in similar fashion to other healthcare professions.
Please refer to Appendix F for an inventory of relevant CPD programs in social work in Ontario.
Identified Needs
In no particular order, the following topics were cited as needing attention for CPD:
Cognitive decline and dementia
Depression
Anxiety
Bullying
Grief
Housing
Financial
Chronic disease
Dying and death
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Community and home care
Living in poverty
Multiplicity of family forms
People living longer and with disabilities
Enabling social workers to, in turn, enable caregivers with appropriate training to facilitate social engagement, access to information resources and use of technology to facilitate social interaction for those who would otherwise be isolated
OASW noted that a key role for social work in this context is to help ‘optimize caregiver capacity’.
Competency Model
No competency model is in place for CPD in social work in the context of seniors care. From our literature review, two competency models are in use in the US for geriatric social work: the CSWE Gero-Ed Center Competency Goals and the Hartford Partnership Program in Aging Education (HPPAE) Geriatric Social Work Competency Scale, for the advanced practice level.27 Both initiatives have been supported by the Hartford Foundation. These may be useful guides for Ontario social work practitioners and educators. OASW has also pointed to the strong work of this Foundation as one to emulate in Ontario.
Other Resources
There is a general reliance on occasional speakers, conferences (e.g. Canadian Association on Gerontology (CAG)), webinars and other events – as opposed to structured education programs – to support continuing education in social work. A wide range of web resources are available, as well, from across or beyond Ontario. These types of resources are not included in the inventory.
A number of important resources are available for service providers to complement educational programs, such as Elder Abuse: A Practical Handbook for Service Providers - Second Edition [2009] from OASW. OASW has also supported the National Initiative for the Care of the Elderly (NICE) to develop various materials.
Platforms
Education is delivered predominantly in face-to-face/classroom settings. There is a high level of interest to provide more educational programming via e-learning. For example, OASW has identified geographic challenges to reach practitioners across Ontario and is keen to embark on e-learning programs. Funding is required, though, to support the necessary design and development work. Operational support and hosting services are also needed to run e-learning programs once developed. Currently, OASW is unable to use the Ontario Telemedicine Network
27 http://www.cswe.org/CentersInitiatives/GeroEdCenter/TeachingTools/Competencies/History.aspx [accessed March 21, 2014]
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for this purpose as this profession is not funded by MOHLTC.28 OASW would like to see a well-developed, well-supported e-learning infrastructure with equal access across the province.
There is also interest at the University of Toronto’s Faculty of Social Work, as an example academic institution, to run blended learning courses (combining classroom and e-learning). They have also previously delivered two sessions on mental health in the form of Massive Open Online Courses (MOOCs) and reached up to 35,000 participants. They may apply the same approach to gerontology topics.
28 Similarly, social workers are denied access to HealthForceOntario literature research and labour studies database.
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Findings – Practical Nursing 5.
Registered practical nurses (RPNs) play a major role in seniors care, in a variety of settings. Of the approximately 40,000 RPNs practicing today, 60% are in geriatric care, according to the Registered Practical Nurses Association of Ontario (RPNAO). There is broad recognition in the profession of the increasing importance and relevance of practical nursing in seniors care.
Inventory of CPD Programs
Based on our survey of the principle organizations offering nursing education in Ontario, numerous CPD offerings were found relating to seniors care or gerontology at colleges.
Fanshawe College is working toward a possible graduate certificate in seniors care, in collaboration with long-term care facilities in the region.
RPNAO has instituted an eight-week/eight-module e-learning program for leadership education for practical nurses, which is applicable to a range of settings and populations.29 It is available, as well, to other healthcare professionals. Their continuing education e-learning programs extend to Health Coaching Skills Development, Patient-Centred Care and other topics. A 3-course health promotion program, which is expected to be beneficial for seniors care too, is in the planning stage. RPNAO also runs the Leadership/Clinical Practice Fellowship Initiative30 which involves mentoring for selected RPNs; they have indicated a desire to expand the program to encompass seniors care more directly.
A needs survey was conducted by Algonquin College, in conjunction with Bruyère Long-Term Care. No other needs assessments for CPD with respect to practical nursing in connection with seniors care were uncovered at the organizations interviewed.
It appears that there are no CPD programs available in French.
Please refer to Appendix E for an inventory of relevant CPD programs for practical nursing in Ontario (this Appendix also includes CPD programs for baccalaureate /registered nursing and PSWs).
Identified Needs
In no particular order, the following topics were cited as needing attention for CPD:
More programs needed for community care and home settings
Mental health assessment and treatment (often complicated by medications and other physical ailments)
Behavioural supports
Some clinical/technical skills (e.g. starting an IV)
29 http://www.rpnao.org/practice-education/e-learning [accessed March 21, 2014] 30 http://www.rpnao.org/practice-education/fellowships [accessed March 21, 2014]
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Palliative care
Educating RPNs to, in turn, educate caregivers
Health promotion
Leadership
Delegation, conflict resolution and other soft skills
Competency Model
There are no competency models in place for CPD for practical nursing in relation to seniors care. There has been, however, some adaptation of the CNA and CGNA models mentioned in Section 3.
Other Resources
Beyond the CPD programs cited, the profession also utilizes occasional speakers, conferences, webinars and other events to support continuing education. A wide range of web resources are also available within and beyond Ontario. These types of resources are not included in the inventory, but some selected resources are briefly described below.
One interesting example of an alternative education provider is Medline, a medical products supplier, and its Medline University.31 They have approximately 230 courses, many video-based and online, that are particularly suited to practical nurses (as well as PSWs). These include clinical as well as non-clinical content. Accreditation has been obtained through California or Florida in most instances.
RPNAO operates the Award for Excellence in the Care of Older Ontarians program32. The program acknowledges and highlights the contributions of registered practical nurses providing exemplary care for seniors. It also elevates the importance and appeal of seniors care as a career choice – a critical element in promoting a positive image and cultural change toward practicing in this field.
Platforms
Education is delivered with both face-to-face/classroom and e-learning approaches. The latter is seen to have advantages in reaching practitioners across a large province and providing for more flexible learning options. In some cases, such as RPNAO, e-learning is well established. Funding is often a barrier to design and develop additional programs. Operational support is also needed to run e-learning programs once developed. Algonquin College used the Ontario Telemedicine Network for a period of time, but as an institution not funded by MOHLTC, found the fees to be a barrier.
31 https://www.medlineuniversity.com [accessed March 21, 2014] 32 http://www.rpnao.org/sites/default/files/RPNAO%20Excellence%20in%20Care%20of%20Older%20Ontarian%20Award.pdf [accessed March 21, 2014]
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Findings – Personal Support Work 6.
There is broad recognition of the importance and relevance of Personal Support Workers (PSWs) as front-line staff in seniors care. There are more than 90,000 PSWs in Ontario, working predominantly in long-term, community and home care settings. It has been noted that PSWs often hold the most information about their client given the frequency and extent of their interaction, yet they are not highly valued. PSWs are unregulated in Ontario and there is no officially recognized association in the province representing them (though several associations do exist, such as the Ontario Community Support Association (OCSA) and the Personal Support Network of Ontario, to serve PSW interests). There is now a PSW registry.
It is noteworthy that, in general, the least appealing PSW setting is home care as it involves low remuneration and much travel. The long-term care setting is more appealing, with better remuneration, a more reliable schedule and a fixed place of work. Acute care offers the best remuneration. This hierarchy is seen as perverse when policy suggests that it is best to have seniors living at home and caring for them there, whenever possible.
Inventory of CPD Programs
Based on our survey of the principle organizations offering PSW education in Ontario, a few CPD offerings were found relating to seniors care or gerontology, while many more were applicable to PSWs, nurses as well as other health professionals.
There is no continuity in education for PSWs and there is high-turn-over. Currently, no standards or requirements are in place for ongoing professional development. Largely, it is left to individual employers, resulting in a high degree of variation in continuing education.
Various open enrollment programs are also available, primarily at community colleges.
No needs assessments for CPD in connection with seniors care were uncovered at the organizations interviewed.
It appears that there are no CPD programs available in French.
Please refer to Appendix E for an inventory of relevant CPD programs for PSWs in Ontario (this Appendix also includes CPD programs for baccalaureate /registered and practical nursing).
Identified Needs
In no particular order, the following topics were cited as needing attention for CPD33:
Leadership, communication, negotiation, teamwork and related soft skills (much of such training would depend upon and be aided by the inclusion of other professions working closely with PSWs, such as registered and practical nurses)
33 Prof. Whitney Berta of the University of Toronto’s Institute of Health Policy, Management and Evaluation is conducting a research survey with PSWs across Ontario during summer, 2014. She has offered to include a few questions which might support this work while complementing her research.
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Depression
Anxiety
Bullying
Grief
Dementia, cognitive impairments, acquired brain injuries
Dying and death
Orientation to the utilization of best practices guidelines and other evidence-based knowledge
Noteworthy is a leadership training program for PSWs (and others) working in long-term care and residence settings.34 The program has been designed by the Schlegel Centre for Learning, Research and Innovation in Long Term Care35, in collaboration with Conestoga College, and is being piloted at several Schlegel facilities. It emphasizes the development of six key leadership capabilities: aligning, serving, mobilizing, connecting, stewarding and improving. There are six corresponding modules delivered through a hybrid learning approach, for a total of 180 hours of learning over 28 weeks. Included are 18 weekly 1.5 – 2-hour online interactive webinars, 5 in-class days with expert speakers and group exercises, online resources and weekly assignments. A personal Leadership Portfolio is developed by each individual. Applied exercises rather than examinations are used.
A second example, specifically aimed at PSWs, and again designed by the Schlegel Centre for Learning, Research and Innovation in Long Term Care, in collaboration with Conestoga College, is the Excellence in in Resident-Centred Care program.36 It is intended to address the:
Need for additional training in infection control, restraint use, oral care, nutrition, continence care, skin/wound care and geriatric safety
Desire to anchor skills in a resident-centred framework
Desire for an innovative teaching/learning approach
Modules addressing these areas were developed using practice expertise, educational expertise and best practices for front-line knowledge translation. Learning takes place in 45-60 minute segments, given the time constraints of busy staff, and typically in a group of learners at each site to shift culture. The material is interactive and allows learners to directly apply the content to their practice.
Competency Model
No competency model is in place for CPD for personal support workers in the context of seniors care. Indeed, this may need to await unification of the multiple curriculum models currently in use for entry to practice education (in progress). Best Practice Guidelines from nursing are
34 http://www.the-ria.ca/products/leadership.php [accessed March 21, 2014] 35 http://www.the-ria.ca/lri/index.php [accessed March 21, 2014] 36 http://www.the-ria.ca/products/ercc.php [accessed March 21, 2014]
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sometimes adapted for use, though it has been noted, there can be language and educational barriers to effectively utilize such resources.
Other Resources
PSWs are one discipline where there is a high reliance on employer/facility-sponsored educational programs. Capacity Builders, associated with OCSA, is one example of suppliers providing training for PSWs. Employers hire them to train their staff in areas such as: client-centred care; communication; elder abuse; difficult behaviour; falls; blood pressure; palliative care; clients with diabetes; depression; and, wound care. Training typically ranges from 3 hours – 2 full days. Employers use special MOHLTC funding to support these training activities.
A novel program to develop empathy, ‘Through Other Eyes’, outfits the learner with goggles and other impairments which mimic certain conditions, such as glaucoma, physical challenges when using a walker, and so on.
Many PSWs are unable to access or afford CPD programs on their own. Program options are also more limited for those working away from major urban centres. There are some conferences, webinars and other events which also support continuing education for PSWs. Some useful web resources are also available, including from commercial sources. One interesting example is Medline, a medical products supplier, and its Medline University. They have approximately 230 courses, many video-based and online, and particularly suited to PSWs and nurses. These include clinical as well as non-clinical programs. Accreditation has been obtained through California or Florida in most instances.
The Seniors Health Knowledge Network has developed a number of ‘pocket dockets’ as quick reference cards and checklists aimed at PSWs.37 The Network also offers live and archived webinars for PSWs as well as for broader audiences on a range of seniors care topics.38
There may be application in Ontario of the notion of the transitional worker, which has been developed in the UK. These are care providers who move with the client through different stages of care. Often, they forge close ties with the client and provide companionship, as well. Subject to policy implications, such an arrangement would require new approaches to training PSWs.
Platforms
Education is delivered predominantly in face-to-face/classroom settings, but there are some online learning opportunities also (e.g. Medline). Time, access, digital literacy and communications literacy may be factors. e-learning for topics such as safety on the job and patient transfers has been developed as a collaborative effort between the Seniors Health Knowledge Network, VON and VHA (funded by HealthForceOntario and MOHLTC). Though there is a high level of interest, to provide more educational programming via e-learning, funding is required to support the design and development. Operational support and hosting services are also needed to run e-learning programs once developed. Some use is made of OTN and there is a desire to expand this use for training.
37 One example: http://shrtn.on.ca/node/1669 [accessed March 21, 2014] 38 http://seniorshealthknowledgenetwork.ca/home [accessed March 21, 2014]
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Findings – General 7.
A number of the interviewees provided a more general, rather than discipline-specific, perspective. The following points were noted (in no particular order):
Deeper training is required for the complex care needs of seniors, including for dementia, bone health, frailty, incontinence and various combinations
There is increasing complexity in community care as people stay in their homes longer and longer
There should similarly be better recognition and preparation for complexity in acute care and long-term care settings, not just to attend to individual conditions – which also calls for integrated health teams
Complexity extends as well to social and cultural aspects – language, ethnicity, etc.
People are living longer with various physical, mental or other disabilities
More is needed in terms of tools (including for geriatric assessments), guides, knowledge brokers, communities of practice
There are a large number of transfers to hospitals from long-term care facilities, potentially unnecessary with better education in areas such as catheters, skin care
The Ontario Long-Term Care Association is launching Phase I of its Learning Academy to cover a wide range of topics, both clinical and non-clinical, for its membership (including an OLTCA-branded leadership program)
Wound care expertise is lacking in long-term care facilities (the Long-Term Care Homes Act specifies that a wound care team should be in place)
Diabetes training is needed, given the prevalence of diabetes, with 50% of long-term care residents having Type I or Type II
Need for education for all disciplines regarding palliative care, pain management.
Alzheimer’s Knowledge Exchange offers the U-First program39 for dementia and related care (working toward an e-learning version) and are developing modules for pain and pain management in dementia care
There is an increasing emphasis on person-directed care – which will have various implications for education
Need for all to be better communicators, at least partly driven by greater expectations on performance
Employers need tools to assess skills and competencies of their staff
Challenges of moving knowledge into education and into practice
The importance of physical activity, spiritual care and dealing with social isolation issues
39 http://u-first.ca/u-first-curriculum/ [accessed March 21, 2014]
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Putting someone on the ground, in context, to provide educational support and coaching in the moment, is a very good model to use
There should be more integration of learning into the workplace, including (but not limited to) the point of care
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Modes of Education Delivery 8.
The mix of educational program delivery varies by discipline, though it is overall predominantly face-to-face/classroom-based. There are some fully e-learning as well as blended (combining classroom and e-learning) forms of learning available and it appears that such programs are growing. For shorter, less formal programs, webinars are becoming more common.
There is broad recognition that e-learning and blended modes of delivery will be increasingly necessary given geography, effective dissemination of expertise and flexibility of access.
There are several key enablers for the e-learning and blended modes: growth in computer as well as internet literacy; improvements in internet coverage and network speed; and, increased credibility for these forms of education.
At the same time, there are a number of important barriers to offer e-learning and blended programs: high up-front costs for design, development and testing; acquiring the necessary expertise; and, having the required infrastructure and services for hosting.
The Ontario Telemedicine Network (OTN)40 plays a major role in enabling the dissemination of videos for continuing education for healthcare professionals. These are typically speaker events and other short forms of education, either as live webcasts and/or archived presentations. They are primarily focused on clinical, but also administrative and educational roles. OTN facilitates video-conferencing, webcasting and archiving for clinical and other healthcare needs, but does not develop content. It currently hosts 225,000 views per year through its webcasting centre. It supports 3,000 video-conferencing sites across the province and 1,000 user organizations.
OTN’s recent entry into tele-home care may create opportunities for education for practitioners and caregivers working with seniors in their homes. The approach was developed with RNAO within a best practices framework and piloted across 3 Local Health Integration Networks (LHINs). The initiative now has 1,400 patients, enrolled through their primary care provider. The model is to have a nurse who looks in on the patient daily.
OTN is currently determining if the same kind of service may be applied to diabetes management. LHINs have also expressed other needs regarding home- and community based services, such as for palliative care.
Recommendation 134 from Living Longer, Living Well speaks to the role of OTN in education:
The Ministry of Health and Long-Term Care should support the collaborative working of the Ontario Telemedicine Network (OTN) with knowledge transfer partners to create and manage an online repository of educational presentations that help health, social, and community care providers acquire additional knowledge and skills in the care of older adults. [p. 203]
In response to this recommendation, an initiative is under way at OTN to establish and manage a repository of resources, including educational materials for providers involved in seniors care.
40 www.otn.ca [accessed March 21, 2014]
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As a first phase, appropriately tagged existing OTN resources will be assembled into a seniors care microsite over the next few months. In a second phase, through the advice of thought leaders, a wider range of webcasts or other materials will be gathered. The primary, targeted audience will continue to be practitioners, though the public may also make use of these resources. Indeed, OTN does have a mandate today to offer services to patients and informal caregivers. A patient-driven, patient-centric ‘consumer strategy’ is currently in development. A roadmap is expected to be ready during 2014. No specific provisions have been established as yet for educators.
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Better Aging Summit – Commentary from Break-Out Group Discussions 9.
As previously mentioned, the Better Aging Summit was held on February 13, 2014 at Baycrest Health Sciences in Toronto. The program included break-out sessions for participating stakeholders to express their views and suggestions to move forward. The discussion points have been gathered and summarized in the Proceedings Report for the Better Aging: Ontario Education Summit.41
Sections 6.2 and 7.2.3 are specifically about continuing professional development.
The commentary has been reviewed for the purposes of the present report.
41 Council of Ontario Universities. March 28, 2014
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Analysis and Priorities for Moving Forward 10.
There is very good alignment between findings from interviews, commentary from the Better Aging Summit break-out sessions and background literature review.
As an overview, it is useful to analyze the range of CPD educational offerings to assess which areas need more attention. Figure 10.1 is an aggregated representation for the five disciplines addressed (the ‘discipline-specific’ category), but also incorporates general findings regarding interprofessional or open programs which were encountered during the needs assessment. It illustrates that programs which are open to a range of disciplines are in a relatively good position. In particular, colleges offer a range of options of this kind across Ontario. There are also quite a number of less formal or ad hoc discipline-specific opportunities for learning on a wide range of topics.
For the discipline-specific and interprofessional categories, however, there are few structured programs – whether classroom-based or utilizing e-learning (fully or in hybrid forms). These four areas of weakness are depicted in orange. These are the broad CPD categories in need of attention. We might further subdivide each cell in the figure by discipline, the categories of clinical versus non-clinical, or even further in terms of specific topic area (e.g. delirium, falls, leadership). They might also be probed in terms of provincial geography, by care setting, suitability for non-professionals such as informal caregivers or English/French content.
Figure 10.1: Seniors Care-Related CPD Education – Areas of Strength vs. Areas of Weakness
* Interprofessional education is being covered in more detail within a separate report.
Less formal/ Ad hoc
Structured [Classroom-based]
Structured [e-Learning/
Hybrid]
Discipline-Specific
Many [e.g. Webinars,
conferences, rounds]
Few [e.g. Excellence in Resident-Centred
Care]
Few [e.g. Geri-EM]
Inter-professional*
Insufficient information Few Few
[e.g. Bridges to Care]
Open Many
[e.g. Webinars, conferences]
Many [e.g. Gerontology
certificate programs]
Some - Growing [e.g. Gerontology
certificate programs]
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According to our findings, each discipline is at a different level of maturity with regard to seniors care-related CPD, as is evident below. Even within this sample set of five disciplines covered, there are ‘have’ and ‘have-not’ professions. Nevertheless, there is considerable room for improvement within the ‘have’ professions, also, to strengthen their educational supports in the CPD context.
10.1 Discipline-Specific Priorities
Medicine
M1 Expand CPD programs. Medicine is in a very strong position overall regarding seniors care insofar as it has the geriatric medicine specialization, competency models in use and a range of other pertinent resources available (conferences, rounds, self-study groups, web materials, etc.). The existence of Divisions of Geriatric Medicine at Ontario medical schools, the Canadian Geriatrics Society and other organizations, helps to bring focus and recognition to the field of seniors care.
There are several targeted CPD programs, cited in Section 2. And in Appendix D, covering emergency medicine, the medical director role in long-term care facilities, and one for general practice. Nevertheless, few CPD offerings appear to be available for the general practitioner, whether through university medical continuing education programs or elsewhere in Ontario. The same may be said in relation to classroom-based versus e-learning/hybrid modes of delivery.
Specific topics, which would be primarily of assistance to general practitioners and possibly specialists other than those in geriatric medicine, have also been raised as being in need of attention (listed in Section 2.). Prioritization will be required to address the most pressing needs in a timely way. Efforts to replicate successful programs, in order to offer them in additional regions or to make them available via e-learning or hybrid approaches, should be pursued. French programs should also be introduced where appropriate.
Nursing (Baccalaureate /Registered)
N1 Expand CPD programs. Nursing is in an excellent position overall regarding seniors care. There is the CNA program for gerontology specialization along with a national-level designation, competency models in use, the RNAO fellowship and Spotlight programs, as well as a range of other pertinent resources available (webinars, conferences, workshops, self-study groups, web materials, etc.). The existence of Gerontological Nurses Associations in Ontario, in other provinces and at the national level, helps to bring strong focus and recognition to the field of seniors care.
Again, few CPD offerings appear to be available, whether through university nursing continuing education programs or elsewhere in Ontario. The same may be said in relation to classroom-based versus e-learning/hybrid modes of delivery. Specific topics have also been raised as being in need of attention (listed in Section 3.). Prioritization will be required to address the most pressing needs in a timely way. Efforts to replicate successful programs, in order to offer them in additional regions or to make them available via e-learning or hybrid approaches, should be pursued. French programs should also be introduced where appropriate.
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Social Work
SW1 Consider establishment of competency model. While there is strong interest in having CPD programs for seniors care, the profession is currently in quite a weak position overall in this regard. There is no competency model in use related to CPD and seniors care.
SW2 Expand CPD programs. Few CPD offerings appear to be available, whether through university social work continuing education programs or elsewhere in Ontario. Specific topics have been raised as being in need of attention (listed in Section 4.). Prioritization will be required to address the most pressing needs in a timely way. French programs should also be introduced where appropriate.
SW3 Support initiatives in e-learning. There is interest in delivering CPD offerings via e-learning, but there are barriers to designing, developing, testing and operating such programs for the profession. Restrictions regarding the use of OTN should be addressed.
Practical Nursing
PN1 Expand CPD programs. Practical nursing is in quite a good position overall regarding seniors care insofar as there are some programs available. Also, the professional association, RPNAO, is acknowledging and highlighting exemplary seniors care, as well as offering leadership education and other relevant programs for its members. In addition, it is supporting fellowships (which may be applied to seniors care). Specific topics have been raised as being in need of attention (listed in Section 5.). Prioritization will be required to address the most pressing needs in a timely way. Efforts to replicate successful programs, in order to offer them in additional regions or to make them available via e-learning or hybrid approaches, should be pursued. Again, French programs should be introduced where appropriate.
Personal Support Work
PSW1 Expand CPD programs. PSWs are in a reasonably good position overall regarding seniors care insofar as there are some programs available. Further development is likely to be dependent on the standardization of the entry-to-practice curriculum. Through this work, a competency model may also emerge for PSWs. There appears to be a substantial level of attention on this discipline, given the extent of interaction PSWs have with seniors as well as the sheer size of this workforce. The attention is particularly in the long-term care setting. Specific topics have been raised as being in need of attention (listed in Section 6.). Prioritization will be required to address the most pressing needs in a timely way. Efforts to replicate successful programs, in order to offer them in additional regions or to make them available via e-learning or hybrid approaches, should be pursued. Again, French programs should be introduced where appropriate.
10.2 General Priorities
G1 Overcoming fragmented sources and minimal reuse of resources. A variety of high-quality resources are available across (and beyond) Ontario, for a range of healthcare disciplines, but there is very limited coordination and reuse. This means that practitioners must do their own time-consuming research and navigation. It also leads to duplication of efforts.
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A seniors care-focused, web-based portal, directory or database function should be established to help overcome these challenges, minimize duplication and highlight gaps which should be addressed. Of particular importance would be to organize what is available to make it more accessible and relevant for daily practice. Utilizing an organizational framework spanning care settings, topics, disciplines, etc. would help with searches. One gap which has been noted is the lack of video-based case study or patient simulation resources. Such resources, which may well require funding, are deemed enormously valuable for education.
The database should serve all Ontario healthcare and social services practitioners and educators, across all disciplines. Alternatively, such a directory may be integrated into a broader-based one. In either case, Wikipedia may serve as a good approach, one where contributions, reviews and updates – the curating process – are largely self-maintaining.
G2 Development of competency models. For those disciplines lacking competency models for CPD, collaborative efforts are needed within the discipline community, including educators, professional associations, regulatory bodies, practitioners and others, to create appropriate models in order to guide the development of suitably informed programs. Such work may benefit from the NICE-GERI Core Interprofessional Competencies for Gerontology42 or other appropriate discipline-specific and interprofessional models from elsewhere.
G3 Promotion of seniors care/geriatrics/gerontology as a worthwhile career option. As noted by several of the disciplines covered, seniors care has a poor image and cultural issues hampering its appeal as a worthwhile career option. Addressing such perceptions should begin with entry-to-practice education. Motivational programs, such as RPNAO’s Award for Excellence in the Care of Older Ontarians, are to be applauded. NICE established Gerontology groups on campuses across Canada for undergraduate and graduate students to promote gerontology and seniors care as an important and gratifying field (the program has been discontinued). Over 2 years, such groups conducted tours, had guest speakers and held a variety of other events. Each group was assigned a mentor. Additional initiatives are required of this kind to create a much more positive and compelling picture to draw professionals to this field.
G4 More coordinated funding approach between MOHLTC, MTCU and MCSS to prevent ‘silo-ing’ of educational programs. Some disciplines appear to be disadvantaged due to differing levels of funding support from various Ministries. There is much attention on health care support and funding of medical needs; there is much less for community and home-based care and social services. The majority of seniors continue to live at home, yet supports – including for education – are relatively limited.
G5 Expansion of role of OTN (or similar organization) to host and support online learning. Since OTN is well-established in the healthcare sector and already provides a range of video-conferencing and webinar services, it is a natural candidate to also support e-learning programs for seniors care-related education. Access is required for non-MOHLTC-funded organizations to contribute their e-learning programs and have them hosted on the OTN infrastructure. MOHLTC has negotiated an arrangement with the Ontario Ministry of Children and Youth Services for such access. Similar arrangements should be struck with the Ontario
42 http://www.nicenet.ca/files/NICE_Competencies.pdf [accessed March 21, 2014]
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Ministry of Training, Colleges and Universities and the Ontario Ministry of Community and Social Services.
OTN’s recent entry into tele-home care may create opportunities for education for practitioners and caregivers working with seniors, and indeed for the seniors themselves, in their homes. This possibility, to provide in situ CPD related to home care, should also be explored. OTN’s ‘consumer strategy’, currently in development, would reinforce delivery of educational programs to caregivers and seniors.
G6 Exploit opportunities for replication. There are a number of programs, resources and even approaches which should be replicated or extended across the province. The program and the approach used for the Virtual Certificate in Geriatrics, developed by the Regional Geriatric Program of Hamilton, is a good example of a candidate for replication. There are others. Some initiatives will require support and funding; others may be feasible to do within existing capacity. In many, though certainly not all instances, replication will be best accomplished through e-learning so as to reach practitioners across the province.
G7 Incorporate overarching characteristics and competencies in programs. Interviewees as well as participants in the Better Aging Summit break-out sessions have recommended that programs be patient- or client-centred, include cultural competence, be interprofessional in approach, possess an experiential flavour and have clear learning outcomes (geared to improved patient outcomes), as much as possible. It has also been suggested that a common, baseline set of competencies for seniors care should be developed for all healthcare and social services CPD, with more specific competencies developed at the level of the discipline or specialty.
G8 Address cross-cutting needs – develop once, use for multiple disciplines. Every discipline has a stake in understanding and applying well certain common topics. Some examples are: leadership; mental health; teamwork; consent, capacity and substitute decision-making; and, collaborative care planning. A combined effort by a broad set of disciplines to develop these once as high-quality modules, and then disseminate to all, would be highly efficient. It would have the added benefit of facilitating shared concepts, terminology and approaches in support of interprofessional work.
G9 More partnering between educational institutions, clinical sites and/or professional associations. There are some excellent collaborations in place already, such as between Schlegel and Conestoga College, the University of Toronto – Faculty of Medicine and University Health Network, and the Regional Geriatric Program of Hamilton and McMaster University. Many more should be encouraged to exploit the expertise, content and educational capabilities of the partners and launch richer CPD programs much sooner.
G10 Explore more direct funding of educational institutions rather than employers. MOHLTC, MCSS or other Ministries allocate funds to employers for practitioner training. Sometimes, the employers create their own programs. Of course, these training opportunities are then limited to the staff at that site, may not be of the highest quality and carry no credentials. This also fragments CPD in that enrollments at educational institutions can become too small for them to viably mount needed courses. An alternative approach, directly funding educational institutions for these continuing education programs, would be advantageous in multiple ways.
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G11 Provide supports for informal caregivers. While the focus of this needs assessment has been on healthcare and social services professionals engaged in seniors care, the many informal caregivers (family, friends, volunteers) involved should be included in continuing education plans. This should cover direct training for informal caregivers, as well as training practitioners to, in turn, train the informal caregivers. The training should encompass the active exchange of skills and knowledge transfer. This is a crucial way to build capacity and to improve the effectiveness of those who are part of each senior’s support network.
G12 Ensure continuity of learning between entry-to-practice and CPD. CPD does not stand alone. There should be continuity between the various stages of learning throughout the career of a practitioner. Analysis would be required, by discipline, as to the optimal distribution of competency development across these stages. Certification and regular re-certification of certain competencies may also be warranted.
G13 Seek opportunities to integrate learning within the workplace. Several interviewees have commented on this as an important element in CPD. Similar points are raised in the literature, including (but not limited to) learning at the point-of care.
G14 Complement education with superior toolkits. Many well-researched tools and resources exist today from NICE, the Seniors Health Knowledge Network, Alzheimer’s Knowledge Exchange and others. Some others need to be refined further or are yet to be developed. There appears to be a great need for evidence-based, high quality information that has been translated into a format that can be readily applied by practitioners and, in some instances, by informal caregivers.
G15 Rethink aging. It has been suggested that perspectives on aging are outdated and should take into account much more the many seniors who are living longer, living well and living independently. This implies that at least some aspects of CPD should be about wellness management and health protection.
G16 Future work and implementation. Five disciplines were covered for the purposes of this needs assessment. There are more than 20 other healthcare and social services disciplines, both regulated and unregulated, which also have important roles in seniors care. While each discipline should be studied with the lens of seniors care-related education, it would be a lengthy process, likely with many similar findings as was the case for the five reviewed here. Instead, it is recommended that such discipline-specific research be carried out within the discipline itself, with appropriate support and funding. From a change enablement standpoint, this will also help build momentum and buy-in to introduce initiatives to address any gaps. In parallel, it is recommended that priorities from the current needs assessment be pursued through various pilot projects, with a view to implementation and expansion to serve other disciplines as they prepare themselves with their own findings and plans.
G17 Establish a guiding coalition to provide direction and monitor. In connection with priority G15, but also more generally, putting in place a guiding coalition would be of significant value. Direction-setting, encouragement, monitoring, coordination, prodding, some change management, helping make the case for funding and other forms of support will be needed to
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continue the momentum. A process for continuously surveying educational needs and navigating accordingly would also be of benefit.
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Appendix A: Interview Questionnaire
Continuing Professional Development Health Workforce Education Needs for Seniors Care
eFuel Partners Inc., on behalf of the Council of Ontario Universities
Identification
Name______________________________ Title____________________________
Organization_________________________________________ Date___________
Questions
1. Please tell us about major needs and trends over the next five years concerning seniors care (geriatrics/gerontology) in the context of continuing professional development (CPD) for your discipline.
2. What do you have in place to address these needs and trends?
3. What do you think should be offered beyond what is in place or planned?
4. Which areas concerning seniors care are particularly strong or well covered with CPD programs? Example programs?
5. Which areas concerning seniors care are particularly weak or are considered gaps?
6. What, if any, are the barriers to addressing these weaknesses or gaps?
7. Beyond formal courses, do you offer other learning opportunities such as mentorships, experiential learning, etc., concerning seniors care? To what extent should alternate modes of learning be made available?
8. Have you done an analysis or needs assessment with regard to certain desired competencies or to develop a competency framework for CPD for seniors care? What is your process for conducting such a needs assessment? Would it be possible to share the outcomes of your assessment with us?
9. May we obtain an inventory of relevant existing courses or programs? May we obtain an inventory of relevant courses or programs planned or in development?
10. Are there particular leading organizations to which you might like to point us, in relation to CPD for seniors care for your discipline (Canadian, international)?
11. Do you have any key professional or educational partners with whom you collaborate to plan or develop or deliver CPD programs? Are there any new partnerships which may be required in relation to CPD for seniors care? Would you recommend we speak with any partners?
12. To what extent are programs designed for particular specialists vs providing for general education in the area? To what extent should programs be designed for particular specialists vs providing for general education in the area?
13. To what extent are programs currently delivered via classroom vs online vs mobile or in other ways? To what extent should programs be delivered via classroom vs online vs mobile mode or in other ways?
14. What are the relative costs of these different approaches to delivery?
15. Are there any other thoughts or suggestions you may have for us toward this project?
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Appendix B: Organizations Interviewed
[Number of individuals interviewed in organization; 1, unless otherwise indicated]
Algonquin College [2]
Alzheimer Society of Ontario/Alzheimer Knowledge Exchange
Baycrest [2]
Colleges Ontario
Council of Ontario Universities - CPD-Medicine Committee [8]
Faculty of Social Work, University of Toronto
Heads of Nursing (Chair), Ontario Colleges / Fanshawe College (Chair, Nursing)
Institute for Life Course and Aging, University of Toronto / National Initiative for the Care of the Elderly (NICE)
Institute of Health Policy, Management and Evaluation, University of Toronto
MEDLINE
MOHLTC - eHealth Liaison Branch
Ontario Association of Non-Profit Homes & Services for Seniors
Ontario Association of Social Workers [4]
Ontario Community Support Association
Ontario Long-Term Care Association [2]
Ontario Telemedicine Network [3]
Regional Geriatric Program - Hamilton
Regional Geriatric Programs of Ontario
Registered Nurses Association of Ontario [6]
Registered Practical Nurses Association of Ontario [2]
Ryerson University/ Ontario Gerontological Nurses Association
Schlegel Centre for Learning, Research and Innovation in Long Term Care
Seniors Health Knowledge Network
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Appendix C: Open Enrollment Gerontology CPD Programs
Detailed Example: Ryerson University – Chang School of Continuing Education
Certificate or Other Program Name
(if applicable)
Course Name Course No. Targeted Disciplines
[Specific / General]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Certificate in Gerontology
Interdisciplinary Studies: Gerontology: Critical Issues and Future Trends [Core]
CINT 901 General O E http://ce-online.ryerson.ca/ce/calendar/default.aspx?section=course&sub=cert&cert=55b7a6dd-3a2f-4fe6-a359-c12348578738&mode=course&ccode=CINT%20901&subname=Gerontology
March 18, 2014
Aging and the Individual [Core] CVGE 140 General O E http://ceonline.ryerson.ca/ce/calendar/default.aspx?id=5§ion=course&mode=course&ccode=CVGE%20140
Dec. 23, 2013
Aging and Society [Core] CVGE 141 General O E http://ceonline.ryerson.ca/ce/calendar/default.aspx?id=5§ion=course&mode=course&ccode=CVGE%20141
Dec. 23, 2013
Understanding Research [Core] CVGE 205 General C / O E http://ceonline.ryerson.ca/ce/calendar/default.aspx?id=5§ion=course&mode=course&ccode=CVGE%20205
Dec. 23. 2013
Consent, Capacity and Decision Making
CVGE 271 General C E http://ceonline.ryerson.ca/ce/calendar/default.aspx?id=5§ion=course&mode=course&ccode=CVGE%20271
Dec. 23, 2013
Aging and Interpersonal Skills CVGE 297 General C E http://ceonline.ryerson.ca/ce/calendar/default.aspx?id=5§ion=course&mode=course&ccode=CVGE%20297
Dec. 23, 2013
Ability, Disability and Aging CGER 298 General C / O E http://ceonline.ryerson.ca/ce/calendar/default.aspx?id=5§ion=course&mode=course&ccode=CGER%20298
Dec. 23, 2013
Health Services Management: Principles of Long Term Care Service Delivery
CHSM 307 General C / O E http://ce-online.ryerson.ca/ce/calendar/default.aspx?section=course&sub=cert&cert=55b7a6dd-3a2f-4fe6-a359-c12348578738&mode=course&ccode=CHSM%20307&subname=Gerontology
March 18, 2014
Interdisciplinary Studies: Health Promotion and Community Development
CINT 904 General C / O E http://ce-online.ryerson.ca/ce/calendar/default.aspx?section=course&sub=cert&cert=55b7a6dd-3a2f-4fe6-a359-c12348578738&mode=course&ccode=CINT%20904&subname=Gerontology
March 18, 2014
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Psychology: Adult Development CPSY 402 General C E http://ce-online.ryerson.ca/ce/calendar/default.aspx?section=course&sub=cert&cert=55b7a6dd-3a2f-4fe6-a359-c12348578738&mode=course&ccode=CPSY%20402&subname=Gerontology
March 18, 2014
Psychology: Death, Dying, and Bereavement
CPSY 802 General C E http://ce-online.ryerson.ca/ce/calendar/default.aspx?section=course&sub=cert&cert=55b7a6dd-3a2f-4fe6-a359-c12348578738&mode=course&ccode=CPSY%20802&subname=Gerontology
March 18, 2014
Sociology: Work and Families in the 21st Century
CSOC 606 General C E http://ce-online.ryerson.ca/ce/calendar/default.aspx?section=course&sub=cert&cert=55b7a6dd-3a2f-4fe6-a359-c12348578738&mode=course&ccode=CSOC%20606&subname=Gerontology
March 18, 2014
Gerontology: Consent, Capacity and Decision Making
CVGE 271 General C E http://ce-online.ryerson.ca/ce/calendar/default.aspx?section=course&sub=cert&cert=55b7a6dd-3a2f-4fe6-a359-c12348578738&mode=course&ccode=CVGE%20271&subname=Gerontology
March 18, 2014
Gerontology: Aging and Interpersonal Skills
CVGE 297 General O E http://ce-online.ryerson.ca/ce/calendar/default.aspx?section=course&sub=cert&cert=55b7a6dd-3a2f-4fe6-a359-c12348578738&mode=course&ccode=CVGE%20297&subname=Gerontology
March 18, 2014
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Other open enrollment programs across Ontario (program-level information only)
Program Name Program No.
Targeted Disciplines
[Specific / General]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Algonquin College
Working with Dementia Clients Multidiscipline
General O E http://www3.algonquincollege.com/ccol/program/dementia-studies-multidiscipline-part-time-online/
Dec. 23, 2013
Cambrian College
Diabetes Studies Certificate General O E https://secure.cambrianc.on.ca/coned/showcert.cfm?strCert=DICT.HTM Dec. 23, 2013
Canadore College
Palliative Care, Working with the Terminally Ill Certificate
General O E https://ss.canadorecollege.ca:7009/PROD/zwskgrps.P_Courses?sect_code=HSC&ssec_code=HSC-PLC&term_code=201330
Dec. 23, 2013
Conestoga College
Dementia Studies Multidiscipline Certificate
General D E http://www.conestogac.on.ca/parttime/1029.jsp March 25, 2014
Palliative Care Certificate General D E https://www.conestogac.on.ca/parttime/1253.jsp March 25, 2014
Thanatology Certificate General D E http://www.conestogac.on.ca/parttime/1287.jsp Dec. 23, 2013
Confederation College
Working with Dementia Certificate
General O E http://www.confederationc.on.ca/ce/dementia Dec. 23, 2013
Palliative Care Certificate General O E Incomplete Information Dec. 23, 2013
Durham College
Palliative Care Certificate General C E http://ssbp.mycampus.ca/prod/syzkcrss.P_Term?dept_code=CERT&assc_code=CARE
March 18, 2014
Dementia Studies Multidiscipline Certificate
General H E http://ssbp.mycampus.ca/prod/syzkcrss.P_Course?term_code=201441&dept_code=CERT&assc_code=DS
March 25, 2014
Gerontology Studies Certificate General D E https://ssbp.mycampus.ca/prod/syzkcrss.P_Term?dept_code=DECT&assc_code=GERC
March 26, 2014
Fanshawe College
Dementia Studies Certificate Multidiscipline
General C E http://www.fanshawec.ca/continuing-education/health-and-nursing/dementia-studies-multidiscipline
Dec. 23, 2013
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Fleming College
Working with Dementia Clients Certificate
General O E http://flemingcollege.ca/continuing-education/certificates/working-with-dementia-clients-certificate
Dec. 23, 2013
George Brown College
Grief and Bereavement Counselling Certificate
General C E http://coned.georgebrown.ca/owa_prod/cewskcrss.P_Certificate?area_code=PA0042&cert_code=CE0213
March 25, 2014
Studies in Aging Certificate General C E http://coned.georgebrown.ca/owa_prod/cewskcrss.P_Certificate?area_code=PA0042&cert_code=CE0263
March 25, 2014
Georgian College
Dementia Studies Certificate General C E http://www.georgianc.on.ca/coned09/coursescertificates/?f=display_courses&p_cat_code=DESM&p_keyword=Dementia%20Studies&p_url=Health%20and%20Wellness
March 25, 2014
Humber College
Gerontology Multidiscipline Certificate
General C E http://calendardb.humber.ca/LIS/WebCalendar/CE/ProgramOffering.do?name=13021
Dec. 23, 2013
Loyalist College
Dementia Studies Certificate General O E https://www.loyalistbanner.com/PROD/cewkcrss.P_Heading3?divs_code=HLTH&dept_code=DEMS
Dec. 23, 2013
Geriatric Studies Certificate General O E https://www.loyalistbanner.com/PROD/cewkcrss.P_Heading3?divs_code=HLTH&dept_code=GERI
Dec. 23, 2013
Palliative Care Certificate General O E https://www.loyalistbanner.com/PROD/cewkcrss.P_Heading3?divs_code=HLTH&dept_code=PALL
Dec. 23, 2013
Gerontology Certificate General O E https://www.loyalistbanner.com/PROD/cewkcrss.P_Heading3?divs_code=HLTH&dept_code=GERO
Dec. 23, 2013
Mohawk College
Dementia Studies/ Working with Dementia Clients Certificate
General H E http://www.mohawkcollege.ca/continuing-education/dementia-studies.html
Dec. 23, 2013
Gerontology and Working with the Aged Multidisciplinary Certificate
General O E http://www.mohawkcollege.ca/continuing-education/gerontology-working-with-aged-online-certificate.html
Dec. 23, 2013
Palliative Care Certificate General O E http://www.mohawkcollege.ca/continuing-education/palliative-care-certificate.html
Dec. 23, 2013
Niagara College
Community and Geriatric Mental Health Certificate
General C E http://www.niagaracollege.ca/content/ContinuingEducation/CourseGuide/CoursesbyInterest/HealthandWellness.aspx
Dec. 23, 2013
Palliative Care Certificate General C E http://www.niagaracollege.ca/content/ContinuingEducation/CourseGuide/CoursesbyInterest/HealthandWellness.aspx
Dec. 23, 2013
St. Clair College
Dementia Studies Certificate General O E http://www.stclaircollege.ca/online/ecampus_ol-dementia_coned.html Dec. 23, 2013
St. Lawrence College
Dementia Studies Certificate General C E http://www.stlawrencecollege.ca/programs-and-courses/full-time/programs/a_m/dementia-studies-multidiscipline/cornwall-part-time/
Dec. 23, 2013
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Appendix D: Inventory of CPD Programs Relating to Seniors Care for Medicine
Three specific CPD programs were identified in Section 2. These are detailed below.
No other Ontario CPD programs were found relating to seniors care beyond less formal or ad hoc continuing education opportunities such as speakers, webinars, rounds, conferences, etc.
Geri-EM
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[MD / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Personalized E-Learning in Geriatric Emergency Medicine
Cognitive Impairment MD O E http://geri-em.com/ March 25, 2014
Atypical Presentations MD O E http://geri-em.com/ March 25, 2014
Medication Management MD O E http://geri-em.com/ March 25, 2014
Trauma and Falls MD O E http://geri-em.com/ March 25, 2014
Functional Assessment and Discharge Planning
MD O E http://geri-em.com/ March 25, 2014
End of Life Issues and Symptom Management
MD O E http://geri-em.com/ March 25, 2014
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Ontario Long-Term Care Physicians
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[MD / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Medical Director Program
Regulatory, staff management, documentation
MD C E http://oltcp.ca/storage/2-education-program/2014/2014%20CMD%20COURSE%20REGISTRATION%20%20%20INFORMATION%20R1.pdf
March 18, 2014
Quality improvement
MD C E http://oltcp.ca/storage/2-education-program/2014/2014%20CMD%20COURSE%20REGISTRATION%20%20%20INFORMATION%20R1.pdf
March 18, 2014
Leadership, risk and safety management, ethics
MD C E http://oltcp.ca/storage/2-education-program/2014/2014%20CMD%20COURSE%20REGISTRATION%20%20%20INFORMATION%20R1.pdf
March 18, 2014
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University of Toronto, Family and Community Medicine and University Health Network
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[MD / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Care of the Elderly Certificate
Diagnosis and Management of Mild Cognitive Impairment and Dementia
Family Physicians
C E http://www.dfcm.utoronto.ca/about/newsevents/DFCMNEWS/news/121412-2.htm
March 25, 2014
Approach to Physically Frail Elderly Patients with Falls
Family Physicians
C E http://www.dfcm.utoronto.ca/about/newsevents/DFCMNEWS/news/121412-2.htm
March 25, 2014
Mental Health and Chronic Pain Management
Family Physicians
C E http://www.dfcm.utoronto.ca/about/newsevents/DFCMNEWS/news/121412-2.htm
March 25, 2014
Management of Common Medical Problems in the Elderly
Family Physicians
C E http://www.dfcm.utoronto.ca/about/newsevents/DFCMNEWS/news/121412-2.htm
March 25, 2014
Approach to Elderly Patients with Failure to Thrive
Family Physicians
C E http://www.dfcm.utoronto.ca/about/newsevents/DFCMNEWS/news/121412-2.htm
March 25, 2014
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Appendix E: Inventory of CPD Programs Relating to Seniors Care for Nursing (Registered/Baccalaureate), Practical Nursing and Personal Support Work
Algonquin College, Health Sciences, Continuing Education
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Bridging Program from Certificate to Diploma for PNs
Nursing in Geriatric Mental Health
NSG6804 RPN C E Incomplete information provided
Canadore College, Health Sciences
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Activation Techniques in Gerontology Certificate
Gerontology - Introduction ATG400 RPN/PSW D E https://ss.canadorecollege.ca:7009/PROD/zwskgrps.P_SubSection?sect_code=HSC&ssec_code=&term_code=
Dec. 28, 2013
Life Enrichment - Introduction ATG405 RPN/PSW D E Incomplete information provided March 25, 2014
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Anatomy of Aging ATG410 RPN/PSW D E Incomplete information provided March 25, 2014
Pathological Conditions and Interventions
ATG415 RPN/PSW D E https://ss.canadorecollege.ca:7009/PROD/zwskcrss.P_CourseDetail?sect_code=HSC&ssec_code=HSC-ATG&term_code=201330&subj_code=ATG&crse_numb=415
March 25, 2014
Dimensions of Communication ATG420 RPN/PSW D E https://ss.canadorecollege.ca:7009/PROD/zwskcrss.P_CourseDetail?sect_code=HSC&ssec_code=HSC-ATG&term_code=201330&subj_code=ATG&crse_numb=420
March 25, 2014
Promotion of Physical Abilities ATG425 RPN/PSW D E Incomplete information provided March 25, 2014
Promotion of Cognitive and Social Abilities
ATG430 RPN/PSW D E https://ss.canadorecollege.ca:7009/PROD/zwskcrss.P_CourseDetail?sect_code=HSC&ssec_code=HSC-ATG&term_code=201330&subj_code=ATG&crse_numb=430
March 25, 2014
Gerontology - Field Experience ATG435 RPN/PSW I E Incomplete information provided March 25, 2014
Conestoga College, School of Health and Life Sciences and Community Services
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
RPN Upgrade Care of the Aging Client PNUR1600 RPN C E http://www.conestogac.on.ca/parttime/1082.jsp#6506 March 25, 2014
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Confederation College, Health Sciences
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Palliative Care Competencies WR227 PSW C E Not being offered at this time March 25, 2014
Fanshawe College, Health Sciences, Continuing Education
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Postgraduate courses for PSWs
Foot Care for PSWs PSW E Incomplete information
Pharmacology for PSWs PSW E Incomplete information Role of PSW in Palliative Care
and Dying PSW E Incomplete information
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Fleming College, Continuing Education
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
PSW Certificate Bridging to Practical Nursing (out of 7 courses, 1 is relevant to seniors)
Non-Violent Crisis Intervention (CPI)
SOC100 PSW C E http://flemingcollege.ca/continuing-education/certificates/personal-support-worker-bridging-to-practical-nursing
March 25, 2014
Workshops targeted to PSW/RPN
Mental Health and Behaviours New PSW/RPN E Incomplete information provided
Gerontology: Changes associated with Aging
New PSW/RPN E Incomplete information provided Palliative / End of Life Care New PSW/RPN E Incomplete information provided Assisting with Medication
Administration New PSW/RPN E Incomplete information provided
Therapeutic Relationships and Professional Practice
New PSW/RPN E Incomplete information provided
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George Brown College, Health Sciences and Community Services
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Dementia Care Skills Certificate
Caregiver Skills and Issues GERT9017 PSW C E http://coned.georgebrown.ca/owa_prod/cewskcrss.P_CrseGet?subj_code=GERT&crse_numb=9017
Dec. 22, 2013
Dementia and Related Cognitive Disorders
GERT9015 PSW C E http://coned.georgebrown.ca/owa_prod/cewskcrss.P_CrseGet?subj_code=GERT&crse_numb=9015
Dec. 22, 2013
Dementia Intervention Skills GERT9016 PSW C E http://coned.georgebrown.ca/owa_prod/cewskcrss.P_CrseGet?subj_code=GERT&crse_numb=9016
Dec. 22, 2013
Restorative Care Skills Certificate
Care of Clients with neurological Conditions
CARE9045 PSW / Activation / General
C E http://coned.georgebrown.ca/owa_prod/cewskcrss.P_CrseGet?subj_code=CARE&crse_numb=9045
Dec. 22, 2013
Restorative Care GERT9013 PSW / Activation / General
C E http://coned.georgebrown.ca/owa_prod/cewskcrss.P_CrseGet?subj_code=GERT&crse_numb=9013
Dec. 22, 2013
Restorative Care-Principles, Practices, Techniques
GERT9007 PSW / Activation / General
C E http://coned.georgebrown.ca/owa_prod/cewskcrss.P_CrseGet?subj_code=GERT&crse_numb=9007
Dec. 22, 2013
Specializing in Stroke Care CARE9042 PSW / Activation / General
C E http://coned.georgebrown.ca/owa_prod/cewskcrss.P_CrseGet?subj_code=GERT&crse_numb=9042
Dec. 22, 2013
Workshop Oral Health and Dementia CARE9041 PSW C E http://coned.georgebrown.ca/owa_prod/cewskcrss.P_CrseGet?subj_code=CARE&crse_numb=9041
Dec. 22, 2013
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Georgian College, Health and Wellness, Continuing Education
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
RN Oncology/ Palliative Care Certificate
Comfort Measures (ODE) RNRS1066 RN C E http://www.georgianc.on.ca/coned09/coursescertificates/?f=display_outline&p_subj_code=RNRS&p_crse_numb=1065&p_title=Orient%2FPalliative+Care(ODE)
March 25, 2014
Orientation to Palliative Care (ODE)
RNRS1065 RN C E http://www.georgianc.on.ca/coned09/coursescertificates/?f=display_outline&p_subj_code=RNRS&p_crse_numb=1065&p_title=Orient%2FPalliative+Care(ODE)
March 25, 2014
Hospice Palliative Care Nursing RNRS1041 RN C E Incomplete information Pain and Symptom Management RNRS1045 RN C E Incomplete information
Mohawk College, Health Sciences, Continuing Education
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Palliative Care Certificate
PSW E Program has been discontinued
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St. Clair College, Health Sciences, Continuing Education
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Personal Support Worker Certificate
Mental Health and Dementia Studies
PSW200 PSW C E http://www.stclaircollege.ca/programs/coned/health_sciences_coned.html March 25, 2014
Promoting Wellbeing, Comfort and Palliative Care
PSW203 PSW C E http://www.stclaircollege.ca/programs/coned/health_sciences_coned.html March 25, 2014
Consolidation - Long Term Care PSW211 PSW I E http://www.stclaircollege.ca/programs/coned/health_sciences_coned.html March 25, 2014
Upgrading for PSWs
Pharmacology A PRM134A PSW C E http://www.stclaircollege.ca/programs/coned/health_sciences_coned.html March 25, 2014
Pharmacology B PRM134B PSW C E http://www.stclaircollege.ca/programs/coned/health_sciences_coned.html March 25, 2014
RPN Bridging Program
Community, Gerontology and Mental Health Nursing Theory
PNR507 PSW/RPN C E http://www.stclaircollege.ca/programs/coned/health_sciences_coned.html March 25, 2014
Mental Health HCE110N RN/RPN C E http://www.stclaircollege.ca/programs/coned/health_sciences_coned.html March 25, 2014
Gerontology HCE106 RN/RPN C E http://www.stclaircollege.ca/programs/coned/health_sciences_coned.html March 25, 2014
Brain Fitness HCE126N RN/RPN C E http://www.stclaircollege.ca/programs/coned/health_sciences_coned.html March 25, 2014
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St. Lawrence College
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
For PSWs MOHLTC JUST CLEAN YOUR HANDS program
PSW unknown E Incomplete information provided
Accessibility for Ontarians with Disabilities Act (AODA) certification
PSW O E Incomplete information provided
Violence and Harassment in the Workplace certification
PSW O E Incomplete information provided
(WHMIS) certification PSW O E Incomplete information provided
Safe Feeding and Risk management techniques certification
PSW unknown E Incomplete information provided
Safe lifting, transfer, positioning and body mechanics techniques
PSW unknown E Incomplete information provided
Gentle Persuasive approach training and certification
PSW unknown E Incomplete information provided
Safe food handling and preparation for the home environment training and certification
PSW unknown E Incomplete information provided
Personal Care Theory PSW unknown E Incomplete information provided
Palliative Care PSW unknown E Incomplete information provided
Code Purple PSW unknown E Incomplete information provided
Safe-TALK suicide training PSW unknown E Incomplete information provided
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Workshops Gentle Persuasion Approach PSW unknown E Incomplete information provided
Palliative Care PSW unknown E Incomplete information provided
Infection and Wounds PSW unknown E Incomplete information provided
Diabetes PSW unknown E Incomplete information provided
Death and Dying PSW unknown E Incomplete information provided
Swallowing issues PSW unknown E Incomplete information provided
Brain Tumors and client care PSW unknown E Incomplete information provided
Brain, Body and You PSW unknown E Incomplete information provided
Sheridan College
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Part-Time PSW Studies
PSW E Program will no longer be offered through Continuing Education as of May, 2014; disposition not known
Dec. 23, 2013
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RPNAO
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Introduction to Leadership
Leadership RPN Online E http://www.rpnao.org/practice-education/e-learning/leadership-course Mar. 25, 14
Communication RPN Online E http://www.rpnao.org/practice-education/e-learning/leadership-course Mar. 25, 14
Problem Solving RPN Online E http://www.rpnao.org/practice-education/e-learning/leadership-course Mar. 25, 14
Coaching and Mentoring RPN Online E http://www.rpnao.org/practice-education/e-learning/leadership-course Mar. 25, 14
Team Building RPN Online E http://www.rpnao.org/practice-education/e-learning/leadership-course Mar. 25, 14
Motivation RPN Online E http://www.rpnao.org/practice-education/e-learning/leadership-course Mar. 25, 14
Leadership Leadership RPN Online E http://www.rpnao.org/practice-education/e-learning/leadership-course Mar. 25, 14
Personal Leadership RPN Online E http://www.rpnao.org/practice-education/e-learning/leadership-course Mar. 25, 14
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Schlegel Centre for Learning, Research and Innovation and Conestoga College
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[RN / RPN / PSW / Other]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Excellence in Resident-Centered Care Certificate
Resident-Centred Care PSW At the work site
E http://www.the-ria.ca/research/themes_workforce.php March 25, 2014
Infection Control PSW At the work site
E http://www.the-ria.ca/research/themes_workforce.php March 25, 2014
Restraints PSW At the work site
E http://www.the-ria.ca/research/themes_workforce.php March 25, 2014
Oral Care PSW At the work site
E http://www.the-ria.ca/research/themes_workforce.php March 25, 2014
Nutrition PSW At the work site
E http://www.the-ria.ca/research/themes_workforce.php March 25, 2014
Quality Care Consolidation 1 PSW At the work site
E http://www.the-ria.ca/research/themes_workforce.php March 25, 2014
Continence Care PSW At the work site
E http://www.the-ria.ca/research/themes_workforce.php March 25, 2014
Skin and Wound Care PSW At the work site
E http://www.the-ria.ca/research/themes_workforce.php March 25, 2014
Geriatric Safety PSW At the work site
E http://www.the-ria.ca/research/themes_workforce.php March 25, 2014
Pain PSW At the work site
E http://www.the-ria.ca/research/themes_workforce.php March 25, 2014
Responsive Behaviours PSW At the work site
E http://www.the-ria.ca/research/themes_workforce.php March 25, 2014
Quality Care Consolidation 2 PSW At the work site
E http://www.the-ria.ca/research/themes_workforce.php March 25, 2014
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Appendix F: Inventory of CPD Programs Relating to Seniors Care for Social Work
Two Ontario CPD programs were found relating to seniors care beyond less formal or ad hoc continuing education opportunities such as speakers, webinars, rounds, conferences, etc. See the following table.
No CPD programs were found relating to seniors care at:
Algoma University, Department of Community Development and Social Work
Carleton University, School of Social Work
University of Western Ontario, King's University College, School of Social Work
Lakehead University, School of Social Work
Laurentian University, School of Social Work
McMaster University, School of Social Work
University of Waterloo, Renison University College, School of Social Work
University of Windsor, School of Social Work
Ryerson University, School of Social Work
York University, Faculty of Liberal Arts & Professional Studies, School of Social Work
University of Ottawa, School of Social Work
Wilfrid Laurier University, Lyle S. Hallman Faculty of Social Work
Ontario Association of Social Workers
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University of Toronto, Factor-Inwentash Faculty of Social Work
Certificate or Other Program Name (if applicable}
Course Name Course No. Targeted Disciplines
[Social Work (SW) / General]
Delivery Format [Class-room/ Online/
Hybrid/ Distance/ Intern-ship]
English/ French
Link Accessed
[date]
Certificate in Bereavement Education
Introduction to Bereavement and the Grieving Process
BERE1 SW/ General
C E http://www.socialwork.utoronto.ca/conted/certificate/BERE.htm Dec. 22, 2013
Trauma and Grief Throughout the Life-Span
BERE2 SW/ General
C E http://www.socialwork.utoronto.ca/conted/certificate/BERE.htm Dec. 22, 2013
Spiritual, Philosophical and Cultural Issues in Grief and Trauma
BERE3 SW/ General
C E http://www.socialwork.utoronto.ca/conted/certificate/BERE.htm Dec. 22, 2013
Variables and Risks that Affect Trauma and Grief
BERE4 SW/ General
C E http://www.socialwork.utoronto.ca/conted/certificate/BERE.htm Dec. 22, 2013
Families Coping with Trauma and Grief
BERE5 SW/ General
C E http://www.socialwork.utoronto.ca/conted/certificate/BERE.htm Dec. 22, 2013
Special Losses/Support and Healing Groups
BERE6 SW/ General
C E http://www.socialwork.utoronto.ca/conted/certificate/BERE.htm Dec. 22, 2013
Certificate in Grief and Trauma Counselling
Module 1 - Grief and the Self
-
SW/ General
C E http://www.socialwork.utoronto.ca/conted/certificate/Grief_and_Trauma_Counselling.htm
Dec. 22, 2013
Module 2 - Counselling Techniques/CISD
- SW/ General
C E http://www.socialwork.utoronto.ca/conted/certificate/Grief_and_Trauma_Counselling.htm
Dec. 22, 2013
Module 3 - Complicated Grief/Therapy
- SW/ General
C E http://www.socialwork.utoronto.ca/conted/certificate/Grief_and_Trauma_Counselling.htm
Dec. 22, 2013
Module 4 - Trauma & Grief - SW/ General
C E http://www.socialwork.utoronto.ca/conted/certificate/Grief_and_Trauma_Counselling.htm
Dec. 22, 2013
Module 5 - Strategies and Skills for Crisis Intervention
- SW/ General
C E http://www.socialwork.utoronto.ca/conted/certificate/Grief_and_Trauma_Counselling.htm
Dec. 22, 2013
Module 6 - HIV & AIDS/Application of Skills
- SW/ General
C E http://www.socialwork.utoronto.ca/conted/certificate/Grief_and_Trauma_Counselling.htm
Dec. 22, 2013
Practicum - SW/ General
I E http://www.socialwork.utoronto.ca/conted/certificate/Grief_and_Trauma_Counselling.htm
Dec. 22, 2013
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