Geriatrics Curricula for Internal and Family Medicine Residents: Assessing Study Quality and Learning Outcomes

Cheng, Huai Yong; Davis, Martha F.

doi:10.4300/jgme-d-16-00037.1

Cited by 9 publications

(16 citation statements)

References 38 publications

(133 reference statements)

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“…Consensus guidelines for content in geriatrics skills, knowledge, and behaviors for internal medicine residents have been published; twenty-six minimum geriatrics competencies (MGCs) for IM/family medicine (FM) residents were developed in agreement with ACGME core clinical competencies [ 3 ]. However, most published geriatrics curricula address a limited number of MGCs [ 4 ], or are comprehensive programs requiring significant faculty development and additional funding [ 5 , 6 , 7 , 8 ]. Frequently reported outcomes assessments were Kirkpatrick levels 2a and 2b in knowledge and attitudes [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, most published geriatrics curricula address a limited number of MGCs [ 4 ], or are comprehensive programs requiring significant faculty development and additional funding [ 5 , 6 , 7 , 8 ]. Frequently reported outcomes assessments were Kirkpatrick levels 2a and 2b in knowledge and attitudes [ 4 ]. Residency programs should use training strategies that are outcomes based, directly assessing professional skills and behaviors, i.e., Kirkpatrick levels 3 and 4 [ 9 , 10 , 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Teaching Geriatrics and Transitions of Care to Internal Medicine Resident Physicians

Jackson

Larson

et al. 2020

Geriatrics

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(1) Background: Internal medicine (IM) resident physicians need to be trained to care for older adults and transition them safely across care settings. Objective: The study purpose was to evaluate the efficacy of a curriculum in geriatrics assessment and communication skills for transitions of care (TOCs) to IM resident physicians. (2) Methods: IM residents rotated for 4 weeks on the geriatrics consult service at a large public teaching hospital, where they received didactic lectures and clinical experience in consultation and transitional care. The curriculum was designed to meet consensus guidelines for minimum geriatrics competencies expected of IM residents. Previously validated and published assessment tools were used for geriatrics knowledge and attitudes. Locally developed tools were used to directly observe and rate communication skills, and self-assess geriatrics assessment and health literacy skills. The curriculum was evaluated using a quasi-experimental, nonrandomized, single-group pre- and post-test observational design. Data on 31 subjects were collected over 18 months and analyzed using mixed-effects models. (3) Results: Average knowledge scores improved from 65% to 74% (Δ9%, 95% CI 4–13%, p < 0.001). Communication skills improved by an average of 1.15 points (95% CI 0.66–1.64, p < 0.001) on a 9-point scale. Attitudes did not change significantly. Self-rated confidence in geriatrics assessment and health literacy skills improved modestly. (4) Conclusions: The curriculum is effective in teaching basic geriatrics knowledge and communication skills, and increasing self-confidence in geriatrics assessment skills. In settings where an inpatient geriatrics consult service is feasible, the curriculum may be a model for combining geriatrics and TOC training.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Teaching Geriatrics and Transitions of Care to Internal Medicine Resident Physicians

Jackson

Larson

et al. 2020

Geriatrics

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“…The number of geriatric fellowship-trained physicians (geriatricians), who provide appropriate care for older adults, is not expected to meet the needs of a growing aging population. As a result, many older adults will rely on general physicians for their care 10 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the geriatric curriculum implemented at Shiraz University of Medical Sciences, Iran, since 2017: A qualitative study

2019

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Background: Recently, there has been an increase in life expectancy due to improvements in nutrition, health, and sanitation. The aim of this study was to evaluate the geriatric curriculum in the field of general medicine at Shiraz University of Medical Sciences (SUMS), Iran to improve the quality of services provided to this population in the community. Methods: This was a qualitative study. Six educational hospitals and ambulatory centers of Shiraz University of Medical Sciences participated in this study. Within these centers, 15 medical education faculty members and educational experts, 6 medical students, 6 elderly patients and 6 nurses working in the university related to the geriatric field were selected using purposive sampling. Data were gathered through semi-structured interviews, focus group discussion and field observations in the teaching hospital and ambulatory setting of SUMS from June 2017 to May 2018. Based on the qualitative research, the data underwent conventional content analysis and the main themes were developed from this. Results: Three main themes were extracted from the data: effective clinical education, geriatrics curriculum challenges and promotion strategies for geriatric medicine. Subcategories that emerged were a competent curriculum teacher, a challenging program, management of resources, promotion of the program, and the revision required in the curriculum, which were related to other concepts and described in the real-world situation of the geriatric curriculum in the university, as observed in field observations. Conclusions: This study identified three concepts as main themes that can be used to explain how to implement a geriatric curriculum in a medical university. The main contributing factor to different views of the participants was identified as the revision required to the curriculum for integrative care in a geriatric patient. This should be taken into consideration while planning any programs and decisions aimed at education of medical students on this topic.

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“…Older adults account for more than one-third of annual visits to primary care physicians and subspecialists, many of whom lack formal geriatrics training. [1][2][3][4] Polypharmacy, commonly defined as the use of five or more medications, is increasing among older adults (from 31% in 2006 to 36% in 2011) 5 and is a proven predictor of prescribing problems. These problems include inappropriately dosed medications, drug-drug interactions, and drug-disease interactions.…”

Section: Introductionmentioning

confidence: 99%

“…7,8 Many organizations have unilaterally attempted to modify physician education and the health care system to respond to the growing number of older patients. 1,2,[9][10][11][12][13] Despite these efforts, most trainees and practitioners remain less confident in their ability to care for older adults with complex medical conditions and polypharmacy. 3,9,11,12,14 The American Geriatrics Society (AGS), 15 Institute for Healthcare Improvement, 16 and Agency for Healthcare Research and Quality 17 recommend medication reconciliation as a best practice in patient care.…”

Section: Introductionmentioning

confidence: 99%

Brown Bag Simulation to Improve Medication Management in Older Adults

et al. 2019

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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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Geriatrics Curricula for Internal and Family Medicine Residents: Assessing Study Quality and Learning Outcomes

Abstract: Background Prior reviews of geriatrics curricula for internal medicine (IM) and family medicine (FM) residents have not evaluated study quality or assessed learning objectives or specific IM or FM competencies.

Cited by 9 publications

References 38 publications

Teaching Geriatrics and Transitions of Care to Internal Medicine Resident Physicians

Teaching Geriatrics and Transitions of Care to Internal Medicine Resident Physicians

Evaluation of the geriatric curriculum implemented at Shiraz University of Medical Sciences, Iran, since 2017: A qualitative study

Brown Bag Simulation to Improve Medication Management in Older Adults

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