Keeping Granny Safe on July 1: A Consensus on Minimum Geriatrics Competencies for Graduating Medical Students

Abstract

Competency-based education prepares trainees to perform tasks occurring within the context of practice. There are currently no geriatrics-specific, competency-based consensus performance standards for medical students.The authors present the results of a systematic, multimethod process to identify and define the minimum geriatrics-specific competencies needed by a new intern to adequately care for older adults. An alpha draft was crafted by geriatricians, identifying measurable performance subtasks associated with accepted standards of evidence-based geriatric care, patient safety, and "do no harm" within the first-year resident's expected scope of practice. The competencies were then assessed for content validity by key stakeholders and informants. Of the 315 respondents, 26% were geriatricians, 21% family physicians, 24% general internists, 6% neurology program directors, 14% surgery program directors, and 9% other. Twenty-four were decanal appointees. Faculty from almost half (44%) of U.S. medical schools and representatives of several major medical education organizations were present at the working conference.The final document consists of 26 competencies nested within eight content domains: Medication Management; Self-Care Capacity; Falls, Balance and Gait Disorders; Hospital Care for Elders; Cognitive and Behavioral Disorders; Atypical Presentation of Disease; Health Care Planning and Promotion; and Palliative Care.Setting minimum geriatric competency standards establishes the performance benchmarks for medical school graduates who as first-year residents will care for geriatric patients. Only half-facetiously, they are referred to as the "Don't Kill Granny" competencies. Achievement of these minimum competencies by medical students, grounded in evidence-based principles of quality care for older adults, will assure that, each year, older patients are in safer hands on July 1.

Medicine in the 21st Century: Recommended Essential Geriatrics Competencies for Internal Medicine and Family Medicine Residents

“…In the context of numerous ongoing projects to define geriatrics competencies among surgical and related specialties 14 and medical subspecialties, 15 there is an opportunity to identify common and related competencies for all residents who care for older adults. Most immediately, the IM/FM geriatrics competencies can be used as a basis for defining competencies for medical subspecialty fellows, including geriatrics fellows.…”

“…Consistent with this recommendation, in a project beginning in 2007, 26 recommended essential geriatrics competencies that medical students should demonstrate by the beginning of residency have been defined. 15 The recent activity in geriatrics education for physicians in all disciplines, the IOM recommendations, and the development of minimal competencies for medical students provide an opportunity to establish essential competencies in geriatrics for all physicians entering primary care practice or medical subspecialty training. This paper describes the process and outcome of a project to define a set of essential competencies related to the care of older adults by IM and FM residents.…”

Can Scientific Research Enhance the Effectiveness of Training? The Experience of the Department of Family Medicine

“…Далее предварительный вариант программы был предложен для обсуж-дения и согласования заинтересованным орга-низациям: лицензирующим органам, профессио-нальным ассоциациям, преподавателям, универ-ситетам. Подобный подход помогает избежать разногласий, несогласованных действий и обе-спечивает унификацию обучения [8].…”

Assessing Effectiveness of a Geriatrics Rotation for Second-Year Internal Medicine Residents

“…Equally difficult is measuring the effectiveness of this rotation; in addition to knowledge, impact on attitude is a high priority. 2 Resident-level assessments of geriatrics knowledge are few, limited in scope, and often outdated. The University of Michigan Geriatrics Clinical Decision-Making Assessment Instrument, 3 although well-crafted, includes palliative care content and dates back to 2006.…”