1
|
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
|
2
|
Ouellet GM, Kiwak E, Costello DM, Green AR, Geda M, Naik AD, Tinetti ME. Clinician Perspectives on Incorporating Patients' Values-Based Health Priorities in Decision-Making. J Am Geriatr Soc 2020; 69:267-269. [PMID: 33165913 DOI: 10.1111/jgs.16914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/06/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Gregory M Ouellet
- Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Eliza Kiwak
- Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Darcé M Costello
- Program on Aging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ariel R Green
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary Geda
- Program on Aging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Aanand D Naik
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Department of Medicine (Health Services Research and Geriatrics), Baylor College of Medicine, Houston, Texas, USA
| | - Mary E Tinetti
- Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
3
|
Gabbard J, Pajewski NM, Callahan KE, Dharod A, Foley K, Ferris K, Moses A, Grey C, Williamson J. Advance care planning for vulnerable older adults within an Accountable Care Organization: study protocol for the IMPACT randomised controlled trial. BMJ Open 2019; 9:e032732. [PMID: 31843844 PMCID: PMC6924763 DOI: 10.1136/bmjopen-2019-032732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Patients with multimorbidity plus additional impairments (eg, mobility limitations, disability, cognitive impairments or frailty) are at the highest risk for poor healthcare outcomes. Advanced care planning (ACP) provides patients and their surrogates the opportunity to discuss their goals, values and priorities for healthcare-particularly in the context of end-of-life care. ACP discussions promote more person-centred care; however, it is currently underused. There is a tremendous need for systematic, scalable approaches to individualised ACP that promotes patient and family engagement. Here we describe the study protocol for a randomised effectiveness trial of a nurse navigator and informatics intervention designed to improve the documentation and quality of ACP discussions. METHODS AND ANALYSIS This is a randomised, pragmatic, effectiveness trial; patients aged 65 years and older who have multimorbidity plus impairments in either physical function (eg, mobility limitations or disability) or cognition, and/or frailty within an affiliated Accountable Care Organization were eligible. The electronic health record was used to develop an automatic prescreening system for eligible patients (n=765) and participants were randomised in a 1:1 ratio to either the nurse navigator-led ACP pathway or usual care. Our primary outcomes are documentation of ACP discussions within the EHR along with the quality of ACP discussions. Secondary outcomes include a broad range of ACP actions (eg, usage of ACP billing codes, choosing a surrogate decision-maker and advance directive documentation). Outcomes will be measured over 12 months of follow-up. ETHICS AND DISSEMINATION This study has been approved by the appropriate Institutional Review Boards and is guided by input from patient and clinical advisory boards. The results of this study will inform a scalable solution to ACP discussions throughout our healthcare system and statewide. TRIALS REGISTRATION NUMBER NCT03609658.
Collapse
Affiliation(s)
- Jennifer Gabbard
- Department of Internal Medicine, Section of Gerontology & Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - N M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kathryn E Callahan
- Department of Internal Medicine, Section of Gerontology & Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kristie Foley
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Keren Ferris
- Department of Internal Medicine,Section of Gerontology & Geriatric Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Adam Moses
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Carl Grey
- Department of Internal Medicine, Section of Gerontology & Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jeff Williamson
- Department of Internal Medicine, Section of Gerontology & Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
4
|
Blankenburg R, Hilton JF, Yuan P, Rennke S, Monash B, Harman SM, Sakai DS, Hosamani P, Khan A, Chua I, Huynh E, Shieh L, Xie L. Shared Decision-Making During Inpatient Rounds: Opportunities for Improvement in Patient Engagement and Communication. J Hosp Med 2018; 13:453-461. [PMID: 29401211 PMCID: PMC6392000 DOI: 10.12788/jhm.2909] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Shared decision-making (SDM) improves patient engagement and may improve outpatient health outcomes. Little is known about inpatient SDM. OBJECTIVE To assess overall quality, provider behaviors, and contextual predictors of SDM during inpatient rounds on medicine and pediatrics hospitalist services. DESIGN A 12-week, cross-sectional, single-blinded observational study of team SDM behaviors during rounds, followed by semistructured patient interviews. SETTING Two large quaternary care academic medical centers. PARTICIPANTS Thirty-five inpatient teams (18 medicine, 17 pediatrics) and 254 unique patient encounters (117 medicine, 137 pediatrics). INTERVENTION Observational study. MEASUREMENTS We used a 9-item Rochester Participatory Decision-Making Scale (RPAD) measured team-level SDM behaviors. Same-day interviews using a modified RPAD assessed patient perceptions of SDM. RESULTS Characteristics associated with increased SDM in the multivariate analysis included the following: service, patient gender, timing of rounds during patient's hospital stay, and amount of time rounding per patient (P < .05). The most frequently observed behaviors across all services included explaining the clinical issue and matching medical language to the patient's level of understanding. The least frequently observed behaviors included checking understanding of the patient's point of view, examining barriers to follow-through, and asking if the patient has any questions. Patients and guardians had substantially higher ratings for SDM quality compared to peer observers (7.2 vs 4.4 out of 9). CONCLUSIONS Important opportunities exist to improve inpatient SDM. Team size, number of learners, patient census, and type of decision being made did not affect SDM, suggesting that even large, busy services can perform SDM if properly trained.
Collapse
Affiliation(s)
- Rebecca Blankenburg
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA.
| | - Joan F Hilton
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Patrick Yuan
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Stephanie Rennke
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brad Monash
- Division of Hospital Medicine, Department of Medicine, and Division of Hospital Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Stephanie M Harman
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Debbie S Sakai
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
| | - Poonam Hosamani
- Division of Hospital Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Adeena Khan
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ian Chua
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
- Division of Hospital Medicine, Department of Pediatrics, Children's National Medical Center, Washington, DC, USA
| | - Eric Huynh
- Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Lisa Shieh
- Division of Hospital Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Lijia Xie
- Medicine Residency Program, Department of Medicine, Stanford School of Medicine, USA
| |
Collapse
|
5
|
The Case for Dual Training in Geriatric Medicine and Palliative Care: The Time is Now. Am J Hosp Palliat Care 2017; 35:364-370. [DOI: 10.1177/1049909117696251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The majority of older adults die from chronic illnesses which are preceded by years of progressive decline and increasing symptom burden. Delivery of high-quality care cannot take place without sufficient numbers of health professionals with appropriate training and skills in both geriatric and palliative care medicine. Despite the surge in aging population and the majority of deaths being attributed to patients with multiple comorbidities, very few health-care providers undergo dual training in these areas. Thus, the nation is facing a health-care crisis as the number of geriatric patients with chronic disease increasingly outpaces the number of physicians with adequate skills to manage them. Joint training in palliative care and geriatric medicine could prepare physicians to better manage our aging population by addressing all their health-care needs irrespective of their stage of disease emphasizing patient-directed care.
Collapse
|