LTCI ADVANCED LONG-TERM CARE TRAINING PROGRAM
The Vic-SI LTCI’s Advanced Long-term Care Training Program supports Family Physicians in enhancing their clinical experience and skills in order to begin, maintain, or reintroduce caring for frail patients living in long-term care. Participant learning is supported by Family Physician LTC Practice Coaches experienced in caring for the elderly in LTC settings.
Purpose and Goals
This program supports both new Peer Learner physicians (community physicians with varying degrees of LTC experience) to learn about LTC and provide remuneration for their time, as well as later-career and retiring LTC Practice Coach physicians, who are remunerated for their mentoring time, and for any care transfers of LTC residents to the mentee.
By the end of the training program, the goal is for Peer Learners to be familiar with the assessment and management of common geriatric problems– both physical and psychological – in the setting of long-term care.
The LTCI’s Advanced Long-term Care Training Program is currently an informal, non-accredited learning program; however, we are in the process of applying for CME accreditation, and learners may be eligible to claim MainPro credits for participating.
Program Eligibility
This program is designed for licensed Family Physicians (FPs) who:
- are new to practice and wish to augment their LTC skills and experience, or
- are not currently providing LTC but who want to include it in their practice, or
- want additional experience or training to continue to provide LTC
FPs are eligible for consideration to participate in the program if they meet the following criteria:
- completes all required application documentation;
- have obtained full registration and licensure from the College of Physicians and Surgeons of British Columbia to practice family medicine in BC, and are in good standing (*please note we are unable to compensate Family Medicine Residents for participating at this time)
- meet Health Authority privilege requirements to provide care in a LTC setting while participating in the Vic-SI LTCI’s Advanced Long-term Care Training Program
- are a current member of the Victoria or South Island Division of Family Practice
Program Core Competencies
It is expected that through participating in the Vic-SI LTC training program, Peer Learners will complete the program with a solid foundation in core LTC Clinical and Practice Competencies. Given the diverse range of clinical experience, knowledge, and skills among Learners, the Peer Learner and LTC Practice Coaches should work together to co-create a set of learning outcomes tailored to the needs of the Peer Learner.
Core LTC Competencies
The following are suggested core LTC Clinical and Practice Competencies:
1) Clinical Competencies
- perform cognitive assessments
- distinguish between clinical presentations of delirium, dementia, depression
- assess and manage:
- delirium
- falls
- common forms for dementia
- atypical presentations of common medical conditions in the frail elderly
- common end of life care issues (e.g. nutrition, dysphagia, serious Illness Conversation/MOST hospital transfer, LTC visits)
- skin breakdown & wounds
- BPSD including familiarity with the PIECES assessment and management approach
- recognize and initiate management of common issues in dementia care
- outline and evaluate:
- pharmacokinetic changes that commonly occur with aging and frailty and demonstrate ability to modify drug regimens according to recommendations in the Choosing Wisely Toolkit
- advance planning directives (including the roles of physicians & substitute decision-makers) dealing with personal & financial decision-making emphasizing a “goals of care” approach
- pre-morbid & current functional abilities
- medications (using the Choosing Wisely Toolkit), including identification of potential drug-drug and drug-disease interactions
- and initiate management (including pharmacologic/non-pharmacologic therapies) for transient (acute) & established (chronic) urinary incontinence
- other relevant clinical competencies as determined by the Peer Learner and LTC Practice Coach.
2) Practice Competencies
- performs proactive, in-person visits to residents at regular, scheduled intervals; responds to daytime medical needs
- attends care conferences of all residents for whom physician is MRP; understands role during care conferences and collaborates with team members
- attends meaningful medication reviews with pharmacist/MRN every 6 months; understands role during medication reviews and collaborates with team members
- ensures documentation (admission medical history, problem list, progress notes, summary assessment, current MOST) is completed in the care home’s Electronic Health Record in a timely manner
- participates in the After-Hours Call Group
- manages and communicates schedule with care home admin, allowing care home to schedule care conferences and medication reviews when physician is able to attend
- participates in Quality Improvement activities (processes and initiatives that support positive changes in the quality of medical care offered and the working environment of LTC)
- other relevant practice competencies as determined by the Peer Learner and LTC Practice Coach.
Program Outline
Program Schedule
The program is scheduled as a half-day session (3.5 hours), once per week, for up to 8 weeks, with adjustment as needed based on the schedules of the Peer Learner and LTC Practice Coach. The LTC Practice Coach will be a Family Physician who regularly attends long-term care homes on a set day of the week. The Peer Learner will get to know, follow, and provide care for residents and families, participate in care conferences and medication reviews, and learn about documentation.
Additionally, an on-call component is included to help Peer Learners make clinical decisions after-hours. Peer Learners will spend a weekend on call with their LTC Practice Coach, as part of the LTCI After-Hours Call Group. On-call scheduling may be discussed with the LTC Practice Coach at the beginning of the program.
Check-In/Self-Evaluation/Reflections
Approximately halfway through their time together, LTC Practice Coaches and Peer Learners will complete a check-in, providing an opportunity for feedback and updates to learning outcomes and core competencies if needed. Upon completion of the program, Peer Learners will be asked for an exit self-evaluation, as well as informal feedback aimed at improving the training program further.
Accreditation
This training program is currently an informal, non-accredited learning program; however, we are in the process of applying for CME accreditation, and learners may be eligible to claim MainPro credits for participating. For more information, please visit fmf.cfpc.ca/mainpro-credit-reporting/
Program Funding
Peer Learner Training Stipend (up to $5,000 per participant)
Peer Learners are eligible to receive payment for up to 28 hours at the current sessional rate for a maximum of $4,500. Learners do not bill fee-for-service for clinical activities. Additionally, Peer Learners are eligible to receive $500 for one daytime after-hours call shadowing session.
LTC Practice Coach Stipend (up to $2,842 per mentor)
In addition to billing fee-for-service for clinical activities, LTC Practice Coaches are eligible for up to 16 hours of administrative (i.e. non-clinical) time per Peer Learner at the sessional rate. For example, the LTC Practice Coach may spend approximately two hours per session with the Peer Learner doing non-clinical work such as making introductions, answering questions, providing tours. Additionally, LTC Practice Coaches are eligible to receive $500 for one daytime after-hours call shadowing session.
Ineligible Use of Funds
Funding under the Vic-SI LTCI’s Advanced Long-term Care Training Program may not be used for:
- preparation or study time
- clinical time/activities performed by the LTC Practice Coach (it is expected that the LTC Practice Coach bill FFS for clinical tasks)