A model intensive course in geriatric teaching for non-geriatrician educators

An age-friendly residency: Geriatrician and internist perspectives on geriatric education in an internal medicine residency

BACKGROUND

General internists and subspecialists need skills to deliver age-friendly care to older adults, yet a minority of Internal Medicine (IM) residency programs provide robust geriatric-specific clinical instruction. We sought to explore internist and geriatrician perspectives regarding current strengths and weakness of geriatric education, and perceived supports, barriers, and strategies to enhance geriatric education in an IM residency program.

METHODS

Using social learning theory as a conceptual framework, we conducted a needs assessment using focus groups and semi-structured interviews with IM residency leadership and geriatricians at an academic medical center. Interviews were recorded and transcribed; thematic analysis was performed on deidentified transcripts.

RESULTS

We recruited faculty by e-mail in 2021; eight geriatricians and seven internists participated (60% female, 13% Hispanic/Latino, and 73% White). Six participated in two virtual focus groups and nine participated in virtual one-on-one interviews. All had at least monthly teaching contact with residents and six were associate program directors. We identified five key themes: (1) professional role models, (2) personal attitudes toward aging, (3) the powerful influence of patients, (4) clinical complexity of geriatrics, and (5) branding and prestige of the field. Participants offered multiple suggestions for improvement, especially faculty development for non-geriatrician faculty.

CONCLUSIONS

Geriatric education for IM residents is impacted by multiple factors, but uniformly viewed as important. Moving forward, programs could capitalize on opportunities for closer collaboration between residency leadership, internists, and geriatricians to train the next generation of IM residency graduates to deliver age-friendly care.

A national survey on the teaching provision of undergraduate geriatric medicine in Malaysia

Malaysia is becoming an aging nation, with 32 medical schools providing 5,000 graduates every year. The extent these graduates have been trained in core concepts in geriatric medicine remains unclear. This work aims to describe the current state of teaching provision on aging and geriatric medicine to the medical undergraduates in Malaysia. A survey was developed by geriatric medicine experts from the Malaysian Society of Geriatric Medicine (MSGM) to review the teaching provision based on the recommended MSGM Undergraduate Geriatric Medicine Curriculum and was sent to all medical schools across the country. The response rate was 50% (16 out of 32 medical schools). Among 16 medical schools, 10 (62.5%) delivered the learning outcomes as part of an integrated curriculum, and five via a mixed geriatric and integrated curriculum at varying degrees of completeness, ranging from 19% to 94%. One particular medical school did not deliver any of the core topics as part of its undergraduate curriculum. It has been identified that the strongest barrier to delivery was lack of expertise, followed by the fact that the topics were not included in the current curriculum. Improvement in teaching provision should be implemented through a concerted effort to adopt a geriatric medical curriculum nationwide, while future research should aim at the interventions taken to address the barriers in its provision.

Facilitating a change model in age-friendly hospital certification: Strategies and effects

The ageing population is a powerful and transformative demographic force. The World Health Organization (WHO) has encouraged the development of an age-friendly hospital (AFH) network. However, no specific implementation strategies or best practices of AFH standards have been produced. This study sought to apply Kotter's change model to the elements included in a successful AFH certification process and to evaluate the changes in employees' knowledge of ageing and their attitudes toward the elderly. This was an observational study that utilized a pre- and posttest design, before and after an age-friendly hospital certification process was implemented. Participants were 163 hospital employees in Taiwan, who completed both pre- and postquestionnaires. The self-administered online questionnaire consisted of three sections: The Facts on Ageing Quiz, the Geriatric Attitudes Scale, and a demographic questionnaire. Following introduction of the intervention, the change process began, and later Kotter's model was brought in as a descriptive framework. The results showed that Kotter's eight-step framework is a good choice for thinking about how to change practice and make healthcare more age-friendly. Employee knowledge of ageing and their attitudes toward the elderly improved after this certification process. Appointing a chief executive officer, forming a steering committee, obtaining interdepartmental and interdisciplinary cooperation, and "soliciting support" for new policies from all employees, were identified as key factors influencing the success of age-friendly hospital (AFH) certification. This is the first study to apply Kotter's eight-step framework of organizational change to an AFH certification process.

Medical Faculty Beliefs: Self-Rated Importance and Confidence in Teaching Geriatrics Primary Care

OBJECTIVES

To evaluate and contrast 25 content areas essential to the primary care of older adults by medical faculty, thus identifying faculty beliefs and areas of possible improvement.

DESIGN

Using measures from the Healthcare Effectiveness Data and Information Set, the Consumer Assessment of Healthcare Providers and Systems, and Healthy People 2020, nine practicing clinical faculty identified 25 content areas essential to the primary care of older adults.

SETTING

A large academic health center in southeastern United States.

PARTICIPANTS

Eighty-two university medical faculty.

MEASUREMENTS

Faculty rated importance, knowledge, and confidence in teaching the 25 content areas on a scale from 1 (low) to 10 (high). Gap scores reflecting the difference in ratings for importance and confidence in teaching were calculated and assessed. The survey had high internal consistency within each of the three domains-Cronbach's α > .94.

RESULTS

The most important content areas were being able to explain details about patient's condition and taking medication clearly, followed by taking age-appropriate history. The three largest gaps were: "evaluating sensory impairment," "identifying and counseling at-risk drivers," and "evaluating cognition." The three smallest gaps were: "explaining prescribed medications," "explaining health conditions in easy-to-understand language," and "taking an age-appropriate patient history and performing a physical assessment."

CONCLUSION

Medical faculty were comfortable with topics reflecting primary care expertise but expressed less confidence with more specialized topics, such as sensory or cognitive impairment and driving. This may represent key areas for geriatrics training applicable to all those involved in education and training of future healthcare professionals. Integration of specialists (eg, neurologists, psychiatrists) may improve the geriatrics curricula. J Am Geriatr Soc 67:576-580, 2019.

Workforce Analysis of Psychological Practice With Older Adults: Growing Crisis Requires Urgent Action

As the proportion and sheer number of older adults in the United States continues to increase, we need to plan for their behavioral health care. Access to accurate data about current workforce characteristics in psychology can provide essential information to inform workforce planning. In this paper, we present results of the American Psychological Association's Center for Workforce Studies survey of psychologists, with a focus on older adults. Participants (N = 4,109) were doctoral psychologists identified through state licensing boards. Only 1.2% of those surveyed described geropsychology as their specialty area, although 37.2% reported seeing older adults frequently or very frequently, most often from the specialties of rehabilitation psychology, clinical neuropsychology, and clinical health psychology. Frequent providers of aging services were more likely to be older, nonethnic minority, working in independent practice as their primary work setting, and self-employed as compared to other respondents. In addition, frequent providers of services to older adults were more likely to be in practices colocated with medical professionals and to accept Medicare as payment. Low reimbursement rates were cited as a reason for not accepting Medicare by those who did not. There was strong interest in further education in aging from all psychologists in areas including adjustment to medical illness/disability, depression, bereavement, dementia, anxiety, psychotherapy, and caregiver stress. The results of this survey suggest a continued urgent need to train psychologists across subfields in foundational geropsychology competencies that all psychologists should possess to be prepared for the rapidly growing and increasingly diverse population of older adults.

Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study

BACKGROUND

Older adults receiving cancer therapy have heightened risk for treatment-related toxicity. Geriatric assessment (GA) can identify impairments, which may contribute to vulnerability and adverse outcomes. GA management interventions can address these impairments and have the potential to improve outcomes when implemented.

METHODS

We conducted a randomized pilot study comparing GA with management interventions versus usual care in patients with stage III/IV solid tumor malignancies (N = 71). In all patients, a trained coordinator conducted and scored a baseline GA with pre-determined cutoffs for impairment. For patients randomized to the intervention arm, an algorithm was used to identify GA management recommendations based upon identified impairments. Recommendations were relayed to the primary oncologist for implementation. GA was repeated at 3 months. The primary outcome was grade 3-5 chemotherapy toxicity. Secondary outcomes included feasibility, hospitalizations, dose reductions, dose delays, and early treatment discontinuation.

RESULTS

The mean participant age was 76 (70-89). The total number of GA management recommendations relayed was 409, of which 35.4% were implemented by the primary oncologist. Incidence of grade 3-5 chemotherapy toxicity did not differ between the two groups. Prevalence of hospitalization, dose reductions, dose delays, and early treatment discontinuation also did not differ between the two groups.

CONCLUSIONS

An algorithm can be used to guide GA management recommendations in older adults with cancer. However, reliance upon the primary oncologist for execution resulted in a low prevalence of implementation. Future work should aim to understand barriers to implementation and explore alternate models of implementing geriatric-focused care for older adults with cancer.

"Geriatricizing" hospitalists: identifying educational opportunities

The objective of this study was to identify differences between geriatricians and hospitalists in caring for hospitalized older adults, so as to inform faculty development programs that have the goal of improving older patient care. Eleven hospitalists and 13 geriatricians were surveyed regarding knowledge, confidence, and practice patterns in caring for hospitalized older adults, targeting areas previously defined as central to taking care of older hospitalized patients. Overall, geriatricians had more confidence and more knowledge in caring for older hospitalized adults. The areas in which hospitalists expressed the least confidence were in caring for patients with dementia, self-care issues, and care planning. Geriatricians reported more routine medication reviews, functional and cognitive assessments, and fall evaluations. Geriatricians and hospitalists differ in their approach to older adults. Where these differences reflect lack of knowledge or experience, they set the stage for developing curricula to help narrow these gaps.

A 30-year review of a geriatric dentistry teaching programme

OBJECTIVE

To review the development of the Geriatric Dental and Special Needs Education programme at the University of Iowa over the last 30 years.

BACKGROUND

The programme at Iowa evolved from a didactic elective programme taught by a single faculty person to a required didactic and clinical programme, which includes a Special Care Clinic in the dental school and a mobile unit with portable dental equipment which serves ten area nursing homes with comprehensive care.

MATERIALS AND METHODS

Changes have been made in the programme over time based on formal and informal feedback from students and graduates, and we have also looked at the impact of the programme on dental services to our target population.

RESULTS

The factors influencing the curriculum development are identified and discussed.

CONCLUSION

As no dental schools are the same, some general applications are suggested from the Iowa experience.

The Donald W. Reynolds Consortium for Faculty Development to Advance Geriatrics Education (FD~AGE): a model for dissemination of subspecialty educational expertise

PURPOSE

Most U.S. medical schools and training programs lack sufficient faculty expertise in geriatrics to train future physicians to care for the growing population of older adults. Thus, to reach clinician-educators at institutions and programs that have limited resources for enhancing geriatrics curricula, the Donald W. Reynolds Foundation launched the Faculty Development to Advance Geriatrics Education (FD~AGE) program. This consortium of four medical schools disseminates expertise in geriatrics education through support and training of clinician-educators. The authors conducted this study to measure the effects of FD~AGE.

METHOD

Program leaders developed a three-pronged strategy to meet program goals: FD~AGE offers (1) advanced fellowships in clinical education for geriatricians who have completed clinical training, (2) mini-fellowships and intensive courses for faculty in geriatrics, teaching skills, and curriculum development, and (3) on-site consultations to assist institutions with reviewing and redesigning geriatrics education programs. FD~AGE evaluators tracked the number and type of participants and conducted interviews and follow-up surveys to gauge effects on learners and institutions.

RESULTS

Over six years (2004-2010), FD~AGE trained 82 fellows as clinician-educators, hosted 899 faculty scholars in mini-fellowships and intensive courses, and conducted 65 site visits. Participants taught thousands of students, developed innovative curricula, and assumed leadership roles. Participants cited as especially important to program success expanded knowledge, improved teaching skills, mentoring, and advocacy.

CONCLUSIONS

The FD~AGE program represents a unique model for extending concentrated expertise in geriatrics education to a broad group of faculty and institutions to accelerate progress in training future physicians.

The brave new world of GEC evaluation: the experience of the Rhode Island Geriatric Education Center

In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these efforts, and the modifications to assessment that ensued in response to the increased accountability requirements. The evaluation focused on RIGEC's series of continuing education, day-long workshops for health and social service professionals, the completion of all seven of which leads to a Certificate in Interdisciplinary Practice in Geriatrics.