Innovations

A Decade of Dementia Care Training: Learning Needs

of Primary Care Clinicians
Linda Lee, MD, MClSc; Loretta M. Hillier, MA; Tejal Patel, PharmD; W. Wayne Weston, MD, CCFP, FCFP

Introduction: Limited knowledge of dementia among health professionals is a well-documented barrier to optimal care. This
study examined the self-perceived challenges with dementia care and learning needs among primary care clinicians and assessed
whether these were associated with years of practice and perceived preparedness for dementia care.
Methods: Participants were multi-disciplinary clinicians attending a 5-day team-based dementia education program and
physicians attending a similar condensed continuing medical education workshop. Pre-education, they completed an online survey
in which they rated (5-point scales): interest in learning about various dementia-related topics, perceived challenges with various
dementia-related practice activities and preparedness for dementia care, provided additional dementia-related topics of interest,
number of years in clinical practice, and discipline.
Downloaded from http://journals.lww.com/jcehp by BhDMf5ePHKbH4TTImqenVGmuFTCffgFKLDP220+sCGjvX4EUb6RnxTZ/tso12XvdwaexAdOykS4= on 10/27/2020

Results: Thirteen hundred surveys were completed across both education programs. Mean ratings of preparedness for dementia
care across all respondents reflected that they felt somewhat prepared for dementia care. Challenge ratings varied from low to very
challenging and mean ratings reflected a high level of interest in learning more about all of the dementia-related topics; significant
differences between disciplines in these ratings were identified. In most cases, perceived challenges and learning needs were not
correlated with number of years in clinical practice, but in some cases lower ratings of preparedness for dementia care were
associated with higher ratings of the challenges of dementia care.
Discussion: Clinicians perceived that their formal education had not prepared them well for managing dementia and desired
more knowledge in all topic areas, regardless of years in practice. Implications for education are discussed.
Keywords: dementia, continuing education, needs assessment, primary care, interprofessional
DOI: 10.1097/CEH.0000000000000288

I t is expected that the number of new cases of Alzheimer’s

disease and related dementias in Canada will rise from
103,700 in 2008 to 257,800 in 2038, with the associated eco-
nomic burden forecasted to be $153 Billion in 2038.1,2 Yet
dementia care in Canada is currently described as fragmented,
inaccessible, and inadequate to meet the needs of persons and
families living with dementia.3–8 Primary care has an important
role to play in the management of chronic diseases such as
dementia. In comparison to specialist care, primary care can
offer equitable access to care, initiate community-based inter-
ventions early in the disease process to reduce crises that lead to
acute care utilization and associated care costs and can increase
Disclosures: The authors declare no conflict of interest. Funding support was
provided by the Centre for Family Medicine Family Health Team.
Dr. Lee: Lead Physician, MINT Memory Clinic, Centre for Family Medicine Family Health
Team, Kitchener, Ontario, Canada, Associate Professor, Department of Family Medicine,
McMaster University, Hamilton, Ontario, Canada, and Schlegel Research Chair in
Primary Care for Elders, Schlegel-UW Research Institute for Aging, Waterloo, Ontario,
Canada. Ms. Hillier: Research Affiliate, Geriatric Education and Research in Aging
Sciences (GERAS) Centre, Hamilton, Ontario, Canada. Dr. Patel: Pharmacist, MINT
Memory Clinic, Centre for Family Medicine Family Health Team, Kitchener, Ontario,
Canada, and Assistant Clinical Professor, School of Pharmacy, University of Waterloo,
Waterloo, Ontario, Canada, and Assistant Clinical Professor, Department of Family
Medicine, McMaster University, Hamilton, Ontario, Canada. Dr. Weston: Professor
Emeritus, Family Medicine, Schulich School of Medicine and Dentistry, Western
University, London, Ontario, Canada.
Correspondence: Linda Lee, MD, MClSc, The Centre for Family Medicine, 10B
Victoria Street South, Kitchener, Ontario, Canada N2G 1C5; e-mail:
lee.linda.lw@gmail.com.
Copyright ª 2020 The Alliance for Continuing Education in the Health Professions,
the Association for Hospital Medical Education, and the Society for Academic
Continuing Medical Education
access to more appropriate services, resulting in improved
health outcomes.9 Although primary care is well positioned
to identify and manage dementia because of established
longitudinal relationships with patients, evidence suggests
the need to build capacity for dementia care because of the
high prevalence of missed and delayed diagnoses and many
obstacles to timely dementia diagnoses and optimal primary
dementia care.5 Identified barriers to optimal diagnosis and
management have included lack of preparation for dementia
care in professional training,10,11 lack of knowledge and
confidence in skills,12,13 diagnostic uncertainty and com-
plexity of dementia, which often exists in the presence of
multiple comorbid conditions,5,14,15 and constraints within
the structure of primary care, such as limited time and access
to allied health professionals.10,16,17 Family physicians
describe dementia as more challenging to manage than other
chronic conditions,18 often leaving the task of diagnosis and
management to specialists.19–21
Currently, there is a reliance on specialized services for the
diagnosis and management of dementia, with up to 80% of
persons with memory concerns being referred for specialist
consultation.21 To build health system capacity to better meet
the needs of our aging population, new models of person-
centered dementia care will become increasingly important and
particularly those designed for the Canadian health care system,
which leverage our strong primary care infrastructure22,23 and
make strategic and efficient use of limited available specialist
resources. In Canada, there is a shortage of geriatric specialists24
and wait times to access specialists can be lengthy.25 The impact
of this shortage of geriatricians is evident in a recent report

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132 JCEHP n Spring 2020 n Volume 40 n Number 2
noting that in Canada, family physicians provide the bulk
(51%) of all medical services for older adults, compared with
geriatricians who provided less than one percent of all medical
services in a one-year time period.26
There is a critical need to build capacity for dementia care at
a primary care level. Numerous studies examining health care
providers’ needs related to the provision of dementia care have
identified self-reported needs for further education and skills8,27
and have highlighted the need for increased training in dementia
diagnosis and management for all health professionals to sup-
port improved dementia care.5,17,28–30 Continuing education
opportunities do not necessarily address knowledge needs at the
point-of-care,31 so there is a need to ensure that education is
tailored to the individualized needs of learners and specifically
to the needs of different disciplines.
The objectives of this study were two-fold. First, we wanted
to examine and compare the self-perceived learning needs and
perceived challenges with various aspects of dementia care
among health professionals of different disciplines working in
primary care attending a 5-day accredited interprofessional
team-based dementia education program and family physicians
attending a similar, condensed continuing medical education
(CME) workshop. Second, we also wanted to determine
whether these learning needs and perceived challenges were
associated with factors such as years of practice and the extent
to which their formal education prepared them to manage
dementia.
METHODS
A survey methodology was used in this study in which par-
ticipants of two education programs were invited to complete
a survey before attending the education; these programs were
delivered over a 10-year time period. This study was approved
by the Hamilton Integrated Research Ethics Board, McMaster
University.
Education Programs
In 2006, the Centre for Family Medicine (CFFM) Family Health
Team established a MINT, Multispecialty Interprofessional
Team; memory clinic (previously referred to as Primary Care
Collaborative Memory Clinics) to address challenges associ-
ated with the provision of dementia care in primary care. MINT
memory clinics, of which there are now over 100 across
Ontario, Canada, aim to build capacity for quality dementia
care at a primary care level and make efficient use of limited
specialist resources.32,33 These physician-led teams consist of
interprofessional health care providers including nurses, social
workers, pharmacists, occupational therapists (OTs), and rep-
resentatives from local Alzheimer Societies, home care services
and other disciplines as available. Patients with memory con-
cerns are referred by their family physician to the MINT
memory clinic for comprehensive assessment and care plan-
ning. These clinics work within a shared care approach with
patients’ family physician whereby detailed and proactive care
plans assist family physicians to provide quality dementia care.
Further information about these clinics is available else-
where.32–36 With the success of the memory clinic established at
the CFFM, an education program was developed to establish
MINT memory clinics in other primary care practice settings.
This 5-day nationally accredited interprofessional education
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and the Society for Academic Continuing Medical Education. Unauthorized reproduction of this article is prohibited.
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program consists of a 2-day workshop, 1-day observership, and
2 days of individualized mentorship.11,37 The workshop, led by
the CFFM MINT memory clinic team consists of several
modules related to the assessment and management of memory
concerns. More information about the curriculum content is
presented elsewhere.11 Clinic teams are supported by annual
continuing education sessions (“Booster Days”).38 Several
studies have demonstrated the effectiveness of this training
program in establishing primary care memory clinics, changing
clinical practice related to dementia assessment and manage-
ment and improving quality of care.11,34,37
With the success of this education program, it was adapted
into a 3-hour CME workshop, sponsored by the Ontario Col-
lege of Family Physicians, to build capacity for dementia care
for family physicians that do not have access to memory clinic to
which they can refer their patients. These physicians work
primarily in solo or group physician practices that do not have
integrated interprofessional health care providers. This CME
program focused on the assessment of dementia using a clinical
reasoning approach to the diagnosis and management of
dementia, and aimed to provide an overview of dementia and
practical tips for managing dementia within the context of
typical office-based family practice. This CME program is
described elsewhere.39 An evaluative study on this program
demonstrated that it was effective in increasing physicians’ self-
reported confidence and ability to assess and manage dementia,
and in changing their practice behaviour.39
Sample
The sample for this study were physicians, nurses, and allied
health professionals participating in the memory clinic training
program. A total of 1107 participants attending the training
program across 36 training workshops held between October
2008 and January 2018 were invited to participate in this study.
These workshops were held in various locations across
Ontario. In addition, family physicians (N = 426) participating
in the 3-hour CME dementia workshops, of which there were
21 delivered between March 2012 and November 2016 were
also invited to participate in this study. These CME workshops
were delivered across 14 urban centers across three provinces in
Canada (Ontario, British Columbia, and Alberta). Eight of
these workshops were delivered by two authors (L.L., W.W.W.)
and the remaining workshops were delivered by one author
(L.L.).
Measures and Procedures
Before completion of the MINT memory clinic training pro-
gram and the CME workshop, participants were invited, via
email, to complete an online survey. Participants were provided
a link with which to access the online survey, which was posted
on Survey Monkey (www.surveymonkey.com). They were
given a two-week time period to complete the survey.
Reminders to complete the survey were distributed a week
before and the day before the deadline date. Survey completion
was anonymous.
In the survey, using a 5-point scale (1 = not at all challenging;
5 = extremely challenging), respondents were asked to rate the
extent to which they found various dementia-related practice
activities challenging, such as developing a therapeutic alli-
ance with persons with dementia and their caregivers, work-
ing collaboratively with other health care professionals and
Dementia Learning Needs of Primary Care Clinicians Lee et al. 133

community agencies involved in dementia care, managing the Content analysis41 was used on the open-ended question to
needs of persons with dementia and their caregivers within the identify additional dementia-related topics of interest to
practice setting and establishing and maintaining a positive participants.
relationship with persons with dementia. Using a 5-point rating
scale (1 = not at all; 5 = very much so), they rated the extent to
RESULTS
which they would like additional information/education on
a number of dementia related topics: delirium, depression, A total of 1300 surveys were completed; N = 1008 by partic-
normal aging and mild cognitive impairment (MCI), assess- ipants of the MINT memory clinic training program (91.1%
ment of executive functioning, differentiation of dementia response rate; response rates across all 36 workshops ranged
types, pharmacological and nonpharmacological dementia from 68% to 100%) and N = 292 by family physicians com-
management, and driving and dementia. Interest in additional pleting the CME workshop (69% response rate; response rates
dementia-related topics was also solicited (open-ended survey across all 21 workshops ranged from 24% to 100%).
question). The intent in requesting this information was to Respondent characteristics are presented in Table 1. Physicians
ensure that the workshops addressed content that was of par- represented 43% (N = 560) of the sample. Other disciplines
ticular interest to participants. Respondents were also asked to included nurses, OTs, pharmacists, and social workers. Addi-
rate on a 5-point scale (1 = not at all; 5 = extremely well) the tional disciplines and roles identified by less than 2% of par-
extent to which their formal/professional education prepared ticipants were categorized together as “miscellaneous
them to manage cognitive impairment. Demographic infor- disciplines”; these included dietitians, counsellors, physician
mation was collected on respondents’ discipline and years in assistants, Alzheimer Society representatives, and recreation/
clinical practice. Participants of each education program exercise specialists.
received the same survey questions; however, for the CME The average number of years in clinical practice varied sig-
workshops, questions on perceived challenges and years in nificantly across the disciplines (P = .001). Physicians attending
clinical practice were added to the survey in March 2015, and the CME workshop had been in clinical practice longer than
thus, were only available to participants (N = 183) from 10 of OTs, social workers, and miscellaneous disciplines attending
the 21 workshops. the MINT memory clinic training program (Table 1). Across
both training programs and all disciplines, mean ratings of the
Data Analysis extent to which their professional training prepared them for
Survey data were analyzed using SPSS 25.0 software (IBM dementia care reflected that respondents perceived themselves
Corp, Armonk, NY) to generate descriptive statistics (fre- to have been somewhat prepared for dementia care, with mean
quencies, means, standard deviations). Differences in ratings ratings ranging from 2.7 (CME physicians) to 3.0 (MINT clinic
between the two physician groups (MINT training program other disciplines). The exceptions to this were the OTs who
and CME workshop) and other disciplines were explored attended the MINT clinic training program; they had signifi-
using nonparametric analysis of variance (Kruskal–Wallis cantly higher mean rating scores than all other disciplines
Test), and, where relevant, post-hoc pairwise comparisons, attending the MINT clinic training (P = .001). Across all dis-
using the Dunn–Bonferroni post-hoc method,40 to test for ciplines, less than a quarter of respondents (20.3%, N = 264)
differences among means between disciplines. A P-value provided ratings of 4 or 5, reflecting that they were “very” or
threshold of 0.05 was used to establish statistical signifi- “extremely” well prepared for dementia care.
cance. The relationships between learning needs and chal-
lenges in the provision of dementia care and years in clinical Challenging Aspects of Dementia Care
practice and perceived preparation for dementia care were Figure 1 presents each disciplines’ mean ratings of the challenges
measured using the Spearman rho (rs) correlation coefficient. associated with various aspects of dementia care. Generally,

TABLE 1.
Survey Respondent Disciplines (N = 1300)
Years in Clinical Ratings of Preparation for
Discipline % (n) Practice, Mean (SD) Dementia Care, Mean (SD)*
CME workshop physicians 22.5% (292) 16.4 (12.3) 2.7 (0.75)
MINT memory clinic physicians 20.6% (268) 14.7 (11.5) 2.9 (0.88)
MINT memory clinic nurses† 28.6% (372) 13.4 (11.6) 2.8 (0.89)
MINT memory clinic OTs 3.4% (44) 10.3 (9.9) 3.6 (0.78)
MINT memory clinic pharmacists 6.2% (81) 12.4 (11.1) 2.7 (0.78)
MINT memory clinic social workers 12.8% (166) 8.6 (8.5) 2.8 (1.0)
MINT Memory Clinic Miscellaneous Disciplines‡ 5.9% (77) 10.5 (10.0) 3.0 (1.2)
All clinicians 1300 13.0 (11.3) 2.9 (0.92)
CME indicates continuing medical education; MINT, Multispecialty Interprofessional Team; OT, occupational therapist.
*5-point rating scale: 1 = not at all prepared; 5 = extremely well prepared.
†Nurses included registered nurses, registered practical nurses, and nurse practitioners.
‡Miscellaneous—disciplines/roles identified by less than 2% of participants: Dieticians (6); Mental health counsellors/psychologists/psychotherapists/social service workers (16); Physician assistants (7); Alzheimer Society
educators/family support workers (29); Chaplains (2); Therapeutic recreation/kinesiologist/exercise physiologist (5); Coordinators (3); Community health worker/health promotor (3); Gerontologists (4); Early intervention clinician
(1), Physical therapist (1).

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134 JCEHP n Spring 2020 n Volume 40 n Number 2 www.jcehp.org

FIGURE 1. Mean ratings* of the level of challenge associated with various aspects of dementia care, mean ratings, SD across disciplines appear in parentheses,
N = 686. CME indicates Continuing Medical Education; MINT, Multispecialty Interprofessional Team; OT, occupational therapist; PLWD, person living with
dementia; SW, social worker; MCI, mild cognitive impairment. *5-point rating scale: 1 = not at all challenging; 5 = extremely challenging.

across all disciplines, mean challenge ratings varied from low (M
= 2.4 for working collaboratively with other care providers) to
very challenging (M = 3.3 for managing PLWD care needs).
Mean ratings of challenges were similar between physicians
attending the CME workshop and physicians attending the
MINT memory clinic training program, with the exception of
establishing and maintaining positive relationships with patients,
for which CME physicians perceived as more challenging (M =
3.1 versus 2.8, respectively; P = .001), although for both groups,
mean ratings reflected that they found this somewhat challeng-
ing. There were significant differences (P-values = .001) in mean
ratings of challenges between the discipline groups for all aspects
of dementia care, with the exception of collaboration with other
HCP. Post-hoc tests revealed that in most cases, social workers
and “other” disciplines had significantly lower challenge ratings
(P-values = .001) than physicians and pharmacists, particularly
as related to developing therapeutic alliances with persons with
dementia and caregivers, managing the needs of persons with
dementia and caregivers and maintaining positive relationships
with patients.
Association Between Perceptions of Challenges in
Dementia Care and Years in Clinical Practice and
Formal Preparation for Dementia Care
Across all participants and disciplines, number of years in clinical
practice were not associated with ratings of the challenge associ-
ated with any of the aspects of dementia care. Ratings of the level
of preparation for dementia care were negatively associated
with six of the seven listed aspects of dementia care: developing
a therapeutic alliance with persons with dementia (rs = 20.149; P <
.01) and caregivers (rs = 20.098; P < .05), working collaboratively
with community agencies (rs = 20.91; P < .05), managing the
needs of persons with dementia (rs = 20.169; P < .01) and care-
givers (rs = 20.109; P < .01) within the current practice setting, and
establishing and maintaining a positive relationship with persons
with dementia (rs = 20.156; P < .01). These findings reflected that
lower ratings of preparedness for dementia care were associated
with higher ratings of the challenges of dementia care.
Self-Reported Learning Needs
Figure 2 presents the mean ratings of interest in learning about
the various dementia-related topics for each discipline group.
Generally, across all disciplines, mean ratings reflected a high
level of interest in learning more about all of the dementia-
related topics. Although the sample size was large enough to
detect significant difference in mean ratings across the dis-
ciplines for each dementia-related topic, many of these differ-
ences are not necessarily clinically significant. For example,
nurses and pharmacists had higher mean ratings for wanting to
learn more about depression and dementia (4.4 and 4.5,
respectively) than the other disciplines; however, all of the mean
ratings were over 4.0, reflecting that each discipline was very
interested in this topic. Of interest are significant differences
between disciplines in desire to learn more about pharmaco-
logical management and driving fitness. OTs attending the
MINT memory clinic training program had significantly lower
mean ratings (3.2) for interest in learning more about phar-
macological management than all other disciplines, whose

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Dementia Learning Needs of Primary Care Clinicians Lee et al. 135

FIGURE 2. Mean ratings* of interest in various dementia related topic areas for each discipline group; mean ratings, SD across disciplines appear in parentheses,
N = 1300. CME indicates Continuing Medical Education; MINT, Multispecialty Interprofessional Team; OT, occupational therapist; SW, social worker; MCI, mild
cognitive impairment. *5-point rating scale: 1 = not at all interested; 5 = extremely interested.

ratings ranged from 3.7 (social workers) to 4.4 (physicians
attending the CME workshop). Similarly, pharmacists attend-
ing the MINT memory clinic training had significantly lower
mean ratings (3.5) for interest in learning more about driving
fitness than the other disciplines, whose ratings ranged from 4.0
(social workers) to 4.5 (physicians and OTs attending the
MINT clinic training).
Across the physician groups (those attending the CME
workshop and those attending the MINT clinic training),
groups mean ratings of interest were all moderately high,
ranging from 3.7 (delirium—differentiation from dementia,
diagnosis, and management) to 4.4 (pharmacological man-
agement and driving and dementia). Ratings of interest for three
topics (differentiation of dementia types, driving fitness, and
normal aging and MCI) differed significantly between the two
physician groups, although the ratings from these topics were
still relatively high for both groups.
Across all participants, there were no significant associations
between number of years in clinical practice and interest in the
various dementia topics. There were weak, but still statistically
significant relationships between ratings of academic pre-
paredness and interest in learning about specific dementia topics.
Lower ratings of academic preparation for dementia care were
associated with high interest in learning more about normal
aging and MCI (rs = 20.090; P < .01) and how to communicate
with patients and families about the diagnosis and dementia
management (rs = 20.174; P < .01). Conversely, higher ratings of
academic preparation for dementia care were associated with
high interest in learning about driving fitness (rs = 0.061; P < .05).
Analysis of the open-ended responses to the survey question
about additional topics of interest identified a variety of topics
related to the development and implementation of the memory
clinic, dementia characteristics, diagnosis, assessment, care plan-
ning, management of concomitant issues and symptoms, phar-
macological and nonpharmacological interventions, care partner
and family issues, and a number of miscellaneous topics; these
topics are summarized by discipline in Table 2. Many of the topic
areas were identified by all discipline groups, such as psychological
and behavioral symptoms associated with dementia, management
of comorbid conditions, available community services, and care-
giver and family support. Topic areas of interest were not entirely
dictated by discipline scope of practice. For example, occupational
therapists identified an interest in the role of imaging in diagnosis
and interpretation of various tests, and social workers identified an
interest in pharmacological management.
DISCUSSION
Canadian Consensus guidelines on dementia care suggest that
the diagnosis and management of dementia should mainly be

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136 JCEHP n Spring 2020 n Volume 40 n Number 2 www.jcehp.org

TABLE 2.
Additional Dementia-Related of Interest as Identified by Each Discipline Groups (N = 1300)
Physicians* Nurses OTs Pharmacists Social Miscellaneous
Topic Area (N = 109)† (N = 101) (N = 8) (N = 23) Workers (N = 39) Disciplines (N = 20)
MINT clinic implementation ✓ ✓ ✓
Dementia characteristics
Causes ✓ ✓
Expected timeline for deterioration/disease progression ✓ ✓ ✓
Experience of dementia from the perspective of those with ✓ ✓
dementia and families
Psychological and behavioral symptoms (what they are, ✓ ✓ ✓ ✓ ✓ ✓
how to assess and manage)
Reversibility of memory symptoms ✓ ✓
Risk factors ✓ ✓ ✓
Types of dementia (early-onset, Parkinson, ✓ ✓ ✓ ✓ ✓
Lewy body, frontotemporal)
Diagnosis
Conditions (depression, other diseases, and medications) ✓ ✓ ✓ ✓ ✓
that negatively affect memory
Genetic testing ✓
Recommended investigations (laboratory, imaging) ✓ ✓
Risks and benefits of early diagnosis ✓ ✓
Role of imaging in diagnosis and interpretation (CT, MRI, PET) ✓ ✓ ✓
Early signs and symptoms ✓ ✓
Assessment
Administration and interpretation of MoCA and other cognitive tests ✓ ✓ ✓
Assessment in individuals with Down syndrome, aphasia ✓
Capacity assessment/consent ✓ ✓ ✓
Caregiver stress ✓ ✓
Medication review ✓ ✓
Functional status ✓ ✓
Care planning
Advanced care planning, advanced directives ✓ ✓
Care coordination among all relevant care providers and ✓
community services
Management for patients who decline treatment, services or are ✓ ✓ ✓
resistive to care
Power of attorney, substitute decision makers, guardians and ✓ ✓ ✓ ✓
public trustees (roles and responsibilities, how to designate,
legal issues)
Prevention—management of risk factors ✓ ✓ ✓ ✓ ✓
Supporting marginalized populations (indigenous communities, ✓
homeless, newcomers)
Supporting patients who live alone ✓
Managing rapid/abrupt cognitive decline ✓
Therapeutic counselling ✓ ✓
Management of concomitant issues/symptoms
Ambiguous grief ✓
Apathy ✓
Balance/gait issues, movement disorders ✓ ✓
Comorbid conditions (CAD, CHF, diabetes, mental health issues, ✓ ✓ ✓ ✓ ✓ ✓
substance abuse, developmental delay, acute illness)
Elder abuse ✓ ✓
Fall prevention ✓
Pain ✓
Palliative/end-of-life care ✓ ✓
Safety risks ✓ ✓ ✓
Sexuality ✓ ✓
Sleep issues (insomnia, disrupted sleep) ✓ ✓ ✓
Urinary incontinence ✓ ✓
Wandering ✓
Weight loss ✓ ✓

(Continued)

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Dementia Learning Needs of Primary Care Clinicians Lee et al. 137

TABLE 2.
Additional Dementia-Related of Interest as Identified by Each Discipline Groups (N = 1300) (Continued )

Physicians* Nurses OTs Pharmacists Social Miscellaneous

Topic Area (N = 109)† (N = 101) (N = 8) (N = 23) Workers (N = 39) Disciplines (N = 20)
Pharmacological interventions
Antipsychotic medications for behaviour management ✓
Atypical medication adverse events ✓
Cholenergic inhibitors—profile, actions, contraindications, ✓ ✓
interactions with other medications
Compliance ✓
Medications contraindicated in dementia ✓
Pharmacological management—options, benefits, ✓ ✓ ✓ ✓
side effects, costs
Polypharmacy/deprescribing/optimizing medications ✓ ✓ ✓
Over the counter/herbal remedies ✓
Non-pharmacological interventions
Community support services—what services exist locally, ✓ ✓ ✓ ✓ ✓ ✓
how to access them
Interventions to maintain cognitive functioning ✓ ✓ ✓ ✓
(exercise, mental stimulation, nutrition)
Self-management ✓
Care partner/family issues
Caregiver/family support ✓ ✓ ✓ ✓ ✓ ✓
Family relationships (strengthening, maintaining, ✓ ✓ ✓
managing conflict)
How to counsel children of persons with dementia regarding ✓
predisposition
Miscellaneous topics
Confidentiality (information sharing) ✓
Current research (clinical trials, studies) ✓ ✓ ✓
Ethical issues ✓ ✓
Teaching family medicine residents about dementia ✓
management
When to refer patients to specialists ✓ ✓ ✓ ✓
Documentation (templates) ✓
Other available continuing medical education ✓
CAD indicates coronary artery disease; CHF, congestive heart failure; CT, computerized tomography; MRI, magnetic resonance imaging; MoCA, Montreal cognitive assessment; PET, positron emission tomography.
*Both memory clinic physicians and physicians attending continuing medical education.
†Number in parentheses represent the number of respondents who provide an additional topic(s).

the responsibility of primary care.42 This is critical in Canada,
where fewer than 1% of services provided to older adults is
provided by geriatricians, primarily because of a shortage of
geriatricians in Canada.26 However, a key finding in this study
is that health care providers experience challenges in managing
dementia, find themselves inadequately prepared for dementia
care, and are interested in a wide range of topics related to
dementia; over the past 10 years, mean ratings of interest in
dementia topics have been consistently high. Other studies have
also identified knowledge gaps in dementia care. An interna-
tional study that found that fewer than 50% of physicians
across multiple countries reported that they were well prepared
to provide dementia care and Canadian family physicians were
ranked among the lowest in feeling prepared to manage
dementia.43 A survey of 758 American physicians, conducted in
1998, assessing their interest in more education on various
geriatric-related topics identified dementia as the most highly
rated topic of interest.44 This was also the case in a similar
survey administered 11 years earlier.45 Little has changed in 30
years. It has been known for some time now that the incidence
of dementia will increase in the coming years resulting in an
increased burden to the health system.1 However, education
institutions have failed to recognize the increasing need to
prepare the next generation of health care providers to care for
an older population. Doing so will require policy and funding
changes to facilitate curriculum changes that will support
interprofessional education on dementia care. Several studies
have reported that family medicine residents did not feel that
their professional training prepared them well for dementia care
and concluded there is a need for greater attention to dementia
assessment and management in medical school and residency
programs.46,47 The same holds true for other health professions.
Several studies and reports have concluded that health pro-
fessionals of various disciplines have limited exposure to geri-
atrics, and dementia in particular.48–50 There are likely
a number of reasons to explain the lack of attention to de-
mentia care in training programs. Generally, in family medi-
cine programs, as well as training programs for other
disciplines, minimal time is dedicated in the curricula to geri-
atric care, primarily because of conflicting priorities for
time.48,51,52 Limited attention to geriatrics has also been
attributed to a shortage of faculty knowledgeable in geriatrics

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and the Society for Academic Continuing Medical Education. Unauthorized reproduction of this article is prohibited.
138 JCEHP n Spring 2020 n Volume 40 n Number 2
and dementia and limited clinical training opportunities.48,53 In
family medicine, residents may get dementia training led by
specialists, which may not be perceived as relevant to family
physicians.54,55
In this study, challenges experienced in dementia care, as well
as interest in dementia topics, did not vary by years in clinical
practice, so that clinical experience alone may not affect
capacity building for dementia care. There are many strategies
for capacity building in health care. There is much evidence in
the literature that demonstrates that dissemination of infor-
mation via lectures, presentations, or printed materials alone in
academic programs or CME is unlikely to result in practice
change.56–58 In contrast to these passive approaches to knowl-
edge acquisition, multifaceted interactive education strategies
such as audit and feedback, face-to-face small group activities
and discussions, clinical/decision support tools, case-based and
problem-based interventions, and access to expert resources
have been demonstrated to increase knowledge acquisition and
facilitate practice change.59–61 The dementia education pro-
grams described in this paper are examples of multifaceted
education programs that incorporate elements of effective
education interventions in that they are tailored to learners self-
identified knowledge needs, are small-group based and inter-
active, integrate decision support tools into training, and pro-
vide structured approach dementia care.62–64 There is also
growing evidence that communities of practice, in which health
care providers with similar clinical interests share information
and experiences, are a significant mechanism for knowledge
acquisition and practice change.38,65
Several dementia education interventions aimed at family
medicine residents incorporating didactic clinical practice
components have been effective in increasing self-reported
dementia knowledge and confidence.47,66 A review of demen-
tia education programs for various health care professions
found that programs likely to build capacity for dementia care
were characterized as being relevant to learners’ role and
practice, incorporated learning strategies that were interactive
and practice-based, included high-quality training materials
and were led by highly skilled facilitators. As collaborative
multidisciplinary approaches to dementia care are gaining
popularity with the understanding that no one discipline has the
expertise to independently manage the complex medical,
physical, and psychosocial issues associated with this disease,67
it is recognized that interprofessional education opportunities
have an important role in building capacity for dementia care.
Key to the success of the MINT memory clinic training program
has been the interprofessional approach to education.11 There is
growing evidence that interprofessional learning opportunities
can facilitate better understanding of the unique roles that each
discipline plays in dementia care and can facilitate collaborative
care.68,69
Findings that CME physicians found establishing and
maintaining positive relationships with patients more chal-
lenging than MINT memory clinic physicians, and that they
have a greater interest in learning more about normal aging and
how it differentiates from dementia, may reflect different
experiences with care in different practice settings and models.
CME physicians, who worked primarily in settings without
integrated interprofessional teams,39 likely experience chal-
lenges related to being the sole provider contributing to
assessment and diagnosis of memory concerns and providing
Copyright © 2020 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education,
and the Society for Academic Continuing Medical Education. Unauthorized reproduction of this article is prohibited.
www.jcehp.org
dementia care. In contrast, family physicians working within
settings in which they collaborate with interprofessional team
members to assess memory concerns and provide care may
experience less burden of care. More research is needed to
understand physician experiences with dementia care in dif-
ferent practice models and how this is mediated by interpro-
fessional collaborative approaches to care.
Education needs in this study are consistent with those
identified in other studies and across disciplines, particularly as
related to disclosure and communication with persons with
dementia and their families,48,64 managing behavioral and
psychological symptoms,27,64 patient safety,70 and managing
dementia within the context of primary care.29 Education that is
rooted in primary care is important, because educational
opportunities led by specialists may be less effective in facili-
tating knowledge transfer to a primary care context, because
patients seen by specialists tend to be more complex and do not
typically reflect those cared for in primary care.71,72 In this
study, although ratings of interest were fairly high across all
topic areas, and disciplines, there were some differences among
the different disciplines’ interest in additional topic areas that
were mostly consistent with their discipline scope of practice.
For example, social workers identified an interest in learning
more about family relationships within the context of dementia,
caregiver stress, therapeutic counselling, sexuality, and
dementia from the perspective of those with the disease and
their families. However, they also expressed interest in topic
areas that could be perceived as outside of their scope such as
pharmacological management and when to refer patients to
specialists. This was also true of OTs who expressed an interest
in learning about the role of imaging in diagnosis and comorbid
conditions. Caution should be taken in making assumptions
about what is relevant learning for each discipline. For example,
pharmacists expressed an interest in learning about caregiver
and family support and available community services and
although the focus of their role is managing medications within
the scope of their practice, when the patient is no longer able to
self-manage their medications, the pharmacist must turn to
family caregivers or community services to provide assistance.
Thus, education in these areas is relevant to their practice,
although it may not be adequately provided during their formal
education and training. It has been noted that although some
clinical topics may be more relevant to some disciplines than
others, dementia care training is relevant to all primary care
team members particularly as related to practice guidelines,
assessment tools, communication skills, and team collabora-
tion.61 So, although social workers may not be involved in
prescribing medication, an understanding of the medications
commonly used and potential adverse side effects may assist
them in supporting patients and families and may alert them to
issues that arise in their interactions that should be shared with
physicians and pharmacists.
There are several limitations to this study. Individuals who
participated in the CME workshop and the memory clinic
training program were self-selected and thus identified a need
for further training and being highly motivated to complete the
training and work with persons with dementia; this selection
bias may limit the generalizability of these findings. The iden-
tification of additional topics of interest was an open field
within the survey and not all respondents supplied additional
topics. Although we analyzed these data by discipline to get
Dementia Learning Needs of Primary Care Clinicians
sense of discipline-specific interests, the fact that some dis-
ciplines may not have identified similar topics does not neces-
sarily mean that they would not be interested in these topics if
given an opportunity to comment on this. Failure to identify
specific topics of interest may represent that they do not know
what they need to know, or they just had other priorities for
desired information. More research is needed to understand
discipline-specific challenges experienced in dementia care and
how best to address these challenges with educational
opportunities.
CONCLUSION
This study highlights the need for capacity building in
dementia care for all health care disciplines at a primary care
level. With the increasing recognition of the important role
that primary care can play in managing dementia and the
increasing need for quality dementia care, building capacity
for a competent health care workforce that is able to meet the
complex needs of this patient population is paramount. To
this end, formal education and continuing professional
development in medicine and health care needs to provide
greater opportunities to develop core competencies to better
prepare and support health care professionals to provide
quality dementia care.
Lessons for Practice
n A greater focus on geriatrics and dementia care is required in
academic training programs to better prepare the next gen-
eration of health care providers to care for an older population.
n A better prepared workforce may experience fewer challenges
related to dementia care.
n Clinicians are interested in learning more about a range of
dementia-related topics, not just those related to their scope
of practice; when designing education programs assump-
tions should not be made about what is relevant learning for
each discipline.
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