{"id":{"repo_id":"cork","oai_identifier":"oai:cora.ucc.ie:10468/18432"},"canonical_url":"https://search.dev.ndltd.org/etd/cork/oai:cora.ucc.ie:10468/18432","repository":{"repo_id":"cork","name":"University College Cork","base_url":"https://cora.ucc.ie/server/oai/request"},"display":{"title":"The competencies required by hospital doctors to care for older adults","abstract":"Background The ageing population has created an escalating demand for age-attuned healthcare globally. Most older adults will now receive their care from doctors without specialist geriatric medicine training. Older adults are a distinctly heterogenous group with varying co-morbidities that can often present with atypical symptoms. This complexity can make the treatment of older adults challenging for doctors. Calls for integrating generalism into postgraduate training has been proposed as a potential solution. However, what exactly these generalist competencies remain unclear. Equally, how to deliver them in overburdened healthcare systems is also a concern as learning in the clinical learning environment is often hindered by competing demands. Studies suggest that using simulation-based education (SBE) to deliver these competencies may form part of the solution. The aim of this research programme was to determine what are the generalist competencies required by hospital doctors to care for older adults and the role of SBE to support the transformative learning of a subset of these competencies. Methods This research programme consisted of three interconnected studies using a mixed methods approach. The first study was a scoping review. We utilised the Arksey and O'Malley guidelines to determine the generalist competencies already identified in the literature for hospital doctors caring for older adults. To explore this further and determine which competencies should be prioritised we sought stakeholder input via a group concept mapping (GCM) study. We invited healthcare professionals from different disciplines and specialties to participate via a web-based platform. Multidimensional scaling and hierarchical cluster analysis were utilised to analyse participants views and prioritise the identified competencies. The final study explored whether SBE could facilitate transformative learning of a subset of the identified generalist competencies. Guided by transformative learning theory (TLT), a SBE scenario focusing on the assessment and management of an older adult with delirium and Parkinson’s disease was developed. Hospital doctors within a single hospital site were invited to participate in the simulation scenario, followed by an audio recorded debrief and subsequent individual semi-structured interviews. Transcripts were analysed using reflexive hematic analysis. Results 1.) Two hundred and two competencies within twenty-three competency domains were identified in the literature. The most common competency domains identified were medication management, cognitive impairment and chronic diseases and comorbidities management. 2.) Eighty-eight competencies within nine competency domains were generated in the GCM study. Generalist competencies pertaining to communication skills, medicolegal affairs and delirium were rated most important by participants. 3.) Nine SBE scenarios and debriefs were followed by nine individual semi-structured interviews. Four overarching themes reflecting various phases of TLT continuously arose: 1.) ‘Creating a realistic challenge’; 2.) ‘Simulation as a catalyst for reflection’; 3.) ’Planning for future’ and 4.) A paradigm shift’. Conclusion The rapidly ageing population indicates that older adult care will be delivered by doctors not specifically trained in geriatric medicine- particularly in the acute setting. This is a heterogenous population with varying and complex needs. This research programme set out to describe the generalist competencies required by hospital doctors to care for older adults and explore how simulation-based education can facilitate the transformative learning of a subset of these competencies. The resulting competencies are numerous and variable reflecting the complexity and heterogeneity of the older adult population. Simulation-based education was presented as an educational initiative to deliver these competencies to all hospital doctors in a way that can facilitate transformative learning. We recommend that the competencies described in this research programme should undergo expert validation to develop an overarching competency framework for hospital doctors caring for older adults. Finally, efforts should focus on further verification and implementation of SBE as a transformative learning initiative for hospital doctors caring for older adults.","abstract_html":"Background The ageing population has created an escalating demand for age-attuned healthcare globally. Most older adults will now receive their care from doctors without specialist geriatric medicine training. Older adults are a distinctly heterogenous group with varying co-morbidities that can often present with atypical symptoms. This complexity can make the treatment of older adults challenging for doctors. Calls for integrating generalism into postgraduate training has been proposed as a potential solution. However, what exactly these generalist competencies remain unclear. Equally, how to deliver them in overburdened healthcare systems is also a concern as learning in the clinical learning environment is often hindered by competing demands. Studies suggest that using simulation-based education (SBE) to deliver these competencies may form part of the solution. The aim of this research programme was to determine what are the generalist competencies required by hospital doctors to care for older adults and the role of SBE to support the transformative learning of a subset of these competencies. Methods This research programme consisted of three interconnected studies using a mixed methods approach. The first study was a scoping review. We utilised the Arksey and O'Malley guidelines to determine the generalist competencies already identified in the literature for hospital doctors caring for older adults. To explore this further and determine which competencies should be prioritised we sought stakeholder input via a group concept mapping (GCM) study. We invited healthcare professionals from different disciplines and specialties to participate via a web-based platform. Multidimensional scaling and hierarchical cluster analysis were utilised to analyse participants views and prioritise the identified competencies. The final study explored whether SBE could facilitate transformative learning of a subset of the identified generalist competencies. Guided by transformative learning theory (TLT), a SBE scenario focusing on the assessment and management of an older adult with delirium and Parkinson’s disease was developed. Hospital doctors within a single hospital site were invited to participate in the simulation scenario, followed by an audio recorded debrief and subsequent individual semi-structured interviews. Transcripts were analysed using reflexive hematic analysis. Results 1.) Two hundred and two competencies within twenty-three competency domains were identified in the literature. The most common competency domains identified were medication management, cognitive impairment and chronic diseases and comorbidities management. 2.) Eighty-eight competencies within nine competency domains were generated in the GCM study. Generalist competencies pertaining to communication skills, medicolegal affairs and delirium were rated most important by participants. 3.) Nine SBE scenarios and debriefs were followed by nine individual semi-structured interviews. Four overarching themes reflecting various phases of TLT continuously arose: 1.) ‘Creating a realistic challenge’; 2.) ‘Simulation as a catalyst for reflection’; 3.) ’Planning for future’ and 4.) A paradigm shift’. Conclusion The rapidly ageing population indicates that older adult care will be delivered by doctors not specifically trained in geriatric medicine- particularly in the acute setting. This is a heterogenous population with varying and complex needs. This research programme set out to describe the generalist competencies required by hospital doctors to care for older adults and explore how simulation-based education can facilitate the transformative learning of a subset of these competencies. The resulting competencies are numerous and variable reflecting the complexity and heterogeneity of the older adult population. Simulation-based education was presented as an educational initiative to deliver these competencies to all hospital doctors in a way that can facilitate transformative learning. We recommend that the competencies described in this research programme should undergo expert validation to develop an overarching competency framework for hospital doctors caring for older adults. Finally, efforts should focus on further verification and implementation of SBE as a transformative learning initiative for hospital doctors caring for older adults.","abstract_has_math":false,"creators":["Buckley, Emily"],"institution":"University College Cork","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Bennett, Deirdre","Ó Tuathaigh, Colm"],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025","date_published":"2025","updated_at":"2026-07-24T01:47:43Z","subjects":["Competencies","Older adults","Simulation","Postgraduate medical education","Doctor"],"languages":["en"],"rights":["© 2025, Emily Buckley."],"rights_urls":["https://creativecommons.org/licenses/by-nc-nd/4.0/"],"identifier_entries":[]},"links":{"outbound_url":"https://hdl.handle.net/10468/18432","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Bennett, Deirdre","Ó Tuathaigh, Colm"]},{"key":"dc:creator","label":"Author","values":["Buckley, Emily"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2026-01-21T15:42:06Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2026-01-21T15:42:06Z"]},{"key":"dc:date.issued","label":"Date","values":["2025"]},{"key":"dc:publisher","label":"Institution","values":["University College Cork"]},{"key":"dc:type","label":"Dc Type","values":["Doctoral thesis"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Doctoral"]},{"key":"dc:type.qualificationname","label":"Dc Type Qualificationname","values":["MD - Doctor of Medicine"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Competencies","Older adults","Simulation","Postgraduate medical education","Doctor"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en"]},{"key":"dc:rights","label":"Dc Rights","values":["© 2025, Emily Buckley."]},{"key":"dc:rights.uri","label":"Rights URI","values":["https://creativecommons.org/licenses/by-nc-nd/4.0/"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://hdl.handle.net/10468/18432"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Background The ageing population has created an escalating demand for age-attuned healthcare globally. Most older adults will now receive their care from doctors without specialist geriatric medicine training. Older adults are a distinctly heterogenous group with varying co-morbidities that can often present with atypical symptoms. This complexity can make the treatment of older adults challenging for doctors. Calls for integrating generalism into postgraduate training has been proposed as a potential solution. However, what exactly these generalist competencies remain unclear. Equally, how to deliver them in overburdened healthcare systems is also a concern as learning in the clinical learning environment is often hindered by competing demands. Studies suggest that using simulation-based education (SBE) to deliver these competencies may form part of the solution. The aim of this research programme was to determine what are the generalist competencies required by hospital doctors to care for older adults and the role of SBE to support the transformative learning of a subset of these competencies. Methods This research programme consisted of three interconnected studies using a mixed methods approach. The first study was a scoping review. We utilised the Arksey and O'Malley guidelines to determine the generalist competencies already identified in the literature for hospital doctors caring for older adults. To explore this further and determine which competencies should be prioritised we sought stakeholder input via a group concept mapping (GCM) study. We invited healthcare professionals from different disciplines and specialties to participate via a web-based platform. Multidimensional scaling and hierarchical cluster analysis were utilised to analyse participants views and prioritise the identified competencies. The final study explored whether SBE could facilitate transformative learning of a subset of the identified generalist competencies. Guided by transformative learning theory (TLT), a SBE scenario focusing on the assessment and management of an older adult with delirium and Parkinson’s disease was developed. Hospital doctors within a single hospital site were invited to participate in the simulation scenario, followed by an audio recorded debrief and subsequent individual semi-structured interviews. Transcripts were analysed using reflexive hematic analysis. Results 1.) Two hundred and two competencies within twenty-three competency domains were identified in the literature. The most common competency domains identified were medication management, cognitive impairment and chronic diseases and comorbidities management. 2.) Eighty-eight competencies within nine competency domains were generated in the GCM study. Generalist competencies pertaining to communication skills, medicolegal affairs and delirium were rated most important by participants. 3.) Nine SBE scenarios and debriefs were followed by nine individual semi-structured interviews. Four overarching themes reflecting various phases of TLT continuously arose: 1.) ‘Creating a realistic challenge’; 2.) ‘Simulation as a catalyst for reflection’; 3.) ’Planning for future’ and 4.) A paradigm shift’. Conclusion The rapidly ageing population indicates that older adult care will be delivered by doctors not specifically trained in geriatric medicine- particularly in the acute setting. This is a heterogenous population with varying and complex needs. This research programme set out to describe the generalist competencies required by hospital doctors to care for older adults and explore how simulation-based education can facilitate the transformative learning of a subset of these competencies. The resulting competencies are numerous and variable reflecting the complexity and heterogeneity of the older adult population. Simulation-based education was presented as an educational initiative to deliver these competencies to all hospital doctors in a way that can facilitate transformative learning. We recommend that the competencies described in this research programme should undergo expert validation to develop an overarching competency framework for hospital doctors caring for older adults. Finally, efforts should focus on further verification and implementation of SBE as a transformative learning initiative for hospital doctors caring for older adults."]},{"key":"dc:format.mimetype","label":"Dc Format Mimetype","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["The competencies required by hospital doctors to care for older adults"]}]}],"canonical_facts":{"dc:contributor.advisor":["Bennett, Deirdre","Ó Tuathaigh, Colm"],"dc:creator":["Buckley, Emily"],"dc:date.accessioned":["2026-01-21T15:42:06Z"],"dc:date.available":["2026-01-21T15:42:06Z"],"dc:date.issued":["2025"],"dc:description.abstract":["Background The ageing population has created an escalating demand for age-attuned healthcare globally. Most older adults will now receive their care from doctors without specialist geriatric medicine training. Older adults are a distinctly heterogenous group with varying co-morbidities that can often present with atypical symptoms. This complexity can make the treatment of older adults challenging for doctors. Calls for integrating generalism into postgraduate training has been proposed as a potential solution. However, what exactly these generalist competencies remain unclear. Equally, how to deliver them in overburdened healthcare systems is also a concern as learning in the clinical learning environment is often hindered by competing demands. Studies suggest that using simulation-based education (SBE) to deliver these competencies may form part of the solution. The aim of this research programme was to determine what are the generalist competencies required by hospital doctors to care for older adults and the role of SBE to support the transformative learning of a subset of these competencies. Methods This research programme consisted of three interconnected studies using a mixed methods approach. The first study was a scoping review. We utilised the Arksey and O'Malley guidelines to determine the generalist competencies already identified in the literature for hospital doctors caring for older adults. To explore this further and determine which competencies should be prioritised we sought stakeholder input via a group concept mapping (GCM) study. We invited healthcare professionals from different disciplines and specialties to participate via a web-based platform. Multidimensional scaling and hierarchical cluster analysis were utilised to analyse participants views and prioritise the identified competencies. The final study explored whether SBE could facilitate transformative learning of a subset of the identified generalist competencies. Guided by transformative learning theory (TLT), a SBE scenario focusing on the assessment and management of an older adult with delirium and Parkinson’s disease was developed. Hospital doctors within a single hospital site were invited to participate in the simulation scenario, followed by an audio recorded debrief and subsequent individual semi-structured interviews. Transcripts were analysed using reflexive hematic analysis. Results 1.) Two hundred and two competencies within twenty-three competency domains were identified in the literature. The most common competency domains identified were medication management, cognitive impairment and chronic diseases and comorbidities management. 2.) Eighty-eight competencies within nine competency domains were generated in the GCM study. Generalist competencies pertaining to communication skills, medicolegal affairs and delirium were rated most important by participants. 3.) Nine SBE scenarios and debriefs were followed by nine individual semi-structured interviews. Four overarching themes reflecting various phases of TLT continuously arose: 1.) ‘Creating a realistic challenge’; 2.) ‘Simulation as a catalyst for reflection’; 3.) ’Planning for future’ and 4.) A paradigm shift’. Conclusion The rapidly ageing population indicates that older adult care will be delivered by doctors not specifically trained in geriatric medicine- particularly in the acute setting. This is a heterogenous population with varying and complex needs. This research programme set out to describe the generalist competencies required by hospital doctors to care for older adults and explore how simulation-based education can facilitate the transformative learning of a subset of these competencies. The resulting competencies are numerous and variable reflecting the complexity and heterogeneity of the older adult population. Simulation-based education was presented as an educational initiative to deliver these competencies to all hospital doctors in a way that can facilitate transformative learning. We recommend that the competencies described in this research programme should undergo expert validation to develop an overarching competency framework for hospital doctors caring for older adults. Finally, efforts should focus on further verification and implementation of SBE as a transformative learning initiative for hospital doctors caring for older adults."],"dc:format.mimetype":["application/pdf"],"dc:identifier.uri":["https://hdl.handle.net/10468/18432"],"dc:language.iso":["en"],"dc:publisher":["University College Cork"],"dc:rights":["© 2025, Emily Buckley."],"dc:rights.uri":["https://creativecommons.org/licenses/by-nc-nd/4.0/"],"dc:subject":["Competencies","Older adults","Simulation","Postgraduate medical education","Doctor"],"dc:title":["The competencies required by hospital doctors to care for older adults"],"dc:type":["Doctoral thesis"],"dc:type.qualificationlevel":["Doctoral"],"dc:type.qualificationname":["MD - Doctor of Medicine"]},"updated_at":"2026-07-24T01:47:43Z"}