Dementia and other memory problems are an epidemic of the 21st century and one of the leading causes of mortality and disability.1 It has been estimated that the Latin American and Caribbean (LAC) region has 56% of potentially modifiable risk factors attributable to dementia.2,3 Therefore, empowering human talent to prevent and guide the management of these problems is a key action. 4
The Latin American Academy of Medicine for the Elderly (ALMA) was created in 2002 to improve accessibility and the quality of health services for the elderly in LAC. One of its main strategies is strengthening and managing human talent from the region's universities by training geriatric teachers. In addition to the health challenges arising from the COVID-19 pandemic, they suggested others related to maintaining care for people with chronic health problems and teaching innovation to increase healthcare providers' skills in caring for older persons. Older people with dementia were particularly affected by COVID-19. 5,6
A course for academic geriatricians of LAC was designed to acquire and enhance competencies, using the methodology “Training of trainers” (TOT)”7–10 aimed at optimising knowledge on the prevention and management of older people with dementia, and emphasising the needs of services, family, and community. At the same time, this course sought to improve learning and virtual teaching capabilities.11,12 The course was sponsored by the Pan American Health Organization (PAHO/WHO) and the International Association for Gerontology and Geriatrics (IAGG). A massive call was launched through social networks, email, and the ALMA website. The participants were selected according to the academic criteria defined by ALMA (geriatric specialisation degree, academic degree, research, university teaching, scientific publications, and the number of ALMA courses taken previously).
Students were academic geriatricians that certified that they work as teachers in Faculties of Medicine. They were selected according to their curriculum vitae by the course coordinators.
Generic
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Apply analysis and synthesis, induction and deduction, and the systemic approach as general strategies for knowledge acquisition.
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Use critical thinking when analyzing different contexts, sources of information, and facts of reality.
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Effective use of new information and communication technologies.
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Leading and actively participating in work teams and committed to the tasks and achievements.
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Respect for the human being, recognition of rights and obligations.
Specific
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Explain the biomolecular and epidemiological bases that modulate the development of cognitive decline in the elderly.
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Assess the process of pathophysiological, clinical, and diagnostic approaches to the main dementias affecting the elderly.
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Explain therapeutic approaches at the pharmacological and non-pharmacological levels to optimise the trajectory of cognitive functioning of older adults, focused on a life lived and human rights.
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Explain the particularities health services must have to prevent and care for the elderly with dementia seeking healthy and dignified ageing.
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Use a virtual collaborative work environment with students to deal with the topic learned at different levels of complexity.
The thematic contents according to the specific activities can be seen in Table 2.
The course was developed using different coding methodologies (Fig, 1).
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Encoding strategies
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Synchronic masters, individual and team presentations: Real-life cases or examples of problem-based learning were used, which helped to communicate and stimulate discussion of the scientific evidence presented. All the presentations were recorded for posterior review.
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Asynchronous presentations: Videos or short texts were used to stimulate reflection and enrich learning. All course participants could comment or ask through the corresponding forums/channels.
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Readings: Readings selected by teachers and others shared by peers were used.
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Summary of student learning: Participants prepared a PowerPoint presentation of the topic assigned to them and their team. Each group produced an infographic on the given topic.
Based on theories of classical and instrumental conditioning and seeking to achieve different types of knowledge and skills, we used two systems of the human mind (implicit and explicit). That is, top-down and bottom-up strategies were used to engage students and drive their attention. 13
Think pair share activities were promoted during synchronous activities by asking students to explain the topic discussed in their own words or present an example (consolidation). The companion partner repeated their understanding and related their experiences or explained how the new knowledge could be translated into daily practice (forums and teamwork). At the end of the course, there was a quiz for a retrieval strategy. The teaching design was carried out considering the hours the students agreed to participate to avoid work overload and promote adequate rest. A cordial and horizontal work environment was always fostered to create the best environment for learning.
This course is one of three required courses to become a member of ALMA. In addition, documents with publication potential are produced during the course.
Participants are encouraged to recognize the topic's relevance for their career and public health and reflect on the impact of optimizing their knowledge on the subject for their students and patients.
The course applied theoretical-practical procedures to discover and incorporate new knowledge for health care and optimal teaching in Geriatrics concerning the subject of the course. Throughout the course, permanent interaction between teachers, tutors, and students is encouraged to guarantee the exchange and acquisition of knowledge. The teaching methodology focuses on the student, promoting autonomous learning and critical thinking, and giving more importance to the management of learning tools and development of study techniques than the accumulation of data. The methodology used is participatory, collaborative, and involves problem-based learning. Learning activities are the axis of the teaching strategy, based on a process of personal construction, mediated by exchanging with classmates, tutors, and teachers.
These learning activities are appropriate to the profile of the participants. They are progressively organized so that in the initial session, students are provided with the knowledge and tools necessary to achieve the objectives of the following sessions. 14,15 These activities are linked to the practice and the specific scenarios of the students, thereby seeking practical contextualization of learning. 16
1. Lecture strategies
2. Student presentations: "current affairs".
A topic was assigned to 25 students to analyze and then present their conclusions. The student's topic preparation was performed under a tutor's supervision. The presentations were 20 minutes long: 10 min. for their presentation and ten minutes for questions from the other participants. The 10-min. presentations were pre-recorded, and the questions or discussions were conducted live.
3. Teamwork
The groups were made up of 10 participants and a tutor. During the first phase, the group virtually worked on the assigned topic in the related forums. During the second phase, one of the group members made the respective presentation according to the academic program, and the rest actively participated in the discussion. The teachers randomly chose the exhibitor representing the group a few days before the recording. In the plenary session, moderated by a professor, the recorded presentation was presented, and a synchronous debate was held with questions and answers from the attendees that were answered by the participants of the entire group in charge of the topic.
4. Off-learning collaboration/assignments
Students were divided into "learning teams" to perform weekly activities and meet the requested endpoints.
5. General schedule
An academic committee of ALMA members supervised the course's competencies, contents, and activities. The tutors were also members of ALMA. The course had 2 phases. The first phase involved collaborative asynchronous work by groups with one assigned tutor. During this phase, the topics assigned were discussed, and presentations and infographics were prepared. During the second phase, synchronous question-and-answer sessions were held in the plenary session (subjects and development shown in Table 3).
6. Assessments
Continuous evaluation of students, teachers, and teaching strategies was carried out along the course. According to the Kirkpatrick model 17, the evaluation process included evaluation of the teaching strategy, which consisted of an immediate assessment aimed at students, teachers, and tutors, through a voluntary virtual survey, and the realization of a forum with tutors, professors, and the course coordinators.
7. Grading
The program was graded by a combination of grading of formative and summative assessments. Table 1 shows how the students were evaluated. To pass the course, participants had to obtain a mark of at least 70%. Participants who passed received a certificate of completion with the following criteria: minus 70% = failure, 70–90% pass, and more than 90% pass with excellence. To pass, it is required to attend at least 95% of the sessions of the second phase.
8. Use of Technology
Easy-to-use technological tools that promote interaction and achieve learning objectives were selected. We used the Moodle Platform to implement the phase 1 forums, and zoom was integrated within Moodle for the second phase. Instruction and a video were designed to optimize the use of the virtual environment. WhatsApp groups and google drive spaces were developed to improve collaborative work. The course syllabus describes the cordiality and respect rules for participation in the forums. In addition, there was permanent technical advice for the use of work platforms.