Teaching Resident Physicians Chronic Disease Management: Simulating a 10-Year Longitudinal Clinical Experience With a Standardized Dementia Patient and Caregiver

Abstract

Background Education for all physicians should include specialty-specific geriatrics-related and chronic disease-related topics. Objective We describe the development, implementation, and evaluation of a chronic disease/geriatric medicine curriculum designed to teach Accreditation Council for Graduate Medical Education core competencies and geriatric medicine competencies to residents by using longitudinal encounters with a standardized dementia patient and her caregiver daughter. Intervention Over 3 half-day sessions, the unfolding standardized patient (SP) case portrays the progressive course of dementia and simulates a 10-year longitudinal clinical experience between residents and a patient with dementia and her daughter. A total of 134 residents participated in the University of Cincinnati-based curriculum during 2007–2010, 72% of whom were from internal medicine (79) or family medicine (17) residency programs. Seventy-five percent of participants (100) said they intended to provide primary care to older adults in future practice, yet 54% (73) had little or no experience providing medical care to older adults with dementia. Results Significant improvements in resident proficiency were observed for all self-reported skill items. SPs' evaluations revealed that residents' use of patient-centered language and professionalism significantly improved over the 3 weekly visits. Nearly all participants agreed that the experience enhanced clinical competency in the care of older adults and rated the program as “excellent” or “above average” compared to other learning activities. Conclusions Residents found this SP-based curriculum using a longitudinal dementia case realistic and valuable. Residents improved in both self-perceived knowledge of dementia and the use of patient-centered language and professionalism.

Internal Medicine Residents' Ambulatory Management of Core Geriatric Conditions

“…3 In 2010, minimum competencies in geriatrics for IM (and family medicine) residents were developed and supported by the American Medical Association, the American Geriatrics Society, the American Board of Family Medicine, and the Society of General Internal Medicine. 4 Although numerous studies document the positive impact of formal teaching of IM residents in geriatrics with an emphasis on competencies, [5][6][7][8][9] the majority of studies in geriatrics education focus on curricula for subspecialty-specific experience silos such as long-term care 10 or dedicated geriatrics rotations. 11 Few studies have addressed the process of establishing competency in the care of older adults in IM residents' own longitudinal ambulatory experience.…”

Geriatric Educational Interventions for Physicians Training in Non-Geriatric Specialties: A Scoping Review

“…and group collaborative learning (14 studies, 23%). 23,24,28,31,32,37,38,51,57,59,62,65,67,69 One example combined a perioperative ward experience with didactic teaching and group debriefing. 67 The next most common combinations were passive approaches combined with either group learning (9 studies, 15%) 22,27,40,42,45,49,50,58,82 or with practi c al co n s tr u c ti ve ap p r o ach e s (8 s t u d ie s , 13%).…”