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Pingali H, Ulin L, Stiles D, Martinchek M, Schwartz AW. Hearing matters: An audiology and geriatrics collaboration to improve hearing care service utilization among older veterans. J Am Geriatr Soc 2024; 72:1269-1271. [PMID: 38064298 DOI: 10.1111/jgs.18697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 04/16/2024]
Affiliation(s)
- Hema Pingali
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lindsey Ulin
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Danielle Stiles
- Department of Audiology, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Michelle Martinchek
- Department of Geriatrics and Extended Care, VA Boston Healthcare System, Boston, MA, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
| | - Andrea Wershof Schwartz
- Department of Geriatrics and Extended Care, VA Boston Healthcare System, Boston, MA, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Jindal SK, Lee T, Agrawal A, Demers L, Schwartz AW. A National Survey on Point of Care Ultrasonography Use Among Veterans Affairs Clinicians in Home Care and Skilled Nursing Facilities. J Am Med Dir Assoc 2024:104930. [PMID: 38336356 DOI: 10.1016/j.jamda.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/23/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Older adults who are homebound and those in skilled nursing facilities (SNFs) often have limited access to point of care imaging to inform clinical decision making. Point-of-care ultrasonography (POCUS) can help span this gap by augmenting the physical examination to aid in diagnosis and triaging. Although training in POCUS for medical trainees is becoming more common and may focus on settings such as the emergency department, intensive care unit, and inpatient care, little is known about POCUS training among practicing clinicians who work outside of these settings. We conducted a national needs assessment survey around experience with POCUS focused on practicing clinicians in the sub-acute, long-term, and home-based care settings in the Veterans Affairs (VA) health system. METHODS An electronic survey was developed and sent out to clinicians via Listservs for the VA long-term and sub-acute care facilities [Community Living Centers (CLCs)], Home Based Primary Care outpatient teams, and Hospital in Home teams to assess current attitudes, previous training, and skills related to POCUS. RESULTS Eighty-eight participants responded to the survey, for an overall response rate of 29% based on the number of emails on each Listserv, representing CLC, home-based primary care, and hospital in home. Sixty percent of clinicians reported no experience with POCUS, and 76% reported that POCUS and POCUS training would be useful to their practice. More than 50% cited lack of training and lack of equipment as 2 significant barriers to POCUS use. DISCUSSION This national needs assessment survey of VA clinicians reveals important opportunities for training in POCUS for clinicians working with older adults who are receiving home care homebound or living in SNFs.
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Affiliation(s)
- Shivani K Jindal
- Cincinnati VA Medical Center, Medical Service, Cincinnati, OH, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA.
| | | | - Arushi Agrawal
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lindsay Demers
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Aging, Brigham and Women's Hospital, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Rowe KA, Ouchi K, Kennedy M, Breu A, Tolchin DW, Schwartz AW. Preparing Preclinical Medical Students for Routine Code Status Discussions: A Mixed-Methods Study. J Pain Symptom Manage 2024; 67:138-146. [PMID: 37863372 DOI: 10.1016/j.jpainsymman.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/01/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
CONTEXT Medical students are expected to gain competency in inquiring about patients' goals of care, per the Association of American Medical Colleges' Entrustable Professional Activities. While students may be part of teams that conduct routine code status discussions (CSDs), formal training in this skill prior to clinical clerkships is lacking. OBJECTIVES We aimed to address this training gap by designing a curriculum to teach preclinical medical students about routine CSDs. METHODS We designed and conducted an interactive workshop for preclinical medical students to learn about routine CSDs and practice this skill, using Kern's Six Steps to Curriculum Design. A qualitative and quantitative pre- and postsurvey was administered. A convergent, parallel, mixed methods analysis was performed. RESULTS Students (n = 135) named more options for code status following the workshop (presurvey 1.3 vs. postsurvey 4.3, P < 0.01). There was an increase in the proportion of students reporting that they felt "somewhat comfortable" or "extremely comfortable" conducting a CSD (presurvey 19% vs. postsurvey 64%, P < 0.01), and a decrease in those reporting that they felt "extremely uncomfortable" or "somewhat uncomfortable" (presurvey 53% vs. postsurvey 18%, P < 0.01). Thematic analysis revealed that students were concerned about knowledge gaps, communication tools, personal discomfort, and upsetting patients or family. CONCLUSION A workshop to train medical students to conduct routine CSDs can be included as part of a preclinical medical education curriculum. Students reported that the workshop increased their confidence in conducting CSDs and demonstrated an increase in corresponding knowledge, preparing them to deliver person-centered care on their clerkships.
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Affiliation(s)
- Katherine A Rowe
- Department of Surgery (K.A.R.), Massachusetts General Hospital, Boston, MA, USA.
| | - Kei Ouchi
- Department of Emergency Medicine (K.O.), Brigham and Women's Hospital, Boston, MA, USA
| | - Maura Kennedy
- Department of Emergency Medicine (M.K.), Massachusetts General Hospital, Boston, MA, USA
| | - Anthony Breu
- VA Boston Healthcare System and Center for Bioethics (A.B.), Harvard Medical School, Boston, MA, USA
| | - Dorothy W Tolchin
- Department of Physical Medicine and Rehabilitation (D.W.T.), Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Andrea Wershof Schwartz
- New England Geriatrics Research Education and Clinical Center (A.W.S.), Veterans Affairs Boston Healthcare System, Boston, MA, USA
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Cheslock M, Nahas A, Orkaby AR, Schwartz AW. Teaching Frailty to Medical Residents: A Needs Assessment Among Geriatrics Faculty. J Frailty Aging 2024; 13:189-192. [PMID: 38616377 DOI: 10.14283/jfa.2024.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Knowledge of frailty is essential for meeting the Accreditation Council for Graduate Medical Education core competencies for US trainees. The UK General Medical Council requires that frailty be included in undergraduate and graduate medical education curricula. Trainees are expected to appropriately modify care plans and help make patient-centered decisions, while incorporating diagnostic uncertainty, such as frailty, in older adults. Little is known about current needs for frailty instruction in graduate medical education in the US and beyond. OBJECTIVE We sought to capture faculty perceptions on how frailty should be defined and identified, and what aspects and level of detail should be taught to residents. DESIGN The authors developed a 4-item short response questionnaire, and faculty had the option to respond via electronic survey or via semi-structured interviews. SETTING AND SUBJECTS Respondents included 24 fellowship-trained geriatricians based at 6 different academic medical centers in a single urban metropolitan area. METHODS An invitation to participate in either an electronic survey or semi-structured virtual interview was e-mailed to 30 geriatricians affiliated with an academic multi-campus Geriatric Medicine fellowship. Responses were transcribed and coded independently by two authors. RESULTS Responses were received from 24 geriatricians via a combination of digital questionnaires (n=18) and semi-structured online interviews (n=6), for a response rate of 80%. Responses revealed significant diversity of opinion on how to define and identify frailty and how these concepts should be taught. CONCLUSIONS As frailty is increasingly incorporated into clinical practice, consensus is needed on how to define and teach frailty to residents.
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Affiliation(s)
- M Cheslock
- Megan Cheslock, MD, 200 Spring Road, MC 182 B2, Bedford, MA 01730, (781) 809-5630
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Miller RK, Young M, Chippendale R, Jantea R, Goroncy A, Murdock C, Schwartz AW, Sehgal M. Using the Geriatric 5Ms to teach structural and social determinants of health. J Am Geriatr Soc 2023; 71:3967-3972. [PMID: 37596776 DOI: 10.1111/jgs.18518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/26/2023] [Accepted: 06/18/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Rachel K Miller
- Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Geriatrics and Extended Care, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Megan Young
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ryan Chippendale
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rachel Jantea
- Department of Internal Medicine, Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, UTHealth Houston McGovern Medical School, Houston, Texas, USA
- UTHealth Houston Consortium on Aging, Houston, Texas, USA
| | - Anna Goroncy
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Cristina Murdock
- Department of Internal Medicine, Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, UTHealth Houston McGovern Medical School, Houston, Texas, USA
| | - Andrea Wershof Schwartz
- Geriatrics Consult Clinic at Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Mandi Sehgal
- Cleveland Clinic Florida, Weston, Florida, USA
- Florida Atlantic University Charles E. Schmidt College of Medicine Boca Raton, Boca Raton, Florida, USA
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Jindal SK, Paniszyn L, Lee T, Kumar A, Holliday AM, Orkaby AR, Schwartz AW. Bringing age-friendly care to the wards: A feasibility study implementing a 4Ms Bundle. J Am Geriatr Soc 2023; 71:3943-3947. [PMID: 37596886 DOI: 10.1111/jgs.18550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/16/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Shivani K Jindal
- Section of General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
- Section of Geriatrics, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Linda Paniszyn
- Section of Geriatrics, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Truelian Lee
- Harvard Medical School, Boston, Massachusetts, USA
| | - Anagha Kumar
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alison M Holliday
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Multicampus Geriatrics Fellowship, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ariela R Orkaby
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education, and Clinical Centers (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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DuMontier C, Hennis R, Yildirim C, Seligman BJ, Fonseca-Valencia C, Lubinski BL, Sison SM, Dharne M, Kim DH, Schwartz AW, Driver JA, Fillmore NR, Orkaby AR. Construct validity of the electronic Veterans Affairs Frailty Index against clinician frailty assessment. J Am Geriatr Soc 2023; 71:3857-3864. [PMID: 37624049 PMCID: PMC10841281 DOI: 10.1111/jgs.18540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/23/2023] [Accepted: 07/13/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Electronic frailty indices (eFIs) can expand measurement of frailty in research and practice and have demonstrated predictive validity in associations with clinical outcomes. However, their construct validity is less well studied. We aimed to assess the construct validity of the VA-FI, an eFI developed for use in the U.S. Veterans Affairs Healthcare System. METHODS Veterans who underwent comprehensive geriatric assessments between January 31, 2019 and June 6, 2022 at VA Boston and had sufficient data documented for a comprehensive geriatric assessment-frailty index (CGA-FI) were included. The VA-FI, based on diagnostic and procedural codes, and the CGA-FI, based on geriatrician-measured deficits, were calculated for each patient. Geriatricians also assessed the Clinical Frailty Scale (CFS), functional status (ADLs and IADLs), and 4-meter gait speed (4MGS). RESULTS A total of 132 veterans were included, with median age 81.4 years (IQR 75.8-88.7). Across increasing levels of VA-FI (<0.2; 0.2-0.4; >0.4), mean CGA-FI increased (0.24; 0.30; 0.40). The VA-FI was moderately correlated with the CGA-FI (r 0.45, p < 0.001). Every 0.1-unit increase in the VA-FI was associated with an increase in the CGA-FI (linear regression beta 0.05; 95% confidence interval [CI] 0.03-0.06), higher CFS category (ordinal regression OR 1.69; 95% CI 1.24-2.30), higher odds of ADL dependency (logistic regression OR 1.59; 95% CI 1.20-2.11), IADL dependency (logistic regression OR 1.68; 95% CI 1.23-2.30), and a decrease in 4MGS (linear regression beta -0.07, 95% CI -0.12 to -0.02). All models were adjusted for age and race, and associations held after further adjustment for the Charlson Comorbidity Index. CONCLUSION Our results demonstrate the construct validity of the VA-FI through its associations with clinical measures of frailty, including summary frailty measures, functional status, and objective physical performance. Our findings complement others' in showing that eFIs can capture functional and mobility domains of frailty beyond just comorbidity and may be useful to measure frailty among populations and individuals.
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Affiliation(s)
- Clark DuMontier
- Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute
| | - Robert Hennis
- Texas Tech University Health Sciences Center, El Paso, TX
| | - Cenk Yildirim
- VA Providence Healthcare, Providence, Rhode Island, USA
| | - Benjamin J. Seligman
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles, Los Angeles, CA, USA
| | | | - Brooke L. Lubinski
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Mayuri Dharne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA
- VA Boston CSP Center, Boston, MA, USA
| | - Dae Hyun Kim
- Harvard Medical School, Boston, MA, USA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Andrea Wershof Schwartz
- Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jane A. Driver
- Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
| | - Nathanael R. Fillmore
- Harvard Medical School, Boston, MA, USA
- Dana-Farber Cancer Institute
- UMass Memorial Med Center, Worcester, MA, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA
| | - Ariela R. Orkaby
- Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA
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Engel KG, Millham LRI, Yeh IM, Malecha PW, Brizzi K, Schwartz AW, Tolchin DW. Assessing the Impact of a Hospice and Palliative Medicine Mentored Clinical Shadowing Experience for First-Year Medical and Dental Students: A Pilot Study. Am J Hosp Palliat Care 2023:10499091231214787. [PMID: 37950642 DOI: 10.1177/10499091231214787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
Background: All physicians encounter patients with serious illness. Medical students recognize the value of hospice and palliative medicine (HPM) and desire more knowledge and skills in this area. However, both pre-clinical and clinical HPM content are underrepresented within medical school curricula. Objectives: To conduct a pilot study examining the impact of a novel required HPM clinical experience on pre-clinical medical and dental students' learning through mixed methods evaluation of student responses. Design: Students completed a two-part electronic survey following a half-day HPM mentored clinical shadowing experience (HPM-MCSE) which included an introductory session, a faculty-mentored shadowing experience and a debriefing session. Setting/subjects: 163 first-year students at Harvard Medical School in Boston, Massachusetts, USA in 2022. Measurements: The survey collected demographic information and student responses to both closed-ended (Likert-scale) and open-ended prompts. Data were analyzed quantitatively using descriptive statistics and qualitatively using constant comparative methodology. Results: 127 medical and dental students responded (78% response rate). Qualitative analysis yielded three overarching themes: acquisition of knowledge about operational dimensions of HPM, acquisition of knowledge about psychosocial dimensions of HPM, and personal impact including an awareness of discordance between expectations and lived experience of HPM practice. Of the 109 students who completed the entire survey, 67% indicated that this experience increased their interest in palliative care and 98% reported an increase in their understanding of how palliative care enhances patient care. Conclusions: Early clinical exposure to HPM for first year students stimulates multi-dimensional learning about HPM and evokes personal reflection about serious illness care.
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Affiliation(s)
- Kirsten G Engel
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lucia R I Millham
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Irene M Yeh
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Patrick W Malecha
- Harvard Medical School, Boston, MA, USA
- Section of Palliative Care, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kate Brizzi
- Harvard Medical School, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, MA, USA
- New England Geriatrics Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Dorothy W Tolchin
- Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
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James K, Growdon ME, Orkaby AR, Schwartz AW. One Step at a Time: Improving Gait Speed Measurement in a Geriatric Medicine Clinic. Geriatrics (Basel) 2023; 8:81. [PMID: 37623274 PMCID: PMC10454464 DOI: 10.3390/geriatrics8040081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/10/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: Mobility assessment is a key component of the assessment of an older adult as a part of the Age-Friendly Health System (AFHS) "geriatric 4Ms" framework. Several validated tools for assessing mobility and estimating fall risk in older adults are available. However, they are often under-utilized in daily practice even in specialty geriatric medicine care settings. We aimed to increase formal mobility assessment with brief gait speed measurement in a geriatric medicine outpatient clinic using phased change interventions. (2) Methods: This quality improvement (QI) initiative was conducted in a single outpatient geriatric medicine clinic. All clinic attendees who could complete a gait speed measurement were eligible for inclusion. The outcome measure was the completion of a 4 m gait speed. Several change interventions were implemented on a phased basis using the Model for Improvement methodology during the period from December 2018 to March 2020. Statistical process control charts were used to record gait speed measurements and detect non-random shifts. (3) Results: During this QI initiative, 80 patients were seen, accounting for 142 clinic visits. In response to change interventions, gait speed measurement at clinic visits increased from a median of 25% of visits to 67% by March 2020. (4) Conclusions: Adopting an AFHS care model is an urgent and challenging task to improve the quality of care for older adults. This initiative details how to effectively incorporate a brief, validated assessment of mobility using gait speed measurement into every geriatric medicine outpatient visit and progresses implementation of the AFHS "geriatric 4Ms". Mobility assessment can aid in identifying older adults at increased fall risk.
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Affiliation(s)
- Kirstyn James
- Department of Geriatric Medicine, Cork University Hospital, T12 DC4A Cork, Ireland
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA 02130, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Matthew E. Growdon
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA 02130, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of Geriatrics, University of California San Francisco School of Medicine, San Francisco, CA 94143, USA
| | - Ariela R. Orkaby
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA 02130, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA 02130, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
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Monette PJ, Schwartz AW. Optimizing Medications with the Geriatrics 5Ms: An Age-Friendly Approach. Drugs Aging 2023; 40:391-396. [PMID: 37043166 PMCID: PMC10092911 DOI: 10.1007/s40266-023-01016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 04/13/2023]
Abstract
Polypharmacy is a common problem among older adults, as they are more likely to have multiple chronic conditions and may experience fragmentation of care among specialists. The Geriatrics 5Ms framework offers a person-centered approach to address polypharmacy and optimize medications, including deprescribing when appropriate. The elements of the Geriatrics 5Ms, which align with the approach of the Age-Friendly Health Systems initiative, include consideration of Medications, Mind, Mobility, Multicomplexity, and What Matters Most. Each M domain impacts and is impacted by medications, and learning about the patient's goals through questions guided by the Geriatrics 5Ms may inform an Age-Friendly medication optimization plan. While research on the implementation of each of the elements of the Geriatrics 5Ms shows benefit, further research is needed to study the impact of this framework in clinical practice.
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Affiliation(s)
| | - Andrea Wershof Schwartz
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
- New England Geriatrics Research Education and Clinical Center and Geriatrics and Extended Care, VA Boston Healthcare System, and Brigham and Women's Hospital, 150 South Huntington #182, Boston, MA, 02130, USA.
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Powers BB, Van Zuilen RM, Schwartz AW, Dang S, McLaren JE, Hoang-Gia D, Moo LR. Competencies for video telemedicine with older adult patients. J Am Geriatr Soc 2023; 71:1283-1290. [PMID: 36951209 DOI: 10.1111/jgs.18246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 03/24/2023]
Abstract
BACKGROUND Telemedicine has recently become a part of mainstream clinical practice. Many curricula have been developed to teach general and specialty-specific video telemedicine skills; however, a lack of defined best practices for translating comprehensive interprofessional geriatric care to the virtual setting presents a unique challenge to educators and clinicians. This manuscript introduces and describes the development of competencies for video telemedicine with older adults for all health professionals who treat them. METHODS A modified Delphi process was used in competency development. In 2019, interprofessional clinicians and educators who had expertise in telemedicine formed a competency development workgroup. The aim was to draft competencies for interprofessional video telemedicine with older adults while not duplicating existing competencies in geriatrics, interprofessional care, or general telemedicine. Draft competencies were circulated among experts in geriatric telemedicine and geriatric education for two rounds of comments. The competencies incorporated comments from 41 clinicians representing 7 professions. RESULTS Twenty-three competencies were created spanning six domains. A temporal organization by domain was used: (1) Overarching considerations, (2) Pre-visit preparation, (3) Beginning of the visit, (4) History taking and communication during the visit, (5) Exam during the visit (organized by the 5Ms: Mind, Mobility, Medication, Multicomplexity, and Matters Most), and (6) Post-visit coordination. CONCLUSIONS These newly developed competencies fill a gap left by those developed for specific disciplines or that do not address considerations for older adults. They lay the groundwork for curriculum development and the development of virtual Age-Friendly care.
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Affiliation(s)
- Becky B Powers
- Division of Geriatrics Gerontology and Palliative Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
- South Texas Veterans Health Care System Geriatric Research Education and Clinical Center, San Antonio, Texas, USA
| | - Rose Maria Van Zuilen
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrea Wershof Schwartz
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA
| | - Stuti Dang
- Departmet of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- VA Miami Health Care System, Geriatric Research Education and Clinical Center, Miami, Florida, USA
| | - Jaye E McLaren
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Bedford Health Care System, Boston, Massachusetts, USA
| | - Dat Hoang-Gia
- VA Palo Alto Health Care System, Geriatric Research Education and Clinical Center, Palo Alto, California, USA
| | - Lauren R Moo
- VA Miami Health Care System, Geriatric Research Education and Clinical Center, Miami, Florida, USA
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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13
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Abstract
Background The Age-Friendly Health Systems Initiative is a quality improvement movement led by the Institute for Healthcare Improvement and supported by the John A. Hartford Foundation to improve care for older adults. The US Department of Veterans Affairs (VA) has set a goal to become the largest integrated Age-Friendly Health System in the United States. Observations As the veteran population ages, delivering Age-Friendly care is an urgent priority. VA clinicians should apply the 4Ms of the Age-Friendly Health Systems Initiative: Mobility, Mentation, Medications, and What Matters. Conclusions No matter which floor a veteran exits on a VA elevator, they should expect to receive Age-Friendly care that will meet their needs as they age.
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Affiliation(s)
- Andrea Wershof Schwartz
- New England Geriatrics Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Massachusetts
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14
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Schwartz AW, Solomon SR. Finding and doing what matters most: Five productivity strategies for physicians in academic medicine. Med Teach 2023; 45:123-127. [PMID: 36175169 PMCID: PMC9898133 DOI: 10.1080/0142159x.2022.2126762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
While structural change is needed to address the burnout epidemic among healthcare workers, it is important for physicians to avail themselves of the many productivity strategies that can help them succeed in navigating the multiple responsibilities of academic medicine. We present here 5 key strategies within our control that can help increase productivity in the pursuit of work in academic medicine that is meaningful and sustainable: (1) Clarify Priorities, (2) Track Tasks Systematically, (3) Focus and Monotask, (4) Invest in Timesavers, and (5) Celebrate Successes. The specific tools listed under each strategy may help academic physicians feel grounded and maintain our focus on doing meaningful work. While system-wide culture change around expectations, and institutional support for physician wellbeing, is more critical than ever, individual physicians can still benefit from learning strategies to prioritize, track, focus on, delegate and celebrate the work that matters to us in our lives.
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Affiliation(s)
- Andrea Wershof Schwartz
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- New England Geriatrics Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sonja R. Solomon
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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15
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Schwartz AW, Driver JA, Pollara LM, Roefaro J, Harrington MB, Charness ME, Skarf LM. Increasing Telehealth Visits for Older Veterans Associated with Decreased No-Show Rate in a Geriatrics Consultation Clinic. J Gen Intern Med 2022; 37:3217-3219. [PMID: 35476240 PMCID: PMC9045203 DOI: 10.1007/s11606-022-07598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Wershof Schwartz
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA. .,New England Geriatrics Research Education and Clinical Center, Boston, USA. .,Harvard Medical School, Boston, USA. .,Brigham and Women's Hospital Division of Aging, Boston, USA.
| | - Jane A Driver
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA.,New England Geriatrics Research Education and Clinical Center, Boston, USA.,Harvard Medical School, Boston, USA.,Brigham and Women's Hospital Division of Aging, Boston, USA
| | - Lisa M Pollara
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA
| | - John Roefaro
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA
| | - Mary Beth Harrington
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA.,New England Geriatrics Research Education and Clinical Center, Boston, USA
| | - Michael E Charness
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA.,Harvard Medical School, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Lara Michal Skarf
- Veterans Affairs Boston Health Care System, 150 South Huntington Avenue #182, Boston, MA, 02130, USA.,Harvard Medical School, Boston, USA
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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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
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17
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Nathan S, Fiore LL, Saunders S, Vilbrun-Bruno Pa-C SO, Hinrichs KL, Ruopp MD, Schwartz AW, Moye J. My life, my story: Teaching patient centered care competencies for older adults through life story work. Gerontol Geriatr Educ 2022; 43:225-238. [PMID: 31498034 DOI: 10.1080/02701960.2019.1665038] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We implemented "My Life, My Story" as an educational activity for enhancing patient-centered care (PCC) competencies across health professions trainees. Four hundred and eighty-two stories were completed for patients (M age = 72.5, SD = 12.7) primarily in inpatient medical settings, by trainees from seven disciplines. Trainees spent approximately 2 hours on the assignment; 84% felt this was a good use of their time. A mixed method survey evaluated the effectiveness of the activity on enhancing PCC competencies using open ended questions and ratings on the Consultation and Relational Empathy (CARE) Measure adapted for this project. The assignment most influenced trainees' ability to understand the patient as a "whole person" along with other PCC competencies such as showing empathy, really listening, building knowledge of values and goals, and building relationships. In addition, trainees perceived the activity enhanced patient care and was a positive contrast to usual care.
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Affiliation(s)
- Susan Nathan
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Laura L Fiore
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Sandra O Vilbrun-Bruno Pa-C
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kate Lm Hinrichs
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcus D Ruopp
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Andrea Wershof Schwartz
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- New England GRECC (Geriatric Research Education and Clinical Center), Boston and Bedford, Massachusetts
| | - Jennifer Moye
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- New England GRECC (Geriatric Research Education and Clinical Center), Boston and Bedford, Massachusetts
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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19
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Goreshnik A, Corey MT, Rhodes Kropf J, Schwartz AW. Learning about sites of care for older adults: a jigsaw educational session for medical students. Age Ageing 2022; 51:6540131. [PMID: 35231089 PMCID: PMC9383527 DOI: 10.1093/ageing/afac032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Indexed: 11/26/2022] Open
Abstract
Choosing the appropriate site of care for patients is a vital clinical skill when caring for older adults. For better patient safety and smoother transitions of care, we need improved curricula to train clinicians about the system of sites and services where older adults receive care. Here we present an innovative introduction for medical trainees to the complexities of long-term and post-acute care for geriatric patients. Students participated in a team-based ‘jigsaw’ learning activity, in which each team researched a particular site of care and then taught a larger group of their peers about that site. It was subsequently converted to a virtual format due to COVID-19. The activity was assessed using students’ written feedback and satisfaction scores. Students enjoyed the interactivity and hands-on approach, giving the activity an average score of 3.9 out of 5 (1 = ‘poor’; 5 = ‘excellent’). The jigsaw provided an engaging, case-based foundation for learning about sites of care and was well-received by students.
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Affiliation(s)
| | - Matthew T Corey
- Harvard Medical School, Boston, MA, USA
- Cambridge Health Alliance, Cambridge, MA, USA
| | | | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, MA, USA
- Division of Geriatrics and Palliative Care and New England Geriatrics Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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20
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Brunette AM, Rycroft SS, Colvin L, Schwartz AW, Driver JA, Nothern A, Harrington MB, Jackson CE. Integrating Neuropsychology into Interprofessional Geriatrics Clinics. Arch Clin Neuropsychol 2022; 37:545-552. [PMID: 34718368 PMCID: PMC9630824 DOI: 10.1093/arclin/acab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Interprofessional healthcare teams are increasingly viewed as a clinical approach to meet the complex medical, psychological, and psychosocial needs of older adult patients. Despite the fact that older adults are at risk for cognitive difficulties, neuropsychologists are not routinely included on Geriatrics consult teams. The primary aim of this paper is to highlight the utility of neuropsychology within an interprofessional Geriatrics consult clinic. To address this aim, we describe specific benefits to patient care that may be associated with the inclusion of neuropsychologists on Geriatrics consult teams, including differential diagnosis, enhanced patient care, and reduced barriers to care. We provide a description of the integration of neuropsychology within a Veterans Health Administration (VA) interprofessional Geriatrics consult clinic team in order to illustrate the implementation of this model.
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Affiliation(s)
- Amanda M. Brunette
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA,Corresponding author at: The University of Kansas Health System, 4330 Shawnee Mission Pkwy Suite 2180, Fairway, KS 66205, USA. Tel.: 913-588-6973; Fax: 913-588-6964. (A.M. Brunette)
| | | | - Leigh Colvin
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
| | - Andrea Wershof Schwartz
- Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA,New England Geriatric Research Education and Clinical Center (GRECC), Boston Division, Boston, MA, USA,Harvard Medical School, Department of Medicine, Boston, MA, USA,Brigham & Women’s Hospital, Division of Aging, Boston, MA, USA
| | - Jane A. Driver
- Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA,New England Geriatric Research Education and Clinical Center (GRECC), Boston Division, Boston, MA, USA,Harvard Medical School, Department of Medicine, Boston, MA, USA,Brigham & Women’s Hospital, Division of Aging, Boston, MA, USA
| | - Alexandra Nothern
- Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA
| | - Mary Beth Harrington
- Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA,New England Geriatric Research Education and Clinical Center (GRECC), Boston Division, Boston, MA, USA
| | - Colleen E. Jackson
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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21
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Abstract
Telemedicine is now an established mode of clinical care for most medical specialties, and clinical teachers must teach and precept learners in this modality. However, faculty need training on how best to teach students when caring for patients via telemedicine. Effectively incorporating learners into telemedicine visits to optimize their education is a critical skill for clinical teachers. In this article, we review 12 practical tips unique to telemedicine to engage and educate undergraduate medical education learners in building their clinical skills. We outline synchronous and asynchronous elements before, during, and after the patient encounter to facilitate teaching while improving patient care. These principles can also be adapted for teaching in other health professions as well as postgraduate medical education.
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Affiliation(s)
- Alexandra Hovaguimian
- Instructor in Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashwini Joshi
- Fourth-Year Medical Student, Harvard Medical School, Boston, MA, USA
| | - Sarah Onorato
- Fourth-Year Medical Student, Harvard Medical School, Boston, MA, USA
| | - Andrea Wershof Schwartz
- Assistant Professor of Medicine, Geriatrics, VA Boston Healthcare Center, New England Geriatrics Research Education and Clinical Center, Harvard Medical School, Boston, MA, USA
| | - Susan Frankl
- Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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22
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Schwartz AW, James K, Orkaby AR. The Reply. Am J Med 2021; 134:e564. [PMID: 34799009 PMCID: PMC9648368 DOI: 10.1016/j.amjmed.2021.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Andrea Wershof Schwartz
- New England Geriatric Research, Education, and Clinical Centers and Division of Geriatrics & Extended Care, Veteran Affairs Boston Healthcare System, Boston, Mass; Harvard Medical School, Boston, Mass; Department of Medicine/Division of Aging Brigham and Women's Hospital, Boston, Mass.
| | - Kirstyn James
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Ariela R Orkaby
- New England Geriatric Research, Education, and Clinical Centers and Division of Geriatrics & Extended Care, Veteran Affairs Boston Healthcare System, Boston, Mass; Harvard Medical School, Boston, Mass; Department of Medicine/Division of Aging Brigham and Women's Hospital, Boston, Mass
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23
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Hawley CE, Doherty K, Moye J, Phillips SC, Ngoc Phung ET, Dawson CMP, Schwartz AW. Implementing an interprofessional workshop based on the 4Ms for an age-friendly health system. J Am Geriatr Soc 2021; 69:E27-E30. [PMID: 34610145 DOI: 10.1111/jgs.17502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Chelsea E Hawley
- New England Geriatric Research Education and Clinical Center (NEGRECC), Bedford, Massachusetts, USA
| | - Kelly Doherty
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jennifer Moye
- New England Geriatric Research Education and Clinical Center (NEGRECC), Bedford, Massachusetts, USA.,New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah C Phillips
- Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Division of Geriatrics, Boston University School of Medicine, Boston, Massachusetts, USA.,Division of Geriatrics, Upham's Elder Service Plan, Dorchester, Massachusetts, USA
| | - Elizabeth T Ngoc Phung
- Beacham Center for Geriatric Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Catherine M P Dawson
- New England Geriatric Research Education and Clinical Center (NEGRECC), Bedford, Massachusetts, USA.,Geriatrics Clinic, Division of Geriatrics and Palliative Care, Bedford VA Medical Center, Bedford, Massachusetts, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Geriatrics Clinic, Division of Geriatrics and Palliative Care, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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24
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Affiliation(s)
- Lauren R Moo
- New England Geriatrics Research Education and Clinical Center, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, Massachusetts
- New England Geriatrics Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
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25
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Affiliation(s)
- Kirstyn James
- From the New England Geriatric Research Education and Clinical Center, the Veterans Affairs Boston Healthcare System (K.J., A.W.S., A.R.O.); the Division of Gerontology, Beth Israel Deaconess Medical Center (K.J.); Harvard Medical School (K.J., A.W.S., A.R.O.); and the Division of Aging, Brigham and Women's Hospital (A.W.S., A.R.O.) - all in Boston; and the Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland (K.J.)
| | - Andrea Wershof Schwartz
- From the New England Geriatric Research Education and Clinical Center, the Veterans Affairs Boston Healthcare System (K.J., A.W.S., A.R.O.); the Division of Gerontology, Beth Israel Deaconess Medical Center (K.J.); Harvard Medical School (K.J., A.W.S., A.R.O.); and the Division of Aging, Brigham and Women's Hospital (A.W.S., A.R.O.) - all in Boston; and the Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland (K.J.)
| | - Ariela R Orkaby
- From the New England Geriatric Research Education and Clinical Center, the Veterans Affairs Boston Healthcare System (K.J., A.W.S., A.R.O.); the Division of Gerontology, Beth Israel Deaconess Medical Center (K.J.); Harvard Medical School (K.J., A.W.S., A.R.O.); and the Division of Aging, Brigham and Women's Hospital (A.W.S., A.R.O.) - all in Boston; and the Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland (K.J.)
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26
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Onorato S, Joshi A, Schwartz AW. Lights, Camera, Action: Optimizing Virtual Video Visits to Provide High-Quality Care. J Gen Intern Med 2021; 36:1751-1754. [PMID: 33111243 PMCID: PMC7592130 DOI: 10.1007/s11606-020-06278-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/28/2020] [Indexed: 02/08/2023]
Affiliation(s)
| | | | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, MA, USA
- New England Geriatrics Research Education and Clinical Center and Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA
- Brigham & Women's Hospital, Boston, MA, USA
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Petriceks AH, Kumar A, Schwartz AW. The urgency of now: Opportunities for advocacy among geriatrics health professionals and trainees. J Am Geriatr Soc 2021; 69:2445-2448. [PMID: 34048601 DOI: 10.1111/jgs.17300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, Massachusetts, USA.,New England Geriatric Research, Education, and Clinical Center and Division of Geriatrics and Palliative Care, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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James K, Baglini C, Wershof Schwartz A. From the ground up: recognising risk of frailty syndromes and functional decline through foot examination. BMJ Case Rep 2021; 14:14/5/e236229. [PMID: 34031059 DOI: 10.1136/bcr-2020-236229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Foot pathologies in older adults are associated with falls and complications such as amputations and ulcers. We report a case of an older man who presented to the geriatric medicine outpatient clinic. History taking revealed a fall, recent episode of delirium and decline in functional status with the patient reporting he was no longer able to cut his own toenails. Medical history included hypothyroidism, depression and hearing impairment. Physical examination detected very long, thickened toenails with bilateral bony deformities of the foot. Additionally, he had borderline slow gait speed and had difficulty completing a chair stand. Inability to maintain foot care suggested an early insight into a deterioration of overall function and emergence of frailty. An interprofessional team approach to the patient's care included a medication review, referrals to podiatry, orthotics, physiotherapy and occupational therapy. His toenails were debrided and orthopaedic shoes were prescribed with no further falls.
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Affiliation(s)
- Kirstyn James
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA, USA .,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | | | - Andrea Wershof Schwartz
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Roseen EJ, Purtle J, Zhang W, Miller DW, Schwartz AW, Ramanadhan S, Sherman KJ. The Intersection of Dissemination Research and Acupuncture: Applications for Chronic Low Back Pain. Glob Adv Health Med 2021; 10:2164956120980694. [PMID: 34104573 PMCID: PMC8150432 DOI: 10.1177/2164956120980694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/05/2020] [Accepted: 11/23/2020] [Indexed: 12/29/2022] Open
Abstract
Dissemination research is the study of distributing information and intervention materials to a specific clinical practice or public health audience. Acupuncture, a healthcare practice involving the stimulation of certain body points, often with thin needles, is considered an evidence-based treatment for low back pain (LBP), but is underutilized in the United States. Body: We will use the example of acupuncture for LBP to identify opportunities to leverage dissemination research to increase utilization of acupuncture. Deficits in the awareness or knowledge of acupuncture may limit its adoption by patients and other stakeholders. Thus, we summarize methods to gather data on stakeholder awareness and knowledge of acupuncture for LBP, i.e., audience research. Engaging multiple stakeholder audiences (e.g., health system leaders, primary care providers, patients), is needed to generate knowledge on promising dissemination strategies for each audience. Audience segmentation is important for identifying population subgroups for whom adoption of acupuncture may require a more intensive or tailored dissemination strategy. To illustrate potential audience ‘segments’, our research discussion focused on developing dissemination strategies by age (i.e., older adults – those age 65 years or older, and younger adults – those under age 65 ). This decision was prompted by Medicare’s recent policy covering acupuncture for chronic LBP. We leverage current knowledge of barriers and facilitators of acupuncture use to discuss how further tailoring of dissemination strategies might optimize adoption of acupuncture in both groups of adults. Experimental study designs could then be used to compare the effectiveness of such strategies to increase awareness, knowledge, or adoption of acupuncture. Conclusions: Conducting dissemination research may improve awareness and knowledge of acupuncture, and ultimately the adoption of acupuncture in biomedical settings. We anticipate that the concepts highlighted in this manuscript will also be helpful for those disseminating information about other complementary and integrative health approaches.
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Affiliation(s)
- Eric J Roseen
- Department of Family Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.,Department of Rehabilitation Science, MGH Institute of Health Professions, Boston, Massachusetts.,New England Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Weijun Zhang
- Department of Medicine, UCLA Center for East-West Medicine, Los Angeles, California.,Division of General Internal Medicine and Health Service Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David W Miller
- Department of Pediatrics, Connor Integrative Health Network, University Hospitals, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Karen J Sherman
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle, Washington
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Affiliation(s)
- Kirstyn James
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland; New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA, United States; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Ariela R Orkaby
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA, United States; Department of Medicine/Division of Aging, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA, United States; Department of Medicine/Division of Aging, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Affiliation(s)
- Henrike Besche
- Associate director for curriculum integration, Office of Educational Quality Improvement, Harvard Medical School, Boston, Massachusetts
| | - Andrea Wershof Schwartz
- Assistant professor of medicine, Harvard Medical School, as well as medical director, Geriatrics Clinic, Division of Geriatrics and Palliative Care, and member, New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Barbara Cockrill
- Director of faculty development, MD Program, and Harold Amos Academy Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts;
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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] [What about the content of this article? (0)] [Affiliation(s)] [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
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Abstract
COVID-19 has necessitated a rapid shift to the remote delivery of medical education. We present a timely collection of tips, techniques, and strategies for the facilitation of remote teaching sessions and modification of curriculum design, assessment, and evaluation. We step through Kern's six-step curriculum design, recommending to (1) consider session necessity and a variety of teaching models; (2) inform your session with surveys and polls; (3) keep session endpoints consistent; (4) make the most of technology and translate in-person strategies to virtual forms; (5) engage with individual learners and eliminate distractions; and (6) consider online methods of assessment and evaluation methods.
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Affiliation(s)
| | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, MA USA
- Division of Geriatrics & Palliative Care, New England Geriatrics Research Education and Clinical Center, VA Boston Health Care System, 150 South Huntington Avenue, Jamaica Plain, MA 02130 USA
- Brigham and Women’s Hospital, Boston, MA USA
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Abstract
The foot changes with age. Foot disorders in older adults are associated with falls, lower limb ulcers, and pain. Physical examination of the feet as part of the routine assessment of older adults is imperative to detect foot problems. Foot pain and pathologies are common in older adults. Regular foot care is important to prevent these issues. However, some older adults may find it difficult to complete foot care, including cutting toenails. Regular foot examination can detect common foot problems, functional decline, and is recommended for preventing falls. We describe a technique for performing a focused examination of the feet for older adults. This review addresses current podiatric issues in older patient populations and describes a method for foot examination to address the needs of older adults that can be incorporated into patient assessments in any clinical setting.
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Affiliation(s)
- Kirstyn James
- New England Geriatric Research, Education and Clinical Centers, Veteran Affairs Boston Healthcare System, Boston, Mass; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Ariela R Orkaby
- New England Geriatric Research, Education and Clinical Centers, Veteran Affairs Boston Healthcare System, Boston, Mass; Department of Medicine/Division of Aging, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education and Clinical Centers, Veteran Affairs Boston Healthcare System, Boston, Mass; Department of Medicine/Division of Aging, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
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Rosenberg LB, Goodlev ER, Izen RSE, Gelfand SL, Goodlev CL, Lanckton RB, Skarf LM, Wershof Schwartz A, Jones CA, Tulsky JA. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Jewish Patients. J Palliat Med 2020; 23:1658-1661. [PMID: 33085936 DOI: 10.1089/jpm.2020.0601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Judaism, one of the world's oldest religions, claims an estimated 14.3 million members worldwide. There is great diversity in terms of identity, practice, and belief among people who identify as Jewish. As of 2017, 40% of the global Jewish community resided in the United States, making it essential for palliative care clinicians to understand religious and cultural issues related to their serious illness care. In this article, we will discuss 10 important concepts relevant to the inpatient care, advance care planning, and bereavement needs of Jewish patients and families.
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Affiliation(s)
- Leah B Rosenberg
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric R Goodlev
- Division of Palliative Care, Department of Medicine, Einstein Medical Center Montgomery, East Norriton, Pennsylvania, USA
| | - Rabbi Shulamit E Izen
- Spiritual Care Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Samantha L Gelfand
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Lara M Skarf
- Division of Geriatrics and Palliative Care, Department of Medicine, Education and Clinical Centers, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research, Education and Clinical Centers, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine/Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
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36
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Affiliation(s)
- Catherine MP Dawson
- Veterans Health AdministrationNew England Geriatric ResearchEducation, and Clinical Center (GRECC) Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
| | - Andrea Wershof Schwartz
- Veterans Health AdministrationNew England Geriatric ResearchEducation, and Clinical Center (GRECC) Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
- Brigham and Women's Hospital Boston Massachusetts USA
| | - Susan E Farrell
- Harvard Medical School Boston Massachusetts USA
- Brigham and Women's Hospital Boston Massachusetts USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Holliday AM, Hawley CE, Schwartz AW. Geriatrics 5Ms Pocket Card for Medical and Dental Students. J Am Geriatr Soc 2019; 67:E7-E9. [PMID: 31802487 DOI: 10.1111/jgs.16226] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/14/2019] [Accepted: 09/21/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Alison M Holliday
- Harvard Medical School, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts
| | - Chelsea E Hawley
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, Massachusetts.,Brigham and Women's Hospital, Boston, Massachusetts.,New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts.,Division of Geriatrics and Palliative Care, VA Boston Healthcare System, Boston, Massachusetts
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Hawley CE, Triantafylidis LK, Phillips SC, Schwartz AW. Brown Bag Simulation to Improve Medication Management in Older Adults. MedEdPORTAL 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Triantafylidis LK, Phillips SC, Hawley CE, Schwartz AW. Finding the Sweet Spot: An Interactive Workshop on Diabetes Management in Older Adults. MedEdPORTAL 2019; 15:10845. [PMID: 31911936 PMCID: PMC6944249 DOI: 10.15766/mep_2374-8265.10845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Intensive glucose lowering in older adults with diabetes leads to increased risks with minimal benefits. Surveys indicate that clinician confidence for individualizing glycemic goals and regimens remains low. We created an interactive workshop and clinical tool kit to improve clinician knowledge of safe diabetes management in older adults. METHODS Finding the Sweet Spot was a 1-hour workshop taught by pharmacists to medical and pharmacy learners that introduced a five-step framework for diabetes management in older adults. The interactive presentation included cases and a clinical tool kit based on current recommendations from the American Diabetes Association and American Geriatrics Society. Pilot workshops were held for 6 months, allowing for real-time revisions based on feedback; final implementation occurred for 6 months thereafter. We evaluated learner self-efficacy (via a 5-point Likert scale) and knowledge (via multiple-choice questions) of diabetes management in older adults before and after the workshop. RESULTS Thirty learners participated in Finding the Sweet Spot (70% medicine, 30% pharmacy). The percentage of confident learners increased from 55% to 97% (p < .05) after the workshop. All learners demonstrated improvements in knowledge, with the mean score on the knowledge assessment increasing from 61% to 80% (p < .05). Via open-ended feedback, learners expressed satisfaction and found the clinical tool kit especially helpful. DISCUSSION Our Finding the Sweet Spot workshop demonstrated statistically significant changes in self-efficacy and knowledge among learners, indicating that this interactive workshop improves medical and pharmacy provider confidence and skills in caring for older adults with diabetes.
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Affiliation(s)
| | - Sarah C. Phillips
- Instructor, Department of Family Medicine, Boston University School of Medicine
- Physician, Upham's Corner Elder Service Plan
- Affiliated Fellow in Geriatrics, VA Boston Healthcare System and New England Geriatric Research Education and Clinical Center
| | - Chelsea E. Hawley
- Clinical Pharmacist, Pharmacy Department, VA Boston Healthcare System
- Advanced Fellow in Geriatrics, New England Geriatric Research Education and Clinical Center
| | - Andrea Wershof Schwartz
- Associate Fellowship Director of the Harvard Multicampus Geriatrics Fellowship, VA Boston Healthcare System and New England Geriatric Research Education and Clinical Center
- Assistant Professor of Medicine, Department of Medicine, Harvard Medical School
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Streiter S, Loewenthal J, Berry S, Schwartz AW. Better Together: Promoting Geriatrics Education across Residency Specialties with a Pilot Peer Teaching Exchange. J Am Geriatr Soc 2019; 67:E1-E3. [PMID: 31574161 PMCID: PMC8593872 DOI: 10.1111/jgs.16170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Shoshana Streiter
- New England GRECC (Geriatric Research, Education, and Clinical Center), VA Boston Healthcare System, Boston, Massachusetts.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Julia Loewenthal
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sarah Berry
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
| | - Andrea Wershof Schwartz
- New England GRECC (Geriatric Research, Education, and Clinical Center), VA Boston Healthcare System, Boston, Massachusetts
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Abstract
INTRODUCTION The Geriatrics 5Ms provide a novel framework for caring for older adults that directly maps to the current Accreditation Council for Graduate Medical Education (ACGME) core competencies in geriatrics for internal and family medicine residents. Using the 5Ms framework of Mobility, Medications, Mind, Multicomplexity, and Matters Most, we conducted a workshop for residents in a primary care clinic to improve care of older adults. METHODS Through Kern's six-step approach to curriculum development, we used our needs assessment and stakeholder interviews to guide development of a half-day Geriatrics 5Ms workshop for residents in primary care. The workshop was piloted with 33 internal medicine residents and included interactive modules and point-of-care tools for each of the Geriatrics 5Ms centered on a longitudinal primary care patient case. RESULTS Initial evaluation of the workshop showed high satisfaction and indicated residents appreciated learning about point-of-care tools for primary care, particularly for cognitive assessment, prognosticating, and deprescribing. Of the learners completing the workshop, 75% reported high self-efficacy ratings (score > 3.5) on the Geriatrics 5Ms domains, compared to only 40% of control learners and 20% of learners completing the preworkshop needs assessment. DISCUSSION A longitudinal, interactive, case-based workshop using the Geriatrics 5Ms framework improved primary care residents' self-efficacy and knowledge of tools in the care of older adults and geriatric competencies outlined by the ACGME. The workshop offers an innovative and efficient method to teach geriatrics to residents in primary care and prepare them to care for an aging population.
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Affiliation(s)
- Sarah C. Phillips
- Fellow, Division of Geriatrics, Boston University School of Medicine
- Physician, Division of Geriatrics and Palliative Care, VA Boston Medical Center
- Affiliated Fellow in Geriatrics, New England Geriatric Research Education and Clinical Center
| | - Chelsea E. Hawley
- Clinical Pharmacist, Department of Pharmacy, VA Boston Medical Center
- Advanced Fellow in Geriatrics, New England Geriatric Research Education and Clinical Center
| | | | - Andrea Wershof Schwartz
- Physician, Division of Geriatrics and Palliative Care, VA Boston Medical Center
- Instructor of Medicine, Department of Medicine, Harvard Medical School
- Geriatrician, New England Geriatric Research Education and Clinical Center
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Amir O, Schwartz AW. IMPROVING CARE FOR RURAL TRIBAL OLDER ADULTS THROUGH A GERIATRICS CURRICULUM FOR INDIAN HEALTH SERVICE PROVIDERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- O Amir
- New England GRECC and Harvard Medical School, Jamaica Plain, Massachusetts, United States
| | - A W Schwartz
- Division of Geriatrics and Palliative Care, VA Boston Healthcare System VA New England GRECC - Geriatric Research Education and Clinical Center, Boston, MA, USA; Instructor in Medicine, Harvard Medical School, Boston, MA, USA
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44
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Affiliation(s)
- Ariela R Orkaby
- New England GRECC (Geriatric Research, Education, and Clinical Center), Division of Geriatrics and Palliative Care, VA Boston HealthCare System, Boston, Massachusetts.,Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrea Wershof Schwartz
- New England GRECC (Geriatric Research, Education, and Clinical Center), Division of Geriatrics and Palliative Care, VA Boston HealthCare System, Boston, Massachusetts.,Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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45
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Affiliation(s)
- Andrea Wershof Schwartz
- Division of Geriatrics and Palliative Care, Veterans Affairs Boston HealthCare System New England GRECC (Geriatrics Research Education and Clinical Center), Boston, Massachusetts2Harvard Medical School, Boston, Massachusetts
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Schwartz AW. James P. Ferris 1932-2016. ORIGINS LIFE EVOL B 2016; 47:1-2. [PMID: 27068152 DOI: 10.1007/s11084-016-9505-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A W Schwartz
- Radboud University Nijmegen, Nijmegen, Netherlands.
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Wershof Schwartz A. "The best of doctors go to hell": how an ancient talmudic aphorism can inform the study and practice of medicine. Virtual Mentor 2014; 16:656-658. [PMID: 25140691 DOI: 10.1001/virtualmentor.2014.16.08.mnar1-1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Medical students and faculty explore the medical humanities for diverse reasons: as a medium for self-reflection, a means to cultivate professionalism and humanism, and a way to gain an appreciation for the broader contexts in which illness and health occur. One important area for development is increasing the exposure of learners and clinicians of various levels of training to the medical humanities and to role models in the field. Student-led programs in the medical humanities at the American Medical Student Association (AMSA) address these needs by offering unique opportunities for learning and sharing experiences. AMSA programs connect physicians-in-training using technology to create virtual communication and learning opportunities. These include monthly book discussion webinars, the Writers' Institute and the Medical Humanities Scholars Program (MHSP).
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Affiliation(s)
- Aliye Runyan
- Education and Research Fellow, American Medical Student Association, 21855 Locomotive Terrace, #303, Sterling, VA, 20166, USA,
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Affiliation(s)
| | | | - Sathya Karunananthan
- Solidage Research Group on Frailty and Aging: McGill University and Université de Montréal; Montreal; Canada
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Schwartz AW, Abramson JS, Wojnowich I, Accordino R, Ronan EJ, Rifkin MR. Evaluating the Impact of the Humanities in Medical Education. ACTA ACUST UNITED AC 2009; 76:372-80. [DOI: 10.1002/msj.20126] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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