The Consortium of E-Learning in Geriatrics Instruction

This paper describes the activities of the Consortium of E-Learning in Geriatrics Instruction (CELGI), a group dedicated to creating, using, and evaluating e-learning to enhance geriatrics education. E-learning provides a relatively new approach to addressing geriatrics educators' concerns, such as the shortage of professionals trained to care for older people, overcrowded medical curricula, the move to transfer teaching venues to community settings, and the switch to competency-based education models. However, this innovative education technology is facing a number of challenges as its use and influence grow, including proof of effectiveness and efficiency. CELGI was created in response to these challenges, with the goal of facilitating the development and portability of e-learning materials for geriatrics educators. Members represent medical and nursing schools, the Department of Veterans Affairs healthcare system, long-term care facilities, and other institutions that rely on continuing streams of quality health education. CELGI concentrates on providing a coordinated approach to formulating and adapting specifications, standards, and guidelines; developing education and training in e-learning competencies; developing e-learning products; evaluating the effect of e-learning materials; and disseminating these materials. The vision of consortium members is that e-learning for geriatric education will become the benchmark for valid and successful e-learning throughout medical education.     

Geriatrics Consultation:

Geriatric consultation in an acute hospital setting is one of a number of modalities used to teach clinical geriatric medicine to post-graduate trainees and clinical clerks. Since 1980 the Medical College of Wisconsin, Department of Medicine, Section of Geriatrics and Gerontology has offered a consultation service in geriatrics. This report summarizes our two-year experience using two different consultation modalities.     

Learner-Centered Education in Gerontology and Geriatrics

ABSTRACT

This article serves as an introduction to the special issue on learner-centered education in gerontology and geriatrics. The author discusses the origin of the special issue in a preconference workshop sponsored by the Association for Gerontology in Higher Education at the Annual Scientific Meeting of the Gerontological Society of America in 2006, introduces the concept of learner-centered education, and briefly describes the articles in the special issue.     

Integrating and Evaluating Geriatrics in Medical School: A Novel Approach for the Challenge

Brown Medical School developed a comprehensive curriculum in which enriched aging content increased from 22 to 80 hours in preclerkship courses and was also added for clerkships, residencies, and nongeriatrician physicians. Innovative evaluation strategies are also described. Highlights include “treasure hunts” in the anatomy laboratory, a Scholarly Concentration in Aging, Schwartz Communication Sessions, a Website of aging-related materials, and a monthly column in the state medical journal. Evaluation includes “tracking” to compute the “dose” of aging content, and “journaling” and focus groups to evaluate students' responses. Integrating geriatrics across a broad range of courses and clinical experiences is feasible.     

Medical Readers' Theater: Relevance to Geriatrics Medical Education

Medical Readers' Theater (MRT) is an innovative and simple way of helping medical students to reflect on difficult-to-discuss topics in geriatrics medical education, such as aging stereotypes, disability and loss of independence, sexuality, assisted living, relationships with adult children, and end-of-life issues. The authors describe a required MRT experience involving third-year medical students on their Family Medicine clerkship and volunteer residents from a nearby continuing care retirement community. Evaluation of the program shows positive benefits to student and senior participants in terms of greater awareness of each other's perspectives and improved communication.     

Professional Development and Exposure to Geriatrics: Medical Student Perspectives From Narrative Journals

Teaching professionalism is an important goal in American medical education. With the aging of the U.S. population, it is critical to understand how medical students develop professional behaviors when caring for older adults. Exposure to geriatrics and older patients can enhance students’ professional development with patients of all ages and across different specialties. Medical students learn explicit and implicit messages during their education. In addition to helping to evaluate curricula, reflective journaling encourages individual development and helps in revealing how medical students become professionals. In this study, medical student volunteers described their responses to new geriatrics content in their curriculum, encounters with older patients in clinical settings, and their evolving physician identities. Multidisciplinary team analysis elicited 10 themes regarding: evaluation of geriatrics within the curriculum, recognition of geriatrics principles, and attitudes regarding aging and professional development over time. This article focuses on the impact of geriatrics exposure on students’ professional development, revealing ways that students think about professionalism and older patients. Medical educators should consider journaling to help foster and gauge students’ professional development.     

Community Physician Education in Geriatrics: Applying the Assessing Care of Vulnerable Elders Model with a Multisite Primary Care Group

Providing practicing physicians with effective education that leads to better patient outcomes remains challenging. In 2003, the University of Cincinnati College of Medicine developed a comprehensive program to enhance practicing physician geriatric medicine education based on the Assessing the Care of Vulnerable Elders model. The program was implemented with a large, multisite primary care group based in the greater Cincinnati area and was designed to increase physicians' clinical skills and assist them in implementing new office and system strategies that could improve the quality of care for their older patients. Four topic areas were chosen: medication management, falls and mobility, urinary incontinence, and dementia. A multifaceted physician education program was developed for each topic area, with lunch‐time, in‐office, geriatrician‐led presentations as the primary intervention. Over a 4‐year period (2004–2007), more than 60 physicians in 16 primary care practices attended 107 teaching sessions. The value of the presentation content, quality of the presentations, and perception of meeting the primary care physicians' (PCPs') educational needs were each rated at 3.8 or above (4=excellent). Between 80% and 92% of the PCPs planned to make a change in their practice behavior as a result of the training, but only two offices initiated formal quality improvement projects. During the teaching sessions, the PCPs were provided with screening tools to identify “at risk” patients, assessment chart templates, and community resource and patient education materials. The application of a modified version of the ACOVE model to reach a large group of primary care physicians is possible and may be one strategy to improve the assessment and management of geriatric syndromes.     

A Brief, Intensive, Clinically Focused Geriatrics Course During the Third Year of Medical School

During the next several decades, the aging of the "baby boom" generation in the United States will result in a dramatic increase in the number of patients aged 65 and older seeking medical care, but current projections suggest that the shortage of geriatrics-trained specialists will only worsen during this time period. As a result, the care of elderly patients will largely fall to other types of physicians. Consequently, it is imperative that medical school training include exposure to the basic skills needed to care safely for older adults. This goal is challenging, because the number of geriatric medicine faculty in most academic medical centers is small, and multiple other medical specialties are also vying for time in a busy medical school curriculum. Whether a 3-day course conducted during the third year of medical school could teach basic principles of geriatric medicine in a time- and manpower-effective manner was explored. It was found that even this brief exposure to geriatrics could have meaningful effects on student knowledge of and comfort with geriatrics.     

Position Statement on Interdisciplinary Team Training in Geriatrics: An Essential Component of Quality Health Care for Older Adults

Interdisciplinary team training (IDT) is an important component of ensuring quality geriatric care delivery, which can be complex and time intensive, requiring coordination of many medical, psychosocial, and therapeutic interventions and professionals. The Partnership for Health in Aging (PHA), a loose coalition of more than 30 organizations representing healthcare professionals who care for older adults supported by the American Geriatrics Society, identified IDT training in geriatrics as a priority area in addressing the geriatrics workforce shortage described in the 2008 Institute of Medicine report, Retooling for An Aging America: Building the Health Care Workforce. A PHA Workgroup on Interdisciplinary Team Training in Geriatrics was convened to review the literature focused on geriatrics IDT training and to develop a position statement that would inform and influence groups involved in the development and expansion of academic and continuing education programs in IDT training, including professional associations, credentialing and licensing bodies, accreditation organizations, and university administrators. There are significant challenges to expanding the development and implementation of geriatrics IDT training for health professionals, and such training will be successful only with substantial and sustained advocacy from the above professional groups.     

Interprofessional training: Geriatrics and palliative care principles for primary care teams in an ACO

ABSTRACT

There is a well-described need to increase the competence of the primary care workforce in the principles of geriatrics and palliative care, and as value-based payment models proliferate, there is increased incentive for the acquisition of these skills. Through a Geriatric Workforce Enhancement Program grant, we developed an adaptable curriculum around commonly encountered topics in palliative care and geriatrics that can be delivered to multidisciplinary clinicians in primary care settings. All participants in this training were part of an Accountable Care Organization (ACO) and were motivated to improve to care for complex older adults. A needs assessment was performed on each practice or group of learners and the curriculum was adapted accordingly. With the use of patient education and screening tools with strong validity evidence, the participants were trained in the principals of geriatrics and palliative care with a focus on advance care planning and assessing for frailty and functional decline. Comparison of pre- and post-test scores demonstrated increased confidence and knowledge in goals of care and basic geriatric assessment. Participants described feeling more able to address needs, have conversations around goals of care, and more able to recognize patients who would benefit from collaboration with geriatrics and palliative care.     

Medical Students' Recognition and Application of Geriatrics Principles in a New Curriculum

Given the aging U.S. population, it is imperative that medical students recognize and apply geriatrics principles. To address this need, in 2006, the Warren Alpert Medical School of Brown University integrated geriatrics content into a new medical school curriculum. Preclinical and clinical medical students submitted written reflective journals in response to prompts regarding the geriatrics content of the new medical school curriculum, including their didactic and clinical experiences. An interdisciplinary team used a structured qualitative approach to identify themes, including the recognition and application of geriatrics principles. Thirty medical student journalers submitted 405 journal entries. Themes regarding students' emerging understanding of geriatrics principles included a growing understanding of geriatrics principles, recognition of the importance of psychosocial factors and patient preferences in caring for older adults, recognition of the complexities of treating older adults and application of geriatric principles to clinical situations, and understanding of physicians' roles in managing the care of older adults. Medical student reflective journaling allows medical educators to obtain timely feedback on curricular innovations and helps illuminate the process by which medical students learn to recognize and apply core geriatrics principles.     

Meeting the Need for Training in Geriatrics: The Geriatrics Education for Specialty Residents Program

The imperative created by increasing numbers of aging Americans coupled with increasing longevity has generated recognition and acceptance within american medicine that education, from medical school through postgraduate training through continuing medical education, must include appropriate knowledge and skills in aging and geriatrics to provide for effective care of older adults. Such education and training is necessary not only for traditional primary care providers, but also for specialty physicians, including those in most surgical specialties and in related fields such as anesthesiology, emergency medicine and physical medicine and rehabilitation. To fill this demand, the American Geriatrics Society Geriatrics for Specialist Initiative established the Geriatrics Education for Specialty Residents Program (GSR). This article reviews the process by which the GSR created a dynamic cohort of geriatric surgical educators and researchers who in turn created a vibrant body of educational tools and scientific works that continue to advance the cause of improving medical care of older adults.     

Designing a Learner-Centered Geriatrics Curriculum for Multilevel Medical Learners

This article describes the development of a learner-centered, needs-based geriatrics curriculum for medical trainees, specifically, a geriatric block rotation for family medicine and internal medicine residents with the incorporation of a new group of learners: medical students. The objectives were to develop a curriculum that meets the needs of learners with diverse levels of geriatric experience and learning needs. The process used to accomplish these objectives is outlined. In an effort to design a learner-centered, competence-based curriculum, two instruments were developed. These instruments served to identify the learning needs of the varied levels of learners and to develop the specific goals and objectives of this 4-week geriatric rotation. The Geriatric Self-Competency Checklist (GSCC) and a Geriatric Knowledge Test were administered before and after the rotation. On average, learners identified eight priority learning needs using the GSCC. Evaluation and feedback from faculty and preceptors was also important in the identification of learning needs and during the learning process. Faculty development was initiated, focusing on the identification of competence in specific curricular areas. Examples of application of adult learning principles in curriculum design and implementation are also shared. No additional costs or faculty were required for this project, which is important if scarce academic geriatrics resources are to be used to reach the many more medical students and residents. This is essential for quality care needs of the rapidly aging population.