Masterclasses 6 and 7 will be held in 2005, training 40 more geriatricians to add to the alumni of 100 already trained.

A 12 month post course evaluation of the first cohort of doctors undertaking the Parkinson’s Masterclass considered the impact on:

• The personal development of the participants
• The development of services within their localities.

  The PD Masterclass is grateful to its sponsors Pharmacia who initially supported the inception and development, and then in 2003-4, Pfizer and now Boehringer-Ingelheim, who have continued their support and further development by an unrestricted educational grant. We can conclude from this evaluation that the courses have trained approximately 100 specialists so far, and through their achievements the care given to many patients with Parkinson’s disease has been enhanced throughout the United Kingdom. This is also the view of the Parkinson’s disease Society UK.

The evaluation included an analysis of course work, an immediate post-course evaluation, followed up by a one-year post-course questionnaire survey by discussion, observation and telephone interviews with course members.

The results of the evaluation demonstrate the extremely positive impact of the Masterclass on the development of participants’ management skills for PD, their increased confidence in prescribing for and managing people with PD, as well as their greater understanding of how to develop services and improve and expand PD service provision.

Cohort 1: September 2002 – March 2003
In September 2002, 20 geriatricians enrolled for the first UK Parkinson’s Disease Masterclass. The demographics of the group were diverse. All but one had completed undergraduate education between 1970 and 1983. Based on their responses to the questionnaire, participants were clearly extremely knowledgeable and already skilled with regard to PD. Most participants were established consultants, and without exception all were primarily front-line clinicians including staff grades, associate specialists and specialist registrars.

Three respondents did not have their MRCP but all were enthusiastic about increasing their skills in PD management. Two had undertaken significant research (although not PD related) but most had done none. In relation to computer skills there was a declared lack, with three having no computer experience whatsoever. Half of participants had no skills in audit and, while about half had carried out audit, this had been purely medical and not clinical (and/or service based).

The cohort’s expectations from the course were grouped into five clusters. As elaborated on in Appendix 1 below, they were clinical – 44%; building a service – 25%; monitoring and audit – 13%; inter-disciplinary issues – 9%; research – 9%.

The participants were recruited from across the UK with representation of each of the nationalities and equal spread of regions.

Needs analysis conclusions
Course planners sometimes make two errors, the first being to develop a training programme without understanding what should be expected of participants in terms of knowledge, understanding, judgement and application, and therefore their abilities at the end of the course. The second is to underestimate the gap between the expertise and diverse skills of the organisers and participants (participants commonly overestimate this gap). The result is that faculty and participants on some courses fail to engage educationally.

The Parkinson’s Masterclass is unique in that it ascertains the actual needs/expectations of the participants. These are then summarised as a list of objectives and the programme is designed to reflect those objectives. Similarly, the needs analysis undertaken prior to the Masterclass (as long as we act on the results) tells us something of the participants in terms of their background, in turn allowing us to deliver our individual contributions appropriately.

Integrating these threads where possible, into all our contribution,s has produced an extremely cohesive course, and the second module of the course has also been informed by the evaluations of the first.
Masterclass post-course evaluation and development
One year after the end of the course, a questionnaire was sent to participants so that we could understand the long-term benefits resulting from attendance at the Parkinson’s Masterclass. The analysis in Table 2 is based on responses from the 18 geriatricians who successfully graduated from the course.

 Mentorship
Mentorship is an integral part of the Masterclass and has proved to be innovative (for geriatricians) and a worthwhile element of the course. Most participants valued the support of their mentor and enjoyed visiting the mentor’s own hospital to see how another’s services has been developed and delivered. Participants welcomed their ability to benchmark their own services against the established services of the mentor, while the ‘lifelong’ possibility of mentorship was also greatly appreciated.

Service development and facilitation
The unique elements of service development support and facilitation were greatly appreciated (40%) as was the ability to visit other services and undertake guided audit and benchmarking (40%)

“I am now taking the lead for PD. Previously the neurologists took the lead in this area but it has passed to me. I have initiated a multidisciplinary stakeholder group to ensure PD service development and we are working towards integrated services. Previously we (as geriatricians) have been excluded from using the PD nurse specialists locally, but I have instigated development in this area with the PCT who will shortly submit our business case. We have conducted 4 audits on care delivery over the last 12 months and are setting care pathways in place. The whole experience of being on the Masterclass has been a catalyst for service development” (Participant 5)

“Since completing the course I now have set aside two days weekly for dedicated PD clinics within the day hospital setting. Patients come to the clinics and see the full multidisciplinary team, this works very well. We have worked with the PCT and have just gained approval for a PD nurse specialist to work as part of this team. Additionally, we intend training our whole medical team on the Masterclass so that all clinicians are competent. One other geriatrician here has now completed his training and we will support a third geriatrician to start training in 2004”. (Participant 7) 
 
Conclusions
The results of the first cohort of the Masterclass programme provide a baseline for the subsequent development of the courses and an evaluation of their worth. Year 1 evaluation data clearly demonstrate the positive impact of the programme in terms of increasing doctors’ confidence in their ability to manage the disease. It also increased participants’ understanding of how services can be developed and the contribution they make as members of the BGS PD Section, maximising the impact of their work within a specialist area of expertise.

The increased sophistication of the networking and strategic ability of attending doctors was notable, as was evidence from some participants of their transformation into developers and leaders of PD services. This was demonstrated through their communication with acute and primary care trusts in negotiating new clinics, specialist nursing and therapy posts; their contribution to national and local PD service development working parties; and their presence at national and international meetings on PD.

The British Geriatrics Society PD Section Committee is unanimous in concluding that the PD Masterclass has been a highly successful and productive project that it wishes to continue.

Doug MacMahon
Peter Fletcher
David Stewart
Sue Thomas

The PD Masterclass is now supported by an unrestricted educational grant from Boehringer Ingelheim Ltd