1
|
Guttman MP, Haas B, Kim M, Mador B, Nathens AB, Ahmed N, Wheeler S, Gotlib Conn L. Innovative curriculum is needed to address residents' attitudes toward older adults: the case of geriatric trauma. BMC MEDICAL EDUCATION 2022; 22:130. [PMID: 35219294 PMCID: PMC8881881 DOI: 10.1186/s12909-022-03196-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/15/2022] [Indexed: 06/08/2023]
Abstract
BACKGROUND Medical trainees' negative perceptions towards older adult care have been widely reported, catalyzing targeted curricula in geriatric medicine. Little is known about surgical residents' attitudes toward and perceptions of the educational value of caring for injured older adults. This information is needed to ensure the surgical workforce is adequately trained to care for this growing patient population. In this study, we assessed surgical trainees' attitudes towards geriatric trauma care to inform a curriculum in geriatric trauma. METHODS We surveyed North American general surgery trainees' beliefs and attitudes toward caring for older trauma patients, and the educational value they ascribed to learning about older trauma patient care. Descriptive statistics were used to report participant characteristics and responses. RESULTS Three hundred general surgery trainees from 94 post-graduate programs responded. Respondents reported too much time co-ordinating care (56%), managing non-operative patients (56%), and discharge planning (65%), all activities important to the care of older trauma patients. They recognized the importance of geriatric trauma care for their future careers (52%) but were least interested in reading about managing geriatric trauma patients (28%). When asked to rank clinical vignettes by educational value, respondents ranked the case of an older adult as least interesting (74%). As respondents progressed through their training, they reported less interest in geriatric trauma care. CONCLUSIONS Our survey results demonstrate the generally negative attitudes and beliefs held by postgraduate surgical trainees towards the care of older adult trauma patients. Future work should focus on identifying specific changes to the postgraduate surgical curriculum which can effectively alter these attitudes and beliefs and improve the care for injured older adults.
Collapse
Affiliation(s)
- Matthew P Guttman
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Haas
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Michael Kim
- Department of Surgery, University of Alberta, Alberta, Canada
| | - Brett Mador
- Department of Surgery, University of Alberta, Alberta, Canada
| | - Avery B Nathens
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- American College of Surgeons, Chicago, IL, United States
| | - Najma Ahmed
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Sarah Wheeler
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Ontario Health, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Sunnybrook Research Institute, Toronto, Ontario, Canada.
| |
Collapse
|
2
|
Koprowski MA, Nagengast AK, Finlayson E, Brasel KJ. Surgical Trainees and The Geriatric Patient: A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2022; 79:179-189. [PMID: 34294567 DOI: 10.1016/j.jsurg.2021.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/25/2021] [Accepted: 06/26/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE There is an increasing emphasis on surgical trainees learning how to appropriately provide care for the geriatric patient. We hypothesized that little published formal curriculum on the topic exists. We sought to perform a scoping review to test this hypothesis. DESIGN PubMed, OVID Medline, and EMBASE databases were queried from inception, supplemented by hand search of references and the grey literature. Included English language abstracts and articles described trainee perceptions of geriatric patients and/or description of dedicated geriatric curricula for trainees. RESULTS There were 21 included abstracts or papers, which were categorized into 8 survey-based studies, 6 descriptions of curricular design, and 7 interventional studies with pre- and post-intervention knowledge tests. General surgery residents were most frequently included. Self-rated confidence and comfort were typically higher than objective measures of resident performance in the care of geriatric patients. Residents were commonly unaware of the standardized assessment tools and recommendations that exist. Medication and delirium management were frequently-identified topics posing the widest gaps in resident knowledge. CONCLUSION There are few published examples of curricula on the care of geriatric patients for surgical trainees. More work is needed for the creation of specialty-specific and needs-based geriatric surgical curricula.
Collapse
Affiliation(s)
- Marina Affi Koprowski
- Department of Surgery, Oregon Health and Science University (OHSU), Portland, Oregon
| | - Andrea K Nagengast
- Division of Trauma, Critical Care, and Acute Care Surgery, OHSU, Portland, Oregon
| | - Emily Finlayson
- Department of Surgery, University of California at San Francisco (UCSF), San Francisco, California
| | - Karen J Brasel
- Division of Trauma, Critical Care, and Acute Care Surgery, OHSU, Portland, Oregon.
| |
Collapse
|
3
|
Improving Outcomes for Elderly Patients Following Emergency Surgery: a Cutting-edge Review. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00500-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose of Review
The aim of this review is to explore the consequence of emergency general surgery in the elderly, and to summarise recent developments in the pre-, peri- and postoperative management of these patients, in order to improve outcomes.
Recent Findings
Preoperatively, accurate risk assessment is vital to ensure the right patients undergo emergency surgery. Perioperatively, there are multiple interventions specific to elderly patients that have been shown to improve outcomes. Postoperatively, elderly patients must be cared more in an appropriate setting in order to avoid failure to rescue and promote return to function.
Summary
This review of contemporary evidence identifies multiple pre-, peri- and postoperative interventions that can improve outcomes for elderly patients after emergency general surgery. These evidence-based recommendations should help direct care of elderly patients undergoing emergency surgery and foster further quality improvement measures and research investigations.
Collapse
|
4
|
Ong EY, Bower KJ, Ng L. Geriatric Educational Interventions for Physicians Training in Non-Geriatric Specialties: A Scoping Review. J Grad Med Educ 2021; 13:654-665. [PMID: 34721794 PMCID: PMC8527951 DOI: 10.4300/jgme-d-20-01484.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/28/2021] [Accepted: 06/01/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Physicians require the expertise to care for an increasingly aging population. A robust understanding of geriatric educational interventions is needed to improve geriatric training for physicians. OBJECTIVE To map the breadth of geriatric educational interventions for residents (in non-geriatric specialties). METHODS We used a scoping review methodology. We searched MEDLINE, Embase, EMCare, CENTRAL, ERIC, and Scopus from 2004 to September 2019 for search terms related to "educational approaches" AND "geriatric" AND "residents." Two authors independently selected eligible studies, extracted data (categorized by educational approaches and Kirkpatrick level outcomes), and critically appraised studies using the Mixed Methods Appraisal Tool. RESULTS There were 63 included studies, with a total of 6976 participants. Twelve studies had comparators, including 5 randomized controlled trials. Fifty-three studies (84%) described multicomponent interventions, incorporating combinations of didactic or self-directed approaches with interactive, simulation, experiential, and/or group-based learning. Use of curricular process was explicitly reported in 34 studies (59%). Most studies met at least 4 of 5 Mixed Methods Appraisal Tool criteria. Studies commonly measured outcomes at Kirkpatrick levels 1 and 2 (reaction and learning), with 15 studies measuring performance outcomes (Kirkpatrick levels 3 and 4b). All included studies had at least one positive result. CONCLUSIONS All educational interventions had positive outcomes; however, curriculum-informed multicomponent interventions were the most common. This scoping review demonstrates that robust methodology with comparators, longer-term designs, and use of higher-level Kirkpatrick outcome measures is possible but not commonly used. Clear direction for future research is provided.
Collapse
Affiliation(s)
- En Ye Ong
- En Ye Ong, BA/MBBS, FRACP, MClinEd, is a Master's Student, Melbourne Medical School, University of Melbourne, and Consultant Geriatrician and Student Geriatric Education Lead, Department of Geriatric Medicine, Eastern Health, VIC, Australia
| | - Kelly J. Bower
- Kelly J. Bower, BPhty, PhD, is a Lecturer, Department of Physiotherapy, University of Melbourne, VIC, Australia
| | - Louisa Ng
- Louisa Ng, MBChB, MD, FAFRM, is Deputy Director, Royal Melbourne Hospital Clinical School, Melbourne Medical School, University of Melbourne, and Supervisor, Intern Training and Rehabilitation Physicians, Department of Rehabilitation Medicine, Royal Melbourne Hospital, VIC, Australia
| |
Collapse
|
5
|
Chan ACH, Chuen V, Perrella A, Limfat G, Ng K, Chau V. A mixed methods evaluation of a 4-week geriatrics curriculum in strengthening knowledge and comfort among orthopaedic surgery residents. BMC MEDICAL EDUCATION 2021; 21:283. [PMID: 34001077 PMCID: PMC8130312 DOI: 10.1186/s12909-021-02716-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND In 2014, the University of Toronto Faculty of Medicine implemented a 4-week "Orthogeriatrics" rotation for orthopaedic surgery residents. We sought to assess the rotation's impact on trainees' knowledge, attitudes, and behaviours toward caring for older adults, and explore areas for improvement. METHODS We used a mixed methods concurrent triangulation design. The Geriatrics Clinical Decision-Making Assessment (GCDMA) and Geriatric Attitudes Scale (GAS) compared knowledge, attitudes, and behaviours between trainees who were or were not exposed to the curriculum. Rotation evaluations and semi-structured interviews with trainees and key informants explored learning experiences and the curriculum's impact on resident physician growth and development in geriatric competencies. RESULTS Among trainees who completed the GCDMA (n = 19), those exposed to the rotation scored higher in knowledge compared to the unexposed cohort (14.4 ± 2.1 vs. 11.3 ± 2.0, p < 0.01). The following themes emerged from the qualitative analysis of 29 stakeholders: Increased awareness and comfort regarding geriatric medicine competencies, appreciation of the value of orthogeriatric collaboration, and suggestions for curriculum improvement. CONCLUSIONS These results suggest that the Orthogeriatrics curriculum strengthens knowledge, behaviour, and comfort towards caring for older adults. Our study aims to inform further curriculum development and facilitate dissemination of geriatric education in surgical training programs across Canada and the world.
Collapse
Affiliation(s)
- Adrian C H Chan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- Department of Medicine, University of Saskatchewan College of Medicine, Saskatoon, Canada.
| | - Victoria Chuen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Department of Medicine, McMaster University, Hamilton, Canada
| | - Andrew Perrella
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Department of Medicine, McMaster University, Hamilton, Canada
| | - Guillaume Limfat
- Queen's University School of Medicine, Kingston , Canada
- Department of Medicine, Western University Schulich School of Medicine & Dentistry, London, Canada
| | - Karen Ng
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Division of Geriatrics, Sinai Health System, Toronto, Canada
| | - Vicky Chau
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Division of Geriatrics, Sinai Health System, Toronto, Canada
| |
Collapse
|
6
|
Parmar KL, Law J, Carter B, Hewitt J, Boyle JM, Casey P, Maitra I, Farrell IS, Pearce L, Moug SJ. Frailty in Older Patients Undergoing Emergency Laparotomy: Results From the UK Observational Emergency Laparotomy and Frailty (ELF) Study. Ann Surg 2021; 273:709-718. [PMID: 31188201 DOI: 10.1097/sla.0000000000003402] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to document the prevalence of frailty in older adults undergoing emergency laparotomy and to explore relationships between frailty and postoperative morbidity and mortality. SUMMARY BACKGROUND DATA The majority of adults undergoing emergency laparotomy are older adults (≥65 y) that carry the highest mortality. Improved understanding is urgently needed to allow development of targeted interventions. METHODS An observational multicenter (n=49) UK study was performed (March-June 2017). All older adults undergoing emergency laparotomy were included. Preoperative frailty score was calculated using the progressive Clinical Frailty Score (CFS): 1 (very fit) to 7 (severely frail). Primary outcome measures were the prevalence of frailty (CFS 5-7) and its association to mortality at 90 days postoperative. Secondary outcomes included 30-day mortality and morbidity, length of critical care, and overall hospital stay. RESULTS A total of 937 older adults underwent emergency laparotomy: frailty was present in 20%. Ninety-day mortality was 19.5%. After age and sex adjustment, the risk of 90-day mortality was directly associated with frailty: CFS 5 adjusted odds ratio (aOR) 3.18 [95% confidence interval (CI), 1.24-8.14] and CFS 6/7 aOR 6·10 (95% CI, 2.26-16.45) compared with CFS 1. Similar associations were found for 30-day mortality. Increasing frailty was also associated with increased risk of complications, length of Intensive Care Unit, and overall hospital stay. CONCLUSIONS A fifth of older adults undergoing emergency laparotomy are frail. The presence of frailty is associated with greater risks of postoperative mortality and morbidity and is independent of age. Frailty scoring should be integrated into acute surgical assessment practice to aid decision-making and development of novel postoperative strategies.
Collapse
Affiliation(s)
- Kat L Parmar
- Manchester Cancer Research Centre, Manchester, UK
| | | | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jonathan Hewitt
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | | | | | - Ishaan Maitra
- North West Deanery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Lyndsay Pearce
- Department of Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - Susan J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, Scotland, UK
| |
Collapse
|
7
|
Dworsky JQ, Shenoy R, Childers CP, Russell MM. Older veterans undergoing inpatient surgery: What is the compliance with best practice guidelines? Surgery 2020; 169:356-361. [PMID: 33077200 DOI: 10.1016/j.surg.2020.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/01/2020] [Accepted: 08/27/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The United States population is aging, and the number of older adults requiring operative care is increasing at a rapid rate. In order to address this issue, the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society created best practice guidelines surrounding optimal perioperative care for the older adult surgical patient. This study aimed to determine the documented compliance with these guidelines at a single institution. METHODS A retrospective chart review was performed on 86 older adults undergoing elective, inpatient coronary artery bypass graft, prostatectomy, or colectomy over a 2-year period (1/2016-12/2017) at a single Veterans Affairs institution. The primary outcome was compliance with the 38 measures from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society Best Practice Guidelines. The secondary outcome was postoperative (including geriatric-specific) complications. RESULTS The mean reported compliance across all measures was 41% ± 4%. Of 38 analyzed measures, compliance for 10 measures was achieved for 0 patients, and only 1 patient for 7 measures. There was variance in compliance by phase of care (P < .05) with a high of 56% ± 8% (immediate preoperative phase of care) and a low of 35% ± 4% (intraoperative phase of care). CONCLUSION Overall reported compliance with the Best Practice Guidelines of the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society is low (41%) at this institution. This study identifies a need to improve the care provided to the vulnerable population of older adults undergoing an operation. Future work is needed to understand barriers for implementation and how compliance relates to outcomes.
Collapse
Affiliation(s)
- Jill Q Dworsky
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Rivfka Shenoy
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA; National Clinician Scholars Program, University of California, Los Angeles, CA
| | | | - Marcia M Russell
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
| |
Collapse
|
8
|
Developing delirium best practice: a systematic review of education interventions for healthcare professionals working in inpatient settings. Eur Geriatr Med 2020; 11:1-32. [DOI: 10.1007/s41999-019-00278-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
|
9
|
Meinema JG, Buwalda N, van Etten-Jamaludin FS, Visser MR, van Dijk N. Intervention Descriptions in Medical Education: What Can Be Improved? A Systematic Review and Checklist. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:281-290. [PMID: 30157087 PMCID: PMC6365274 DOI: 10.1097/acm.0000000000002428] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE Many medical education studies focus on the effectiveness of educational interventions. However, these studies often lack clear, thorough descriptions of interventions that would make the interventions replicable. This systematic review aimed to identify gaps and limitations in the descriptions of educational interventions, using a comprehensive checklist. METHOD Based on the literature, the authors developed a checklist of 17 criteria for thorough descriptions of educational interventions in medical education. They searched the Ovid MEDLINE, Embase, and ERIC databases for eligible English-language studies published January 2014-March 2016 that evaluated the effects of educational interventions during classroom teaching in postgraduate medical education. Subsequently, they used this checklist to systematically review the included studies. Descriptions were scored 0 (no information), 1 (unclear/partial information), or 2 (detailed description) for each of the 16 scorable criteria (possible range 0-32). RESULTS Among the 105 included studies, the criteria most frequently reported in detail were learning needs (78.1%), content/subject (77.1%), and educational strategies (79.0%). The criteria least frequently reported in detail were incentives (9.5%), environment (5.7%), and planned and unplanned changes (12.4%). No article described all criteria. The mean score was 15.9 (SD 4.1), with a range from 8 (5 studies) to 25 (1 study). The majority (76.2%) of articles scored 11-20. CONCLUSIONS Descriptions were frequently missing key information and lacked uniformity. The results suggest a need for a common standard. The authors encourage others to validate, complement, and use their checklist, which could lead to more complete, comparable, and replicable descriptions of educational interventions.
Collapse
Affiliation(s)
- Jennita G. Meinema
- J.G. Meinema is a PhD student, Department of General Practice/Family Medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands; ORCID: https://orcid.org/0000-0003-3706-1360
| | - Nienke Buwalda
- N. Buwalda is a PhD student, Department of General Practice/Family Medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands; ORCID: https://orcid.org/0000-0003-2635-2912
| | - Faridi S. van Etten-Jamaludin
- F.S. van Etten-Jamaludin is clinical librarian, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
| | - Mechteld R.M. Visser
- M.R.M. Visser is senior researcher, Department of General Practice/Family Medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
| | - Nynke van Dijk
- N. van Dijk is professor of general practice/family medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
10
|
Chesney T, Devon K. Training surgical residents to use a framework to promote shared decision-making for patients with poor prognosis experiencing surgical emergencies. Can J Surg 2018; 61:114-120. [PMID: 29582747 DOI: 10.1503/cjs.011317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with poor underlying prognosis experiencing surgical emergencies face challenging treatment decisions. The Best Case/Worst Case (BC/WC) framework has improved shared decision-making by surgeons, but it is unclear whether residents can be similarly trained. We evaluated senior general surgical residents' acceptance of the BC/WC tool and their attitudes, confidence and actions before and after training. METHODS Two-hour training included a didactic session, live demonstration, small-group practice and debriefing. We developed questionnaires to evaluate residents' attitudes, confidence and actions at 3 time points: before the intervention, after the intervention and 6 months after the intervention. We used the Ottawa Decision Support Framework Acceptability questionnaire to evaluate acceptability and a structured observation form to evaluate performance. RESULTS Eighteen (50%) of 36 invited residents participated. Most residents (83%) felt that a new communication tool would be useful. Almost all (94%) used BC/WC in practice. Residents found the tool acceptable and useful to enhance preference-sensitive communications. They felt that the training was valuable and that role play was its greatest strength but that these situations were challenging to simulate. Barriers to BC/WC use included time constraints and difficulty defining the best and worst cases precisely. Summative attitudes and confidence scores were not different before and after the intervention; however, actions scores were higher after the intervention (p = 0.04). Residents performed a median of 15 (interquartile range 13-17) of the 19 elements on the formative performance evaluation. Commonly missed items were narrating outcomes of palliative approaches, prompting deliberation and providing treatment recommendations. CONCLUSION Senior residents found the BC/WC tool to be acceptable and useful, and are amenable to training in this type of communication. After training, self-reported actions scores increased, and observed performance was accurate.
Collapse
Affiliation(s)
- Tyler Chesney
- From the Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Chesney, Devon); Women's College Hospital, Toronto, Ont. (Devon); and the Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Devon)
| | - Karen Devon
- From the Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Chesney, Devon); Women's College Hospital, Toronto, Ont. (Devon); and the Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Devon)
| |
Collapse
|
11
|
|
12
|
Mason MC, Crees AL, Dean MR, Bashir N. Establishing a proactive geriatrician led comprehensive geriatric assessment in older emergency surgery patients: Outcomes of a pilot study. Int J Clin Pract 2018; 72:e13096. [PMID: 29683237 DOI: 10.1111/ijcp.13096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/29/2018] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Increasing numbers of older adults are presenting with acute surgical disease to the unselected general surgical take. General surgeons have little training to manage these patients. We developed a pilot service of proactive geriatrician input into older emergency general surgical patients in a single institution. We wanted to demonstrate if geriatricians improve the management of these patients. METHODS Patients aged 70 years or older admitted acutely under the general surgeons were assessed proactively by a geriatrician using comprehensive geriatric assessment (CGA). Data were collected prospectively using a data collection form of any new issues detected and interventions made by the geriatricians in addition to the surgical plan. This information was entered into an excel database and analysed. RESULTS We obtained data for 447 patients between November 2016 and July 2017. CGA led to additional diagnoses or interventions in 83% of patients. The most common problems identified included a new medical diagnosis (35.2%), polypharmacy (30%), recent falls (19.7%), weight loss (17.2%) and uncontrolled pain (16.7%). Abbreviated mental tests were performed in 87.5% patients, with 22% being detected with cognitive impairment. Frailty screening was performed in 97% of patients resulting in 38% being identified as frail. New interventions included stopping medications (40%), starting medications (28%) and referral to multidisciplinary teams (70.1%). Length of stay was reduced by 0.55 days. CONCLUSION Proactive geriatrician input identifies medical diagnoses and geriatric syndromes missed by the surgical teams. Managing these issues has contributed to a reduced length of stay in these patients.
Collapse
|
13
|
Søreide K, Wijnhoven BPL. Surgery for an ageing population. Br J Surg 2016; 103:e7-9. [DOI: 10.1002/bjs.10071] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 06/11/2015] [Accepted: 10/27/2015] [Indexed: 01/18/2023]
Abstract
The greatest surgical challenge
Collapse
Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, PO Box 8100, Stavanger University Hospital, N-4068 Stavanger, Norway (e-mail: )
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
14
|
Torrance ADW, Powell SL, Griffiths EA. Emergency surgery in the elderly: challenges and solutions. Open Access Emerg Med 2015; 7:55-68. [PMID: 27147891 PMCID: PMC4806808 DOI: 10.2147/oaem.s68324] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Elderly patients frequently present with surgical emergencies to health care providers, and outcomes in this group of patients remain poor. Contributing factors include frailty, preexisting comorbidity, polypharmacy, delayed diagnosis, and lack of timely and consultant-led treatment. In this review, we address common emergency surgical presentations in the elderly and highlight the specific challenges in caring for these patients. We summarize 20 years of reports by various medical bodies that have aimed to improve the care of these patients. To improve morbidity and mortality, several aspects of care need to be addressed. These include accurate and timely preoperative assessment to identify treatable pathology and, where possible, to consider and correct age-specific disease processes. Identification of patients in whom treatment would be futile or associated with high risk is needed to avoid unnecessary interventions and to give patients and carers realistic expectations. The use of multidisciplinary teams to identify common postoperative complications and age-specific syndromes is paramount. Prevention of complications is preferable to rescue treatment due to the high proportion of patients who fail to recover from adverse events. Even with successful surgical treatment, long-term functional decline and increased dependency are common. More research into emergency surgery in the elderly is needed to improve care for this growing group of vulnerable patients.
Collapse
Affiliation(s)
- Andrew D W Torrance
- West Midlands Surgical Research Collaborative, Academic Department of Surgery, University of Birmingham, Queen Elizabeth Hospital, Birmingham, UK
| | - Susan L Powell
- Department of Geriatric Medicine, Heart of England NHS Foundation Trust, Solihull Hospital, Solihull, UK
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
15
|
Eid A, Hughes C, Karuturi M, Reyes C, Yorio J, Holmes H. An interprofessionally developed geriatric oncology curriculum for hematology-oncology fellows. J Geriatr Oncol 2015; 6:165-73. [PMID: 25487037 PMCID: PMC4743749 DOI: 10.1016/j.jgo.2014.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 10/02/2014] [Accepted: 11/20/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Because the cancer population is aging, interprofessional education incorporating geriatric principles is essential to providing adequate training for oncology fellows. We report the targeted needs assessment, content, and evaluation tools for our geriatric oncology curriculum at MD Anderson Cancer Center. METHODS A team comprising a geriatrician, a medical oncologist, an oncology PharmD, an oncology advanced nurse practitioner, and two oncology chief fellows developed the geriatric oncology curriculum. First, a general needs assessment was conducted by reviewing the literature and medical societies' publications and by consulting experts. A targeted needs assessment was then conducted by reviewing the fellows' evaluations of the geriatric oncology rotation and by interviewing fellows and recently graduated oncology faculty. RESULTS Geriatric assessment, pharmacology, and psychosocial knowledge skills were the three identified areas of educational need. Curriculum objectives and an evaluation checklist were developed to evaluate learners in the three identified areas. The checklist content was validated by consulting experts in the field. Online materials, including a curriculum, a geriatric pharmacology job aid, and pharmacology cases, were also developed and delivered as part of the curriculum. CONCLUSION An interprofessional team approach was a successful method for identifying areas of learners' educational needs, which in turn helped us develop an integrated geriatric oncology curriculum. The curriculum is currently being piloted and evaluated.
Collapse
Affiliation(s)
- Ahmed Eid
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Caren Hughes
- Department of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Meghan Karuturi
- Hematology Oncology Fellowship Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Connie Reyes
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jeffrey Yorio
- Hematology Oncology Fellowship Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Holly Holmes
- Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|