Train and support a workforce skilled in care of older people
Respondents articulated the need for both a formal gerontology curriculum and opportunities for interacting with older people from early undergraduate years. Limited undergraduate training in care of older people was recognised across all professions, attributed to low priority by teaching institutions. Gerontology content was generally delivered as elective rather than core curriculum, clinical placements were limited, and there were minimal opportunities for post-graduate study in gerontology.
“Part of the challenge in preparing a workforce is that you need to develop [teamwork] skills just as much as the development of the technical and know-how skills that fascinate accrediting authorities but actually don’t really serve people well in terms of being work-ready.” P18, AHP, academic
Consequently, most training was occurring in the workplace. The importance of experiential learning was well articulated, but exposure to training was generally ad hoc, depending on early placements on geriatric wards or exposure to passionate champions. There was a recognised lack of skilled teachers and mentors with dedicated time to provide training and support, and reliance on individually-sought external conferences and courses.
“If you don’t go through a geriatric unit or work with a geriatrician who is maybe working as a general physician, other than that, I don’t think they will get formal geriatric training.” P5, geriatrician, clinician “It’s just where you end up working. You’re provided with on-the-job training… There’s lots of external courses and conferences but there’s nothing specific here.” P6, nurse, manager
There were challenges in delivering hospital-based education including multi-level learning needs, competing mandatory training, limited education time, high staff numbers and turnover, and the limited value of traditional ‘in-service’ approaches for complex education and skills training. External agencies provided some educational opportunities, but there was a need for continuing support and ‘hands-on’ training, particularly in caring for people with cognitive impairment.
“If the skill mix is poor and you haven’t got those other people with experience, then how do you actually get that?” P13, nurse, clinician “It’s educating staff… coaching them and mentoring them is the difference. It’s constant follow-up. All this in-service and interest groups and stuff like that, it’s great. It’s not enough. It’s not enough to create change and keep motivating people.” P16, nurse, clinician