No abstract

Effectively handling telephone calls about nursing home (NH) residents is an important skill for healthcare professionals, but little formal training is typically provided. The objective of the current study was to describe and evaluate the effectiveness of a novel structured role-playing didactic session followed by an on-call NH longitudinal clinical experience. The effectiveness of the structured role-playing didactic session was compared in different learners, including geriatric medicine fellows (n = 10), family medicine residents and faculty (n = 14), nurse practitioner students (n = 31), and other learners (n = 7). The curriculum focused on common problems encountered while caring for NH residents during on-call periods. Learners rated themselves using an 18-item pre/post questionnaire including five attitude and 13 skills questions, using a 1-to-5 Likert scale. T-tests were used to compare means before and after sessions. Significant improvements were found in overall mean attitudes and skills scores. For all learners, the greatest improvements were seen in "comfort in managing residents at the NH," "managing feeding or gastrostomy tube dislodgement," "identifying different availability of medications, laboratory studies, and procedures in NH," and "describing steps to send NH residents to the emergency department." Geriatric medicine fellows' attitudes and skills improved significantly after the longitudinal clinical experience. The faculty survey demonstrated improved documentation, communication, and fellows' management of on-call problems after curriculum implementation. This novel curriculum used role-playing to provide training for on-call management of NH residents. This curriculum has been successfully disseminated on a national geriatrics educational resource website (POGOe) and is applicable to geriatric medicine fellowships, internal medicine and family medicine residency programs, and other training programs.

Background: VitalTalk is an established training program for serious illness conversations in the US. Previously, this training course has been provided in-person in Japanese, but never virtually. Objectives: To evaluate the feasibility of a virtually administered VitalTalk workshop in Japanese. Setting/Subjects: We conducted a virtual workshop which consisted of 2 days (3 hours per day) of synchronous sessions and preceding asynchronous modules. Five VitalTalk faculty members in the US facilitated 4 workshops for 48 physicians from 33 institutions across Japan. Learners completed surveys before and after the workshop. Measurements: To evaluate the feasibility, learners were asked for their satisfaction with the workshop and the virtual format as primary outcomes and their self-assessed preparedness in serious illness communication as the secondary outcome. Each question employed a 5-point Likert scale. Results: All learners (n = 48, male 79%) participated in the survey. The mean score of the learners’ satisfaction was 4.69 or higher in all questions. The mean score of the virtual format’s satisfaction was 4.33 or higher in all questions. The mean score of self-reported preparedness on the 11 questions were between 2.30 and 3.34 before the workshop, all of which significantly increased to 3.08 through 3.96 after the workshop (p < 0.01 in all questions). Conclusion: Learners in Japan perceived the virtual format of our VitalTalk workshop as satisfactory, and their self-reported preparedness improved significantly after the workshop. VitalTalk faculty members in the US were able to provide virtual communication training to physicians in Japan.

The interdisciplinary team (IDT) approach is critical in the care of elderly adults. Performance-based tools to assess IDT skills have not been well validated. A novel assessment tool, the standardized patient (SP) and standardized interdisciplinary team meeting (SIDTM), consisting of two stations, was developed. First, trainees evaluate a SP hospitalized after a fall. Second, trainees play the role of the physician in a standardized IDT meeting with a standardized registered nurse (SRN) and standardized medical social worker (SMSW) for discharge planning. The SP-SIDTM was administered to 52 fourth-year medical students (MS4s) and six geriatric medicine fellows (GMFs) in 2011/12. The SP, SRN, and SMSW scored trainee performance on dichotomous checklists of clinical tasks and Likert scales of communication skills, which were compared according to level of training using t-tests. Trainees rated the SP-SIDTM experience as moderately difficult, length of time about right, and believability moderate to high. Reliability was high for both cases (Cronbach α = 0.73-0.87). Interobserver correlation between SRN and SMSW checklist scores (correlation coefficient (r) = 0.82, P < .001) and total scores (r = 0.69, P < .001) were high. The overall score on the SP-SIDTM case was significantly higher for GMF (75) than for MS4 (65, P = .002). These observations support the validity of this novel assessment tool.