1
|
Picella DV, Woods DL. Development of the Gerontological Nursing Competency Questionnaire. Nurs Educ Perspect 2024; 45:E16-E21. [PMID: 38497786 DOI: 10.1097/01.nep.0000000000001254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
AIM The aim of this study was to develop an instrument to measure competencies of gerontological nursing faculty. BACKGROUND There is no accepted instrument to assess competencies of gerontological nursing faculty. METHOD To develop the Gerontological Nursing Competency Questionnaire (GNCQ), we used a modified Delphi technique focused on consensus building among experts from the National Hartford Center for Gerontological Nursing Excellence. The 25-item GNCQ measures confidence in knowledge, confidence in teaching, and interest in further training in gerontological nursing. The instrument was piloted in a large nursing department at a university in southern California. RESULTS Low faculty competencies in knowledge and teaching and low interest in further training were observed. CONCLUSION The GNCQ demonstrated initial content validity and an ability to identify key areas of deficiency in knowledge and teaching among nursing faculty. It may be used for improvement initiatives in gerontological nursing programs.
Collapse
Affiliation(s)
- David Vincent Picella
- About the Authors David Vincent Picella, PhD, FNP, CNS, GS-C, CPG, is an assistant professor at Azusa Pacific University School of Nursing, Azusa, California. Diana Lynn Woods, PhD, RN, FAAN, FGSA, is a professor at Azusa Pacific University School of Nursing. For more information, contact Dr. Picella at
| | | |
Collapse
|
2
|
Thillainadesan J, Naganathan V, Hilmer SN, Kerdic R, Aitken SJ. Microlearning for surgical residents enhances perioperative comprehensive geriatric assessment. J Am Geriatr Soc 2023; 71:E30-E33. [PMID: 37776048 PMCID: PMC10952399 DOI: 10.1111/jgs.18612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Janani Thillainadesan
- Department of Geriatric MedicineConcord HospitalConcord, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
- Centre for Education and Research on AgeingConcord HospitalSydneyNew South WalesAustralia
| | - Vasi Naganathan
- Department of Geriatric MedicineConcord HospitalConcord, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
- Centre for Education and Research on AgeingConcord HospitalSydneyNew South WalesAustralia
| | - Sarah N. Hilmer
- Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
- Kolling Institute of Medical ResearchThe University of Sydney and Northern Sydney Local Health DistrictSt Leonards, SydneyNew South WalesAustralia
| | - Richard Kerdic
- Department of Vascular SurgeryConcord HospitalConcord, SydneyNew South WalesAustralia
| | - Sarah J. Aitken
- Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
- Department of Vascular SurgeryConcord HospitalConcord, SydneyNew South WalesAustralia
- Concord Institute of Academic SurgeryConcord HospitalConcord, SydneyNew South WalesAustralia
| |
Collapse
|
3
|
Amirfarzan H, Azocar RJ, Shapeton AD. "The Big Three" of geriatrics: A review of perioperative cognitive impairment, frailty and malnutrition. Saudi J Anaesth 2023; 17:509-516. [PMID: 37779565 PMCID: PMC10540988 DOI: 10.4103/sja.sja_532_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 10/03/2023] Open
Abstract
Cognitive impairment, frailty, and malnutrition are three of the most impactful pathologies facing an aging population, having dramatic effects on morbidity and mortality across nearly all facets of medical care and intervention. By 2050, the World Health Organization estimates that the population of individuals over the age of sixty worldwide will nearly double, and the public health toll of these demographic changes cannot be understated. With these changing demographics comes a need for a sharpened focus on the care and management of this vulnerable population. The average patient presenting for surgery is getting older, and this necessitates that clinicians understand the implications of these pathologies for both their immediate medical care needs and for appropriate procedural selection and prognostication of surgical outcomes. We believe it is incumbent on clinicians to consider the frailty, nutritional status, and cognitive function of each individual patient when offering a surgical intervention, as well as consider interventions that may delay the progression of these pathologies. Unfortunately, despite excellent evidence supporting things like routine pre-operative frailty screening and nutritional optimization, many interventions that would specifically benefit this population still have not been integrated into routine practice. In this review, we will synthesize the existing literature on these topics to provide a pragmatic approach and understanding for anesthesiologists and intensivists faced with this complex population.
Collapse
Affiliation(s)
- Houman Amirfarzan
- Department of Anesthesia, Critical Care and Pain Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Ruben J. Azocar
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alexander D. Shapeton
- Department of Anesthesia, Critical Care and Pain Medicine, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
4
|
Burrell A, Goldszmidt M. Talking About Notes: Using a Design-Based Research Approach to Develop a Discharge Summary Template on a Geriatric Inpatient Unit. Can Geriatr J 2023; 26:326-338. [PMID: 37662060 PMCID: PMC10444522 DOI: 10.5770/cgj.26.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Background Discharge summaries are important educational tools, guiding trainees in their collection and documentation of data. As geriatric competencies are integrated in medical curricula, documentation on in-patient geriatric rotations should represent the unique care and education provided, yet often follow generic templates. What content should be included in a geriatric discharge summary has not previously been explored and was the purpose of this study. Methods A mixed-methods, designed-based research approach was used to assess note quality on a geriatric in-patient unit and iteratively co-develop a template with examples through three phases: 1) needs assessment, 2) consensus building, and 3) template development. Results Sixty-eight discharge summaries were assessed by five geriatricians, with 14 gaps identified. Many of these reflected elements that were present but addressed generically without attention to the specificity required from a geriatric perspective. In response, the team developed a geriatric-specific template with explicit examples. Through the consensus process three barriers to quality notes and trainee education were identified: the chronic state of low-quality notes being accepted as the norm, time limitations due to the high volume of patients, and high volume of clinical documents. Conclusions The identification of gaps in geriatric discharge summaries allowed for the co-development of an instructional template and examples that goes beyond simple headings and highlights the importance of applying and documenting geriatric competencies. Although we encourage others to take up and modify the tools for trainees in their local context, more importantly, we encourage them to take up the dialogue about note quality.
Collapse
Affiliation(s)
- Alishya Burrell
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London
| | - Mark Goldszmidt
- Division of General Internal Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| |
Collapse
|
5
|
Correia RH, Dash D, Hogeveen S, Woo T, Kay K, Costa AP, Siu HYH. Applicant and Match Trends to Geriatric-Focused Postgraduate Medical Training in Canada: A Descriptive Analysis. Can J Aging 2023; 42:396-403. [PMID: 37066844 DOI: 10.1017/s071498082200054x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Physicians with postgraduate training in caring for older adults-geriatricians, geriatric psychiatrists, and Care of the Elderly family physicians (FM-COE)-have expertise in managing complex care needs. Deficits in the geriatric-focused physician workforce coupled with the aging demographic necessitate an increase in training and clinical positions. Descriptive analyses of data from established matching systems have not occurred to understand the preferences and outcomes of applicants to geriatric-focused postgraduate training. This study describes applicant and match trends for geriatric-focused postgraduate training in Canada. In this retrospective cohort study, data from the Canadian Resident Matching Service and FM-COE program directors were analysed to examine program quotas, applicants' preferences, and match outcomes by medical school and over time. Based on their first-choice specialty ranking, applicants to geriatric medicine and FM-COE signalled a preference to pursue these programs and tended to match successfully. The proportion of unfilled training positions has increased in recent years, and the number of applicants has not increased consistently over time. There is a disparity between applicants to geriatric-focused training and the health human resources to meet population-level needs. Garnering interest among medical trainees is essential to address access and equity gaps.
Collapse
Affiliation(s)
- Rebecca H Correia
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus, Kitchener, ON, Canada
| | - Darly Dash
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus, Kitchener, ON, Canada
| | - Sophie Hogeveen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Tricia Woo
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kelly Kay
- Provincial Geriatrics Leadership Ontario, Kingston, ON, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Waterloo Regional Campus, Kitchener, ON, Canada
| | - Henry Yu-Hin Siu
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
6
|
Loewenthal J, Beltran CP, Schwartz AW, Ramani S. An age-friendly residency: Geriatrician and internist perspectives on geriatric education in an internal medicine residency. J Am Geriatr Soc 2023. [PMID: 36947742 DOI: 10.1111/jgs.18315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/25/2023] [Accepted: 02/23/2023] [Indexed: 03/24/2023]
Abstract
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.
Collapse
Affiliation(s)
- Julia Loewenthal
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christine P Beltran
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Andrea Wershof Schwartz
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- New England Geriatrics Research Education and Clinical Center, Veterans Boston Healthcare System, Boston, Massachusetts, USA
| | - Subha Ramani
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Jo A, Dai M, Peterson L, Mainous III AG. Trends of Geriatric Certification and Practice Patterns of Family Physicians: 1988-2019. Fam Med 2023; 55:95-102. [PMID: 36787517 PMCID: PMC10614548 DOI: 10.22454/fammed.2023.917437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Demand for geriatric care is increasing due to aging population. Trends in maintaining certification in geriatrics are unreported. Our objective was to describe the historic trend of family physicians who certified in geriatric medicine (FPs-GM) since 1988 and to assess differences in practice patterns between FPs-GM and family physicians (FPs). METHODS We performed a retrospective descriptive study using administrative data collected by the American Board of Family Medicine (ABFM). The study population was family physicians registering to continue their ABFM certification from 2017 to 2019. Medicare public use billing data was linked to ABFM administrative data on certification history. We used univariate analysis for descriptive analysis and logistic regression to identify contributors of recertification in geriatrics. RESULTS We identified a total of 3,207 FPs-GM between 1988 and 2019. More than half maintained GM certification since 2009 (57%), with male gender, White race, and urban practice associated with maintaining GM certification; 61% of their patients were older adults. FPs-GM were more likely to be in an academic practice setting with nearly half (53%) also practicing in hospitals or nursing homes. In the adjusted regression model, younger FPs or FPs who treat more older patients were significantly more likely to be recertified in geriatrics whereas other demographics and practice characteristics were not significant. CONCLUSIONS Most FPs who recently earned GM certification tended to retain certification since the required accredited fellowship started in 1995.
Collapse
Affiliation(s)
- Ara Jo
- Department of Health Services Research, Management and Policy, University of FloridaGainesville, FL
| | | | | | - Arch G. Mainous III
- Department of Health Services Research, Management and Policy, University of FloridaGainesville, FL
- Department of Community Health and Family Medicine, University of FloridaGainesville, FL
| |
Collapse
|
8
|
Goldlist K, Beltran CP, Rhodes‐Kropf J, Sullivan AM, Schwartz AW. Out of the classroom, into the home: Medical and dental students' lessons learned from a Geriatrics home visit. J Am Geriatr Soc 2022; 70:2659-2665. [DOI: 10.1111/jgs.17968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/20/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Kady Goldlist
- Quimby Center for Geriatric Care Mount Auburn Hospital Cambridge Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| | - Christine P. Beltran
- Shapiro Institute for Education and Research Beth Israel Deaconess Medical Center (BIDMC) Boston Massachusetts USA
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine NYU Grossman School of Medicine New York NY USA
| | - Jennifer Rhodes‐Kropf
- Harvard Medical School Boston Massachusetts USA
- Shapiro Institute for Education and Research Beth Israel Deaconess Medical Center (BIDMC) Boston Massachusetts USA
- Hebrew SeniorLife Boston Massachusetts USA
| | - Amy M. Sullivan
- Harvard Medical School Boston Massachusetts USA
- Shapiro Institute for Education and Research Beth Israel Deaconess Medical Center (BIDMC) Boston Massachusetts USA
| | - Andrea Wershof Schwartz
- Harvard Medical School Boston Massachusetts USA
- New England Geriatrics Research Education and Clinical Center VA Boston Healthcare System Boston Massachusetts USA
- Division of Aging Brigham and Women's Hospital Boston Massachusetts USA
| |
Collapse
|
9
|
Cheung K, Tamura P, Malik Z, Lin J, Cyrus J, Alexander C, Hobgood S. Barriers and motivators to specializing in geriatrics and strategies for recruitment: scoping review. GERONTOLOGY & GERIATRICS EDUCATION 2022:1-17. [PMID: 35603812 DOI: 10.1080/02701960.2022.2078814] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
While the barriers to specializing in geriatrics are known, motivators behind why medical trainees choose geriatrics are not as well understood. It is also unknown if recruitment strategies in the literature address these barriers and motivators. The aim of this systematic scoping review is to examine the current literature on recruitment strategies alongside motivators and barriers for specializing in geriatrics. Eligible articles for this scoping review either focused on motivators or barriers among trainees (medical students, resident-physicians, fellows) or recruitment strategies. A scoping search was conducted in MEDLINE, Embase, CINAHL, and PsychINFO. Data was extracted on article characteristics and themes. 88 of 2064 articles were eligible and included. Personal fulfillment emerged as the most common theme for motivators, contrary to prior studies that cite positive role modeling. Financial disincentive remained the most common barrier, followed by limited exposure and "futile" practice. Promising interventions beyond financial compensation include defining geriatrics better, emphasizing the high job satisfaction rates, increasing clinical exposure for medical students, and additional funding for academic centers to recruit academic geriatricians. Policymakers and medical educators should consider multiple strategies that target the motivators, as well as the barriers to pursuing geriatrics.
Collapse
Affiliation(s)
- Kelly Cheung
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, US
| | - Peter Tamura
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, US
| | - Zeeshan Malik
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, US
| | - Jason Lin
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, US
| | - John Cyrus
- Department of Research and Education, Virginia Commonwealth University, Richmond, Virginia, US
| | - Chuck Alexander
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, US
| | - Sarah Hobgood
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia, US
| |
Collapse
|
10
|
Kramer BJ, Weintraub NT, Richter-Lagha RA. Infusing geriatrics in Indian Health Service general primary care clinics: extending VA workforce development training. GERONTOLOGY & GERIATRICS EDUCATION 2022:1-10. [PMID: 35377832 DOI: 10.1080/02701960.2022.2056735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
As federal partners, the Veterans Health Administration (VA) and the Indian Health Service (IHS) agreed to share resources, such as education. The VA Geriatric Scholars Program, a workforce development program, provides one of its training programs on team-based primary care of elders to clinicians working in IHS and Tribal Health Programs. The practical impact of that training is described. A mixed methods approach was applied to the course's evaluation survey at five clinics in the Northwestern Plains, Southwest, Pacific Coast, and Alaska. Quantitative approaches assessed participants' self-reported intention to improve recognition and assessment of common geriatric syndromes. A qualitative approach applied to open-ended text responses revealed intensions to improve team-based care. Among the 51 respondents in our sample, we found significant improvements in self-reported ability to recognize previously unfamiliar potential risks to elders' health and safety, t(49) = 8.0233, p < .001, as well as increased comfort with conducting geriatric assessments and increased confidence in interprofessional team-based communication. Improvements to team-based care included enhanced clinical skills, organizational factors and the need to train additional employees. This evaluation demonstrates the value of sharing resources among federal partners and its value for participants in IHS and Tribal Health Programs.
Collapse
Affiliation(s)
- B Josea Kramer
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, North Hills, USA
- David Geffen School of Medicine, University of California at Los Angeles, Division of Geriatric Medicine, Los Angeles, USA
| | - Nancy T Weintraub
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, North Hills, USA
- David Geffen School of Medicine, University of California at Los Angeles, Division of Geriatric Medicine, Los Angeles, USA
| | - Regina A Richter-Lagha
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, Clinical Center, North Hills, USA
| |
Collapse
|
11
|
Solberg LM, Sehgal M, Patel P, Akers KG, Pomputius A, Schwartz AW, Scheiner SR, Small A, Hidlebaugh E, Johnson TM, Vaughan CP. Updating the landmark literature for the practice of geriatrics: Notable articles from 2012-2019. J Am Geriatr Soc 2022; 70:872-879. [PMID: 35080010 DOI: 10.1111/jgs.17661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/09/2021] [Accepted: 12/31/2021] [Indexed: 09/15/2023]
Abstract
BACKGROUND Remaining current on the latest advances in the peer-reviewed literature is a basic tenant of medical education and evidence-based practice. We updated an important prior publication (Vaughan, et al.) identifying landmark articles in geriatric medicine by considering the influence of altmetrics and updating the list with notable articles published between 2012 and 2019. METHODS Articles were identified by searching Web of Science and Scopus for highly cited articles clinically relevant to geriatrics or gerontology and by searching the Altmetric Explorer database for relevant articles with high altmetric scores. The results of the literature search were screened and evaluated using a bibliometric score consisting of an adjusted journal impact factor, citation count, and altmetric score. RESULTS The top 12 notable articles in geriatrics were selected by a consensus panel and ranked using an expert opinion survey. This process reinforces the concept of combining subjective and objective measures to identify notable articles to be used for the education of healthcare professionals in geriatrics principles of care for older adults. CONCLUSIONS While our update was performed approximately 9 years after the initial identification of landmark articles, we propose that future updates are conducted at an interval of every 5 years by the governance of a national professional society.
Collapse
Affiliation(s)
- Laurence M Solberg
- North Florida/South Georgia Veterans Health Service, Geriatrics Research, Education, and Clinical Center (GRECC), Gainesville, Florida, USA
- University of Florida College of Nursing, Gainesville, Florida, USA
| | - Mandi Sehgal
- Center for Population Health, Division of Geriatric Medicine, Department of Medicine, Cleveland Clinic Florida, Weston, Florida, USA
| | - Pragnesh Patel
- Division of Geriatric Medicine, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Katherine G Akers
- Shiffman Medical Library, Wayne State University, Detroit, Michigan, USA
| | - Ariel Pomputius
- Health Science Center Libraries, University of Florida, Gainesville, Florida, USA
| | - Andrea Wershof Schwartz
- New England Veterans Health Service, Harvard Medical School Boston Massachusetts, Boston, Massachusetts, USA
| | | | - Alexander Small
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Elizabeth Hidlebaugh
- Department of Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University PGY-3 Internal Medicine Resident, Boca Raton, Florida, USA
| | - Theodore M Johnson
- Birmingham/Atlanta VA Geriatrics Research, Education, and Clinical Center (GRECC), Atlanta VA Health System, Brookhaven, Georgia, USA
- Division of General Internal Medicine, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| | - Camille P Vaughan
- Birmingham/Atlanta VA Geriatrics Research, Education, and Clinical Center (GRECC), Atlanta VA Health System, Brookhaven, Georgia, USA
- Division of Geriatrics and Gerontology, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
12
|
Levine JM. Ars longa: its meaning and context. J Am Geriatr Soc 2022. [PMID: 35049065 DOI: 10.1111/jgs.17668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/21/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jeffrey M Levine
- Department of Geriatric Medicine and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
13
|
Chopra S, Solomon P, Goldhirsch SL, Fernandez H, Cummings K. Geriatrics fellowship during COVID-19: expanding impact, using innovation and maintaining balance. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:55-63. [PMID: 34636287 DOI: 10.1080/02701960.2021.1968855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The COVID-19 pandemic provided an opportunity for geriatricians, especially geriatrics fellows, to demonstrate leadership in a crisis that has significantly affected the 65 and older demographic. Given their expertise in care delivery to complex, multimorbid patients, as well as their ability to navigate different healthcare settings, geriatrics fellows became a valuable resource during the pandemic, particularly at one large, urban academic health system. Their training in patient-centered, value-based care helped determine the best course of action for patients not only in the hospital, but also in the community. Utilizing innovative strategies such as a newly developed Palliative Care Hotline (PATCH-24 line), telehealth, and community paramedicine, fellows delivered services to complex patients in community settings. In addition to providing direct patient care, geriatrics fellows also taught their skills to frontline physicians of other specialties. Strong support from the fellowship program's leadership, as well as an ongoing focus on clinician wellbeing and resilience, have been central factors in the success of geriatrics fellows during the COVID-19 crisis.
Collapse
Affiliation(s)
- Shivani Chopra
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York
| | - Philip Solomon
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Suzanne L Goldhirsch
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York
| | - Helen Fernandez
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York
| | - Kelly Cummings
- Department of Medicine, Weill Cornell Medicine, Division of Geriatrics and Palliative Medicine, New York, New York
| |
Collapse
|
14
|
Jurivich D, Schimke C, Snustad D, Floura M, Morton C, Waind M, Holloway J, Janssen S, Danks M, Semmens K, Manocha GD. A New Interprofessional Community-Service Learning Program, HATS (Health Ambassador Teams for Seniors) to Improve Older Adults Attitudes about Telehealth and Functionality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910082. [PMID: 34639383 PMCID: PMC8507953 DOI: 10.3390/ijerph181910082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022]
Abstract
Senior population health often is underrepresented in curricula for medical and allied health students. Furthermore, entrenched and dense curricular schedules preclude interprofessional teams from clinical experiences related to senior population health. Community service learning potentially offers the opportunity to engage interprofessional students with a panel of older adults to assess health promotion metrics over time. To test this educational concept, we created Health Ambassador Teams for Seniors, also known as HATS. Utilizing a telehealth platform, interprofessional student teams were tasked with older adult wellness promotion. The annual Medicare wellness exam served as a template for patient encounters which was enhanced with key elements of geriatric assessment such as gait and balance, cognition, and functional evaluations. The objective was to have dyads of interprofessional students conduct telehealth visits and gather healthcare data to be used for serial patient encounters and track functional trajectories over time. As a proof of concept, pilot telehealth encounters with medical, physical therapy, nursing and occupational therapy students revealed that data on older adult functional performances such as gait speed, Timed Up and Go test (TUG), and Mini-Cog test could be acquired through telehealth. Equally importantly, trainees received diverse feedback from faculty, peers and volunteer patients. A Research Electronic Data Capture (REDCap) data repository allows trainees to track patient trends relative to their health promotion recommendations as well as handoff their patient panel to the next set of trainees. The HATS program promises to strengthen the Geriatric Workforce, especially with senior population health.
Collapse
Affiliation(s)
- Donald Jurivich
- Department of Geriatrics, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA; (C.S.); (D.S.); (M.F.); (C.M.); (M.W.); (J.H.); (G.D.M.)
- Correspondence:
| | - Carter Schimke
- Department of Geriatrics, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA; (C.S.); (D.S.); (M.F.); (C.M.); (M.W.); (J.H.); (G.D.M.)
| | - Dakota Snustad
- Department of Geriatrics, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA; (C.S.); (D.S.); (M.F.); (C.M.); (M.W.); (J.H.); (G.D.M.)
| | - Mitchell Floura
- Department of Geriatrics, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA; (C.S.); (D.S.); (M.F.); (C.M.); (M.W.); (J.H.); (G.D.M.)
| | - Casey Morton
- Department of Geriatrics, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA; (C.S.); (D.S.); (M.F.); (C.M.); (M.W.); (J.H.); (G.D.M.)
| | - Marsha Waind
- Department of Geriatrics, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA; (C.S.); (D.S.); (M.F.); (C.M.); (M.W.); (J.H.); (G.D.M.)
| | - Jeremy Holloway
- Department of Geriatrics, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA; (C.S.); (D.S.); (M.F.); (C.M.); (M.W.); (J.H.); (G.D.M.)
| | - Sclinda Janssen
- Department of Occupational Therapy, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA;
| | - Meridee Danks
- Department of Physical Therapy, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA;
| | - Karen Semmens
- Department of Nursing, College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, ND 58202, USA;
| | - Gunjan Dhawan Manocha
- Department of Geriatrics, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA; (C.S.); (D.S.); (M.F.); (C.M.); (M.W.); (J.H.); (G.D.M.)
| |
Collapse
|
15
|
Ho VP, Adams SD, O'Connell KM, Cocanour CS, Arbabi S, Powelson EB, Cooper Z, Stein DM. Making your geriatric and palliative programs a strength: TQIP guideline implementation and the VRC perspective. Trauma Surg Acute Care Open 2021; 6:e000677. [PMID: 34337156 PMCID: PMC8286789 DOI: 10.1136/tsaco-2021-000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/05/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Older patients compose approximately 30% of trauma patients treated in the USA but make up nearly 50% of deaths from trauma. To help standardize and elevate care of these patients, the American College of Surgeons (ACS) Trauma Quality Improvement Program's best practice guidelines for geriatric trauma management was published in 2013 and that for palliative care was published in 2017. Here, we discuss how palliative care and geriatrics quality metrics can be tracked and used for performance improvement and leveraged as a strength for trauma verification. METHODS We discuss the viewpoint of the ACS Verification, Review, and Consultation and three case studies, with practical tips and takeaways, of how these measures have been implemented at different institutions. RESULTS We describe the use of (1) targeted educational initiatives, (2) development of a consultation tool based on institutional resources, and (3) application of a nurse-led frailty screen. DISCUSSION Specialized care and attention to these vulnerable populations is recommended, but the implementation of these programs can take many shapes.Level of evidence V.
Collapse
Affiliation(s)
- Vanessa P Ho
- Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Sasha D Adams
- Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | | | | | - Saman Arbabi
- Surgery, University of Washington, Seattle, Washington, USA
| | - Elisabeth B Powelson
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Zara Cooper
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Deborah M Stein
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
16
|
Ramaswamy R, Shah AA, Denson KM, Sehgal M, Syed Q, Powers BB, Schwartz AW, Leipzig RM, Gleason LJ. Teaching geriatrics during the COVID-19 pandemic: Aquifer Geriatrics to the rescue. J Am Geriatr Soc 2021; 69:1740-1742. [PMID: 33834476 PMCID: PMC8250526 DOI: 10.1111/jgs.17169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ravishankar Ramaswamy
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amit A Shah
- Division of Community Internal Medicine, Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA
| | - Kathryn M Denson
- Division of Geriatric and Palliative Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mandi Sehgal
- Section of Geriatric Medicine, Division of Population Health, Cleveland Clinic Florida, Weston, Florida, USA
| | - Quratulain Syed
- Primary Care Internal Medicine, JenCare Senior Medical Center, Atlanta, Georgia, USA
| | - Becky B Powers
- Geriatric Research Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Andrea Wershof Schwartz
- Division of Geriatrics & Palliative Care, New England Geriatric Research Education and Clinical Center, Veteran Affairs Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Rosanne M Leipzig
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren J Gleason
- Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| |
Collapse
|
17
|
McNabney MK, Suh TT, Sellers V, Wilner D. Aligning geriatric medicine fellowships with the Program of All-Inclusive Care for the Elderly (PACE). GERONTOLOGY & GERIATRICS EDUCATION 2021; 42:2-12. [PMID: 30558514 DOI: 10.1080/02701960.2018.1532891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Geriatric medicine fellowship programs provide comprehensive training to one-year clinical fellows and must demonstrate successful progression of competence among fellows by reporting on 23 milestones to the Accreditation Council for Graduate Medical Education (ACGME). The Program of All-inclusive Care for the Elderly (PACE) is a model of care located throughout the United States and can serve as a training venue for fellows. We surveyed 113 fellowship program directors with a response rate of 42% (n = 48). The purpose of the survey was to assess: (1) familiarity and access to PACE and (2) perceived value of PACE to the fellowship program with regard to training and ability to achieve success in the 23 reporting milestones. Milestones involving communication and team management skills were most consistently identified as very valuable with a PACE clinical rotation. We then convened a focus group of four PACE medical directors who developed a fellowship curriculum for use in training fellows at PACE. We discuss the limitations of our design as well as the opportunities to build on the strengths of that model as a training site for fellows.
Collapse
Affiliation(s)
- Matthew K McNabney
- Hopkins ElderPlus
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University
| | - Theodore T Suh
- Turner Geriatric Clinic at East Ann Arbor
- Department of Medicine, University of Michigan and the Geriatric Research, Education and Clinical Center, Ann Arbor VA Medical Center
| | - Verna Sellers
- Geriatric Services and Program of All-Inclusive Care for the Elderly, Centra Health
| | - David Wilner
- Capstone Performance Systems
- University of Massachusetts Medical School
| |
Collapse
|
18
|
Donoghue OA, O'Shea M, McGarrigle CA, Lang D, Hoey C, Whitty H, O'Shea D, Kenny RA. Translating Frailty Assessment Methodologies and Research-based Evidence to Clinical Education and Practice. J Aging Soc Policy 2020; 34:537-551. [PMID: 32634336 DOI: 10.1080/08959420.2020.1777825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Frailty is a common clinical syndrome that predisposes older adults to an increased risk of adverse health outcomes. With population aging, this will become an increasing challenge for the healthcare services; therefore, different models of healthcare training and provision are required to address these increasing demands. In Ireland, the National Clinical Programme for Older People (NCPOP) has partnered with The Irish Longitudinal Study on Ageing (TILDA) to deliver the National Frailty Education Programme. This demonstrates an innovative way in which evidence-based longitudinal research can be translated into clinical education and practice to improve patient care, following a Knowledge to Action (KTA) process. To the authors' knowledge, it is the first time that a longitudinal research study such as TILDA has employed such methods of translation and therefore, this collaboration could serve as an international model of translation and implementation for frailty and other areas of clinical priority.
Collapse
Affiliation(s)
- Orna A Donoghue
- Project Manager, The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
| | - Mary O'Shea
- Research Nurse Manager, The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
| | - Christine A McGarrigle
- Senior Research Fellow, The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
| | - Deirdre Lang
- Director of Nursing, National Clinical Programme for Older People, Health Service Executive, Dublin, Ireland
| | - Carmel Hoey
- HSE Service Planner, National Clinical Programme for Older People, Health Service Executive, Dublin, Ireland
| | - Helen Whitty
- Programme Manager, National Clinical Programme for Older People, Health Service Executive, Dublin, Ireland.,Programme Manager, National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Diarmuid O'Shea
- Clinical Lead, National Clinical Programme for Older People, Health Service Executive, Dublin, Ireland.,Consultant Geriatrician, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Rose Anne Kenny
- Principal Investigator, The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland.,Director, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| |
Collapse
|
19
|
Schwartz AW, Hawley CE, Strong JV, Phillips SC, Amir O, Ludwin BM, Ngoc Phung ET, Moye J. A Workshop for Interprofessional Trainees Using the Geriatrics 5Ms Framework. J Am Geriatr Soc 2020; 68:1857-1863. [PMID: 32557568 DOI: 10.1111/jgs.16574] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Interprofessional trainees need geriatrics training to prepare them to care for our aging population. Team-based care will help them be ready to work in an Age-Friendly Health System. The Geriatrics 5Ms provides a framework to engage learners in five main domains of caring for older adults from an interprofessional perspective: Mobility, Mind, Medications, Multicomplexity, and what Matters Most. DESIGN We created a half-day workshop for interprofessional trainees using the Geriatric 5Ms framework to increase their preparedness in caring for older adults as part of an interprofessional team. SETTING The New England Geriatric Research Education and Clinical Center. PARTICIPANTS A total of 66 trainees from 10 professions. INTERVENTION After introductory sessions on careers in aging, participants engaged in an interactive session to learn about the professions represented. They then formed interprofessional groups to discuss a patient case using the Geriatrics 5Ms framework with a modified jigsaw format. MEASUREMENTS Trainees were surveyed before and after the workshop on their attitudes toward careers in aging, understanding of skills and training paths of other professions, and familiarity with the Geriatrics 5Ms framework. RESULTS Overall, 97% of the trainees rated the workshop highly. Trainee ratings significantly increased in the areas of understanding of other professions, and familiarity and applicability of the Geriatrics 5Ms, particularly for nonphysicians. CONCLUSION A workshop for interprofessional trainees using the Geriatrics 5Ms framework increased the readiness of trainees to care for older adults as part of an interprofessional team. This workshop offers a promising model for needed interprofessional geriatrics education. J Am Geriatr Soc 68:1857-1863, 2020.
Collapse
Affiliation(s)
- Andrea Wershof Schwartz
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Division of Geriatrics and Palliative Care, VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chelsea E Hawley
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jessica V Strong
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychology, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Sarah C Phillips
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Omar Amir
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian M Ludwin
- Division of Geriatrics and Palliative Care, VA Boston Healthcare System, Boston, Massachusetts, USA.,VA Bedford Medical Center, Bedford, Massachusetts, USA.,Inpatient Mental Health, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Elizabeth T Ngoc Phung
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer Moye
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,VA Bedford Medical Center, Bedford, Massachusetts, USA
| |
Collapse
|
20
|
Supporting All Americans as We Age: #Decision2020 and Questions for Candidates. J Am Geriatr Soc 2020; 68:1178-1183. [DOI: 10.1111/jgs.16515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
|
21
|
Perry LP. To All Doctors: What You Can Do to Help as a Bunch of Older People Are About to Get Sick and Die. J Am Geriatr Soc 2020; 68:944-946. [PMID: 32277464 PMCID: PMC7262234 DOI: 10.1111/jgs.16482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Laura P Perry
- Division of Geriatrics, University of California at San Francisco, San Francisco, California
| |
Collapse
|
22
|
Jones CA, Watkins FS, Williams J, Lambros A, Callahan KE, Lawlor J, Williamson JD, High KP, Atkinson HH. A 360-degree assessment of teaching effectiveness using a structured-videorecorded observed teaching exercise for faculty development. MEDICAL EDUCATION ONLINE 2019; 24:1596708. [PMID: 30973089 PMCID: PMC8870659 DOI: 10.1080/10872981.2019.1596708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Filming teaching sessions were reported in the medical literature in the 1980s and 1990s but appear to have been an underreported and/or underutilized teaching tool since that time. National faculty development programs, such as the Harvard Macy Institute (HMI) Program for Educators in Health Professions and the Stanford Faculty Development Center for Medical Teachers program, have attempted to bridge this gap in formal instruction in teaching skills through microteaching sessions involving videos for self- and peer-assessment and feedback. OBJECTIVE Current video-feedback faculty development initiatives are time intensive and impractical to implement broadly at an institutional level. Further, results of peer feedback have not been frequently reported in the literature at the institutional level. Our research aims to propose a convenient and effective process for incorporating video analysis into faculty devleopment programs. DESIGN Our work describes a novel technique using video-recorded, simulated teaching exercises to compile multi-dimensional feedback as an aid in faculty development programs that promote teaching-skill development. This research evaluated the effectiveness of a focused teaching practicum designed for faculty in multiple specialty departments with large numbers of older patients into a geriatrics-based faculty development program. Effectiveness of the practicum is evaluated using quantitative scoring and qualitative analysis of self-reflection as well as peer and trainee input. RESULTS VOTE sessions demonstrate an important exportable product which enable faculty to receive a detailed 360-degree assessment of their teaching. CONCLUSION This intervention can be easily replicated and revised, as needed, to fit into the educational curriculum at other academic medical centers.
Collapse
Affiliation(s)
- Christopher A. Jones
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Franklin S. Watkins
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Ann Lambros
- Health and Exercise Science, Wake Forest University, Winston Salem, NC, USA
| | - Kathryn E. Callahan
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Janice Lawlor
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeff D. Williamson
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kevin P. High
- Department of Internal Medicine, Section on Infectious Diseases, Vice President Health System Affairs, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hal H. Atkinson
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
23
|
Hawley CE, Triantafylidis LK, Phillips SC, Schwartz AW. Brown Bag Simulation to Improve Medication Management in Older Adults. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10857. [PMID: 32166113 PMCID: PMC7050658 DOI: 10.15766/mep_2374-8265.10857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Medical students must care for aging patients with growing medication lists and need training to address negative patient outcomes associated with polypharmacy. The literature shows that many trainees and practitioners are not confident in their abilities to care for this older population with complex medical conditions. We created an innovative simulation activity to teach safe, effective, and simplified medication management to second-year medical students. METHODS We developed the brown bag medication reconciliation simulation to improve self-efficacy and knowledge for trainees working with older adults. The case example was an older patient who presented with his brown bag of medications and prefilled pillbox for a medication reconciliation with his provider. Teams of medical students identified his medication-management errors and determined strategies for resolution. We assessed learner self-efficacy, knowledge, and satisfaction. RESULTS A class of 137 second-year medical students completed the simulation. The average number of learners confident about medication management in older adults increased overall by 41%, with a significant increase across all four self-efficacy domains (p < .001). The average percentage of correctly answered knowledge questions significantly increased from 85% on the presurvey to 92% on the delayed postsurvey (p = .009). Learner open-ended feedback indicated high satisfaction with the simulation. DISCUSSION The brown bag medication reconciliation simulation increased medical student self-efficacy and knowledge related to medication reconciliation and management for older adults. Interactive simulations like this one may be considered for inclusion in health science curricula to improve skills in medication reconciliation and management.
Collapse
Affiliation(s)
- Chelsea E. Hawley
- Advanced Fellow in Geriatrics, New England Geriatrics Research Education and Clinical Center
| | | | - Sarah C. Phillips
- Instructor, Division of Geriatrics, Boston University School of Medicine
| | - Andrea Wershof Schwartz
- Geriatrician, Division of Geriatrics and Palliative Care, VA Boston Healthcare System
- Educator, New England Geriatrics Research Education and Clinical Center
- Assistant Professor of Medicine, Harvard Medical School
| |
Collapse
|
24
|
Solberg LB, Carter CS, Solberg LM. Geriatric Care Boot Camp Series: Interprofessional education for a new training paradigm. Geriatr Nurs 2019; 40:579-583. [PMID: 31147174 DOI: 10.1016/j.gerinurse.2019.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 01/10/2023]
Abstract
Interprofessional education of health care professionals caring for older adults is critical to address the unique needs of geriatric patients. An interprofessional education program - the Geriatric Care Boot Camp Series ("Series") - was designed for health care professionals to fill this education gap. The program consisted of three half-day, intensive boot camps conducted over a one-year period. A total of 112 learners participated; more than half were nurses. Data analysis revealed statistically significant increases following each boot camp in attendees' reported knowledge about caring for older adults; statistically significant increases in comfort caring for older adults were also seen among participants in two boot camps. Attendees found the interprofessional nature of the program beneficial and said they would attend a similar program again. The Series is easily replicable, appealing to the target audience, and fulfills the need to better educate health care professionals on caring for older adults.
Collapse
Affiliation(s)
- Lauren B Solberg
- University of Florida College of Medicine, Gainesville, FL, USA.
| | | | - Laurence M Solberg
- University of Florida College of Medicine, Gainesville, FL, USA; Malcom Randall Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center (GRECC), Gainesville, FL, USA
| |
Collapse
|
25
|
|
26
|
Acute Care for Elders (ACE) Team Model of Care: A Clinical Overview. Geriatrics (Basel) 2018; 3:geriatrics3030050. [PMID: 31011087 PMCID: PMC6319203 DOI: 10.3390/geriatrics3030050] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022] Open
Abstract
The Institute of Medicine (IOM) Reports of To Err is Human and Crossing the Quality Chasm have called for more interprofessional and coordinated hospital care. For over 20 years, Acute Care for Elders (ACE) Units and models of care that disseminate ACE principles have demonstrated outcomes in-line with the IOM goals. The objective of this overview is to provide a concise summary of studies that describe outcomes of ACE models of care published in 1995 or later. Twenty-two studies met the inclusion. Of these, 19 studies were from ACE Units and three were evaluations of ACE Services, or teams that cared for patients on more than one hospital unit. Outcomes from these studies included increased adherence to evidence-based geriatric care processes, improved patient functional status at time of hospital discharge, and reductions in length of stay and costs in patients admitted to ACE models compared to usual care. These outcomes represent value-based care. As interprofessional team models are adopted, training in successful team functioning will also be needed.
Collapse
|
27
|
Won CW, Kim S, Swagerty D. Why Geriatric Medicine Is Important for Korea: Lessons Learned in the United States. J Korean Med Sci 2018; 33:e175. [PMID: 29930487 PMCID: PMC6010741 DOI: 10.3346/jkms.2018.33.e175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/19/2018] [Indexed: 01/25/2023] Open
Abstract
With the rapid increase in the number of Korean older adults, developing and integrating quality, expert older adult care in the Korean health care system will be essential and a tremendous benefit to these older adult patients, their families, and Korean society. While the awareness of geriatric medicine as a specialty for physicians caring exclusively for older adults has improved greatly in recent decades among Korean health care providers and older adult patients, there is still great opportunity to improve training opportunities for all medical students, primary care physicians, and specialty Geriatrics. Korea must also formally establish uniform geriatric medicine fellowships and certification. However, a number of barriers such as insufficient expertise, low incentives, and competitive geriatric societies exist to implement widespread, quality geriatric medicine in the Korean health care system.
Collapse
Affiliation(s)
- Chang Won Won
- Department of Family Medicine, Senior Health Care Center, Kyung Hee University Medical Center, Seoul, Korea
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sunyoung Kim
- Department of Family Medicine, Senior Health Care Center, Kyung Hee University Medical Center, Seoul, Korea
| | - Daniel Swagerty
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
- Department of Geriatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| |
Collapse
|
28
|
Bennett KA. Project ECHO-Geriatrics: Training Future Primary Care Providers to Meet the Needs of Older Adults. J Grad Med Educ 2018; 10:311-315. [PMID: 29946389 PMCID: PMC6008038 DOI: 10.4300/jgme-d-17-01022.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/27/2018] [Accepted: 03/08/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Geriatrics training is essential for future primary care providers. The Extension for Community Healthcare Outcomes (ECHO) model improves access to specialty care via case-based videoconferencing, but Project ECHO has not previously been designed to target residents. OBJECTIVE We designed Project ECHO-Geriatrics to deliver geriatrics education to primary care trainees using the ECHO model and evaluated self-rated geriatrics competency of trainees from the University of Washington Family Medicine Residency Network programs who participated between January 2016 and March 2017. METHODS We assessed outcomes of Project ECHO-Geriatrics through anonymous surveys. Participants rated didactics, case discussions, and geriatrics-specific knowledge before and after sessions on a 5-point scale (1, low, to 5, high). Participants were asked whether they planned to do anything differently in their practice and, if yes, to describe this change. RESULTS Fifteen sessions were held with 204 unique participants from 12 sites, with an average of 28 (range, 13-41) participants per session. From the 9 of 29 (31%) Family Medicine Residency Network programs that enrolled, 63% percent (116 of 184) of eligible residents attended. Sessions were highly rated (89% of responses were 4 or 5). Self-reported geriatrics-specific knowledge increased significantly (before 3.3 [SD = 0.89] versus after 4.0 [SD = 0.60], P < .001). Sixty-five percent (118 of 181) of participants reported plans to change their practice. CONCLUSIONS Project ECHO-Geriatrics is an innovative, feasible way to train the future primary care workforce in geriatrics and grow the capacity to provide high-quality care to older adults.
Collapse
|
29
|
Petriceks AH, Olivas JC, Srivastava S. Trends in Geriatrics Graduate Medical Education Programs and Positions, 2001 to 2018. Gerontol Geriatr Med 2018; 4:2333721418777659. [PMID: 29796406 PMCID: PMC5960854 DOI: 10.1177/2333721418777659] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/04/2018] [Accepted: 04/18/2018] [Indexed: 11/15/2022] Open
Abstract
It is no secret that the average age of the U.S. population is increasing, and this has special significance for the U.S. health care system. The number of individuals above 65 years old is predicted to increase 55% by 2030, and all the while, there is a looming physician shortage, one especially relevant for Geriatricians. Therefore, current Geriatricians must have objective information to assess the past, present, and future state of this important specialty. However, little literature exists regarding the recent changes in Geriatrics-related graduate medical education programs. In the present study, we use data from the Accreditation Council of Graduate Medical Education, to characterize quantitative trends in Geriatrics graduate medical education between academic years 2001-2002 and 2017-2018. We find that, when Hospice/Palliative Care is excluded, Geriatrics-related graduate medical education programs have grown by just 1.1% when adjusting for population growth. There are 58 fewer total filled Geriatrics and Geriatric Psychiatry positions in 2017-2018 than there were in 2001-2002, a population-adjusted decline of 23.3%. Our results confirm the growing notion that the Geriatrics specialty may need to alter its approach toward professional supply, if it is to meet the growing health care demands of an aging U.S. population.
Collapse
|