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Fear of falling (FoF) results in social, functional, physical, and psychological symptoms, including secondary disorders, such as depression and general anxiety disorder (GAD). A vicious cycle develops, where symptoms maintain and reinforce FoF and its consequences, including increasing the risk of falling. In this position paper, we suggest screening for FoF using the falls efficacy scale international (FES-I) questionnaire. The presence of a high score ( 23) warrants an investigation into frailty and exclusion of depression and GAD, during the clinical interview. Stratifying frailty, based on the Fried frailty criteria will guide treatment options based on the most significant health concerns. Frail older adults should first receive physiotherapy and exercise interventions, as physical disabilities are their most significant characteristic, while pre-frail and non-frail older adults should receive multicomponent interventions, consisting of cognitive behavioral therapy (CBT) with physical exercise. The non-frail with predominantly GAD and depression should receive specialized CBT interventions. Currently, only exercise interventions are available for FoF treatment in Switzerland. Although some exercise interventions use CBT elements, such as goal setting and reflections on behavior and feelings, they are not systematically used, are not part of a quality-assured procedure, and do not address the psychological-cognitive aspects of FoF. As the pre-frail and non-frail are the largest groups to use these services, adapting current exercise programs by incorporating a CBT component would be the most practical means to provide optimized care.Sturzangst führt zu sozialen, funktionellen, körperlichen und psychischen Symptomen, einschließlich sekundärer Störungen, wie Depression und generalisierte Angststörung (GAS). Es entsteht ein Teufelskreis, bei dem die Symptome die Sturzangst und ihre Folgen, einschließlich der Erhöhung des Sturzrisikos, aufrechterhalten und verstärken. In diesem Positionspapier schlagen wir vor, ein Screening auf Sturzangst mit dem Fragebogen Falls Efficacy Scale International (FES-I) durchzuführen. Das Vorhandensein eines hohen Wertes ( 23) rechtfertigt eine Untersuchung auf Gebrechlichkeit und erfordert den Ausschluss von Depression und GAS im Rahmen eines klinischen Interviews. Die Stratifizierung der Gebrechlichkeit, basierend auf den Fried-Kriterien für Gebrechlichkeit, leitet die Behandlungsoptionen basierend auf den wichtigsten Gesundheitsproblemen. Gebrechliche ältere Erwachsene sollten zuerst Physiotherapie und Bewegungsinterventionen erhalten, da körperliche Einschränkungen ihr wichtigstes Merkmal sind, während nicht gebrechliche ältere Erwachsene und solche mit Vorstufen von Gebrechlichkeit eine Multikomponenten-Intervention erhalten sollten, bestehend aus kognitiver Verhaltenstherapie (CBT) mit körperlicher Bewegung. Nicht gebrechliche Menschen mit überwiegend GAD und Depressionen sollten spezielle CBT-Interventionen erhalten. Derzeit sind in der Schweiz nur Bewegungsinterventionen für die Behandlung von Sturzangst verfügbar. Obwohl einige Übungsinterventionen CBT-Elemente verwenden, wie z. B. Zielsetzung und Reflexion über Verhalten und Gefühle, werden diese nicht systematisch eingesetzt, sind nicht Teil eines qualitätsgesicherten Verfahrens und gehen nicht auf die psychologisch-kognitiven Aspekte von Sturzangst ein. Da Personen ohne bzw. mit Vorstufen von Gebrechlichkeit die größten Gruppen darstellen, die diese Dienste in Anspruch nehmen, wäre die Anpassung aktueller Trainingsprogramme durch Einbindung einer CBT-Komponente das praktischste Mittel, um eine optimierte Versorgung zu gewährleisten.

Background Entrustable professional activities (EPAs) are increasingly used in undergraduate medical education (UME). We conducted a scoping review to summarize the evidence for the use of EPAs in clinical rotations in UME. Methods We searched multiple databases for scoping reviews based on the PRISMA guidelines for articles reporting qualitative and quantitative research, as well as conceptual and curriculum development reports, on EPAs in UME clinical rotations. Results We identified 3309 records by searching through multiple databases. After the removal of duplicates, 1858 reports were screened. A total of 36 articles were used for data extraction. Of these, 47% reported on EPA and EPA-based curriculum development for clerkships, 50% reported on implementation strategies, and 53% reported on assessment methods and tools used in clerkships. Validity frameworks for developing EPAs in the context of clerkships were inconsistent. Several specialties reported feasible implementation strategies for EPA-based clerkship curricula, however, these required additional faculty time and resources. Limited exposure to clinical activities was identified as a barrier to relevant learning experiences. Educators used nationally defined, or specialty-specific EPAs, and a range of entrustability and supervision scales. We found only one study that used an empirical research approach for EPA assessment. One article reported on the earlier advancement of trainees from UME to graduate medical education based on summative entrustment decisions. Conclusions There is emerging evidence concerning how EPAs can be effectively introduced to clinical training in UME. Specialty-specific, nested EPAs with context-adapted, entrustment-supervision scales might be helpful in better leveraging their formative assessment potential.

Entrustable Professional Activities in Graduate Medical Education in Psychiatry: A Promising Concept Abstract. Entrustable Professional Activities (EPAs) are competency-based learning goals derived from observable clinical activities. In undergraduate medical education, they have now been adopted throughout Switzerland as part of the so-called PROFILES catalog (Principal Relevant Objectives and Framework for Integrated Learning and Education in Switzerland). The nine core EPAs to be mastered in undergraduate medical education can serve as a basis for introducing EPAs in graduate medical education as well. We will discuss this approach in the context of graduate medical education in psychiatry and psychotherapy from the perspective of different training contexts and a pilot example. In this position paper, we describe a promising opportunity to improve graduate medical training through the implementation of EPAs, both in terms of the quality of training and thus of patient care, as well as in terms of the attractiveness of the specialty for future residents.

Objective The psychiatric mental status examination is a fundamental aspect of the psychiatric clinical interview. However, despite its importance, little emphasis has been given to evidence-based instructional design. Therefore, this review summarizes the literature from an instructional design perspective with the aim of uncovering design strategies that have been used for teaching the psychiatric interview and mental status examination to health professionals. Methods The authors conducted a scoping review. Multiple databases, reference lists, and the gray literature were searched for relevant publications across educational levels and professions. A cognitive task analysis and an instructional design framework was used to summarize and chart the findings. Results A total of 61 articles from 17 countries in six disciplines and three educational levels were identified for data extraction and analysis. Most studies were from the USA, presented as educational case reports, and carried out in undergraduate education in the field of psychiatry. Few articles described the instructional rationale for their curriculum. None of the studies compared the effectiveness of different instructional design components. Reported learning activities for each task domain (knowledge, skills, and attitudes) and for each step of an instructional design process were charted. Most articles reported the use of introductory seminars or lectures in combination with digital learning material (videos and virtual patients in more recent publications) and role-play exercises. Conclusions Educators in psychiatry should consider all task domains of the psychiatric interview and mental status examination. Currently, there is a lack of empirical research on expertise acquisition and use of instructional design frameworks in this context.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects (benefits and harms) of cognitive behavioural therapy (CBT), either alone or used in combination with exercise, for reducing fear of falling in older people living in the community.

Entrustable Professional Activities in Graduate Medical Education in Psychiatry: A Promising Concept

Background and Objectives To provide an updated review article studying the applicability and effectiveness of sensor networks in measuring and supporting activities of daily living (ADLs) among non-demented older adults. Research Design and Methods Systematic review following PRISMA guidelines. Systematic search of PubMed, Embase, PsycINFO, INSPEC, and the Cochrane Library, from October 26, 2012 to January 3, 2018 for empirical studies, measuring and supporting ADLs among independently living, non-demented older adults, investigating wireless sensor monitoring networks. Results The search queries yielded 10,782 hits of which 162 articles were manually reviewed. Following exclusion criteria, 13 relevant articles were retained. Although various types of sensor networks with different analyzing algorithms were proposed, from simple video monitoring to complex sensor networks distributed throughout a house, all articles supported the use of wireless sensors for identifying changes in activity patterns. Discussion and Implications Wireless sensor networks appear to be developing into an effective solution for measuring ADLs and for identifying changes in their patterns. They offer a promising solution to support older adults living independently at home. However, there is too much focus on technology, and practical usefulness still needs to be further elaborated. Sensors should focus on ADLs that are sensitive to the earliest signs of cognitive decline, as well as quantitative markers, such as errors in the execution of ADLs.

Background/objectives The diagnostic process in a university memory clinic is based largely on cognitive testing. However, input from informants, acquired through interview or questionnaires, may significantly impact diagnosis. We sought to evaluate whether informant questionnaires for basic and instrumental activities of daily living, or for identifying progressive cognitive decline would improve diagnostic predictability of neurodegenerative disorders compared with either the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological test battery or the Mini-Mental State Examination score alone. Design Retrospective data analysis using logit models. Setting University hospital outpatient memory clinic. Participants A total of 394 patients with dementia, mild cognitive impairment (MCI), depression, or subjective cognitive impairment were assessed. Measurements Bristol Activities of Daily Living Scale, Functional Activities Questionnaire, Informant Questionnaire on Cognitive Decline in the Elderly, and the Physical Self-Maintenance Scale questionnaires were obtained. Analyses through logit models were performed to predict outcome diagnoses, based on cognitive scores alone or in combination with one or more informant questionnaires. Results The four questionnaires were highly correlated (.31-.86). The addition of informant questionnaires improved diagnostic predictability between differential diagnoses of MCI and dementia, or dementia and depression. However, the misprediction rate was reduced by up to 6 percentage points only. Adding more than one questionnaire or all CERAD subtests instead of their sum score never improved prediction in regularized logit models to a clinically relevant extent. Conclusion Although questionnaires contribute to a statistically better prediction of the outcome diagnosis, for some sets of differential diagnoses, the benefit may not be clinically pertinent when routine semistructured informant interviews are used by trained personnel. However, standardized assessment, particularly when patients are seen longitudinally, should not be underestimated.

Objective Entrustable professional activities (EPAs) represent discrete clinical tasks that can be entrusted to trainees in psychiatry. They are increasingly being used as educational framework in several countries. However, the empirical evidence available has not been synthesized in the field of psychiatry. Therefore, the authors conducted a systematic review in order to summarize and evaluate the available evidence in the field of EPAs in undergraduate and graduate medical education in psychiatry. Methods The authors searched PubMed, Cochrane Library, ERIC, Embase, PsycINFO, all Ovid journals, Scopus, Web of Science, MedEdPORTAL and the archives of Academic Psychiatry for articles reporting quantitative and qualitative research as well as educational case reports on EPAs in undergraduate and graduate psychiatry education published since 2005. All included articles were assessed for content (development, implementation and assessment of EPAs) and quality using the Quality Assessment Tool for Studies with Diverse Designs. Results The authors screened 2,807 records and included a total of 20 articles in the final data extraction. Most studies were expert consensus reports (n = 6, 30%) and predominantly conducted in English-speaking countries (n = 17, 85%). Papers reported mainly EPA-development and/or EPA-implementation studies (n = 14, 70%), whereas EPA-assessment studies were less frequent (n = 6, 30%). Publications per year showed an increasing trend both in quantity (from 1 in 2011 to 7 in 2018) and quality (from a QATSDD-score of 27 in 2011 to an average score of 39 in 2018). The main focus of the articles was the development of individual EPAs on different levels of training for psychiatry or on curricular frameworks based on EPAs in psychiatry (n = 10, 50%). The lack of empirical controlled studies does currently not allow for meta-analyses of educational outcomes. Conclusion The concept of EPA-based curricula seems to become increasingly present a focus in the specialty of psychiatry both in UME and GME. The lack of empirical research in this context is an important limitation for educational practice recommendations. Currently there is only preliminary but promising data available for using EPAs with regards to educational outcomes. EPAs seem to be effectively used from a curriculum design perspective for UME and GME in psychiatry.