Continuing medical education, continuing professional development, and knowledge translation: improving care of older patients by practicing physicians

Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners.     

Faculty development in geriatrics for clinician educators: a unique model for skills acquisition and academic achievement

As the size of the aged American population increases, so too does the shortage of trained providers in geriatrics. Educational strategies to train physicians at all levels of experience within adult medical and surgical disciplines are needed to complement fellowship training, given the small size of most academic faculties in geriatrics. This article describes a unique faculty development program that creates geriatrically oriented faculty in multiple disciplines. The Boston University Center of Excellence in Geriatrics (COE), funded by the John A. Hartford Foundation, has trained 25 faculty members. Four to six scholars enter the program each year and participate in the COE 1 day per week. Nine months are spent in four content modules-Geriatrics Content, Clinical Teaching, Evidence-based Medicine, and Health Care Systems; 3 months are spent in supervised scholarly activities and clinical settings. A self-report questionnaire and a structured interview were used to evaluate the outcomes of participation in the COE. The results from the first 4 years of the program are reported. The response rate was 83% for the self-report questionnaire and 75% for the structured interview. The results indicate that the COE is effective in improving scholars' assessment and management of older patients. The structured interview revealed that the COE program promotes the integration of geriatrics into clinical teaching at the medical student and resident level. Participants also completed scholarly projects in geriatrics. This program effectively trains faculty scholars to better care for older adults and to teach others to do likewise.     

Evaluation of a continuing education program in rheumatoid arthritis

A continuing medical education (CME) program in rheumatoid arthritis was implemented and evaluated in six community hospitals. It was targeted at primary care physicians and utilized physicians identified by their peers as being educationally influential for the dissemination of content knowledge. Although inpatient and outpatient audits of physician records demonstrated little change in three control communities, substantial improvement in the utilization of diagnostic procedures and patient management was documented in the three intervention communities utilizing the influential physicians. CME delivered through community-based educationally influential physicians is an effective way to change physician behavior in small communities with no prior ongoing educational programs. This approach should improve the primary care given to patients with rheumatoid arthritis and reduce the need for participation of academic faculty in traditional CME programs.     

The use of the internet in geriatrics education: results of a national survey of medical geriatrics academic programs

In order to characterize use of the Internet in medical geriatrics education programs, 130 medical education programs in the U.S. that train medical students, interns, residents, fellows and practicing physicians were asked to complete a survey developed by the Consortium of E-Learning in Geriatrics Instruction (CELGI). Sixty-eight programs (52.3%) returned surveys. Fifty-four (79%) of those responding reported using the Internet specifically for geriatric medical education, and 38 (56%) reported they are developing Internet materials. Twentythree undergraduate, 31 graduate, and 26 continuing medical education programs reported at least 25% of their curriculum was Internet-based. Users and developers of medical geriatric Internet materials had more full-time faculty and nonclinical faculty. The results of our survey indicate that the Internet is being widely used in medical geriatric education.     

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.     

A Collaborative National Model to Assess Competencies for Medical Students,Residents, and Other Healthcare Practitioners in Gait and Falls Risk Evaluation

To ensure that the healthcare workforce is adequately prepared to care for the growing population of older adults, minimum competencies in geriatrics have been published for medical students and primary care residents. Approaches to teaching and assessing these competencies are needed to guide medical schools, residencies, and continuing medical education programs. With sponsorship by the Education Committee and Teachers Section of the American Geriatrics Society (AGS), geriatrics educators from multiple institutions collaborated to develop a model to teach and assess a major domain of student and resident competency: Gait and Falls Risk Evaluation. The model was introduced as a workshop at annual meetings of the AGS and the American College of Physicians in 2011 and 2012. Participants included medical students, residents, geriatrics fellows, practicing physicians, and midlevel practitioners. At both national meetings, participants rated the experience highly and reported statistically significant gains in overall competence in gait and falls risk evaluation. The largest gains were observed for medical students, residents, and practicing physicians (P < .001 for all); geriatrics fellows reported a higher level of baseline competence and therefore had a lower magnitude of improvement, albeit still significant (P = .02). Finally, the majority of participants reported intent to disseminate the model in their institutions. This article describes the design, implementation, and evaluation of this collaborative national model. A number of institutions have used the model, and the goal of this article is to aid in further dissemination of this successful approach to teaching and assessing geriatrics competencies.     

Collaboration in the preparation of the generalist physician

Collaborative efforts among health care professionals and institutions at all levels will be essential to the increased production of generalist physicians. There have been many successful collaborations in education and patient care among certifying boards, faculty, physicians in practice, specialists, generalists, and non-physician health professionals, as well as among the three generalist specialties. Recommended strategies to encourage collaboration in the preparation of generalist physicians include: creation of an institutional collaborative curriculum committee; design of a longitudinal curriculum on collaboration for physicians-in-training and other health professionals; implementation of collaborative patient care in ambulatory care teaching clinics; development of integrated systems of care that link inpatient, outpatient, and community-based health services; and education of physicians-in-training in these and other collaborative and co-practice models of patient care.     

Collaboration in the preparation of the generalist physician

Collaborative efforts among health care professionals and institutions at all levels will be essential to the increased production of generalist physicians. There have been many successful collaborations in education and patient care among certifying boards, faculty, physicians in practice, specialists, generalists, and non-physician health professionals, as well as among the three generalist specialties. Recommended strategies to encourage collaboration in the preparation of generalist physicians include: creation of an institutional collaborative curriculum committee; design of a longitudinal curriculum on collaboration for physicians-in-training and other health professionals; implementation of collaborative patient care in ambulatory care teaching clinics; development of integrated systems of care that link inpatient, outpatient, and community-based health services; and education of physicians-in-training in these and other collaborative and co-practice models of patient care.     

Building Psychosocial Programming in Geriatrics Fellowships: A Consortium Model

Geriatric psychosocial problems are prevalent and significantly affect the physical health and overall well-being of older adults. Geriatrics fellows require psychosocial education, and yet to date, geriatrics fellowship programs have not developed a comprehensive geriatric psychosocial curriculum. Fellowship programs in the New York tristate area collaboratively created the New York Metropolitan Area Consortium to Strengthen Psychosocial Programming in Geriatrics Fellowships in 2007 to address this shortfall. The goal of the Consortium is to develop model educational programs for geriatrics fellows that highlight psychosocial issues affecting elder care, share interinstitutional resources, and energize fellowship program directors and faculty. In 2008, 2009, and 2010, Consortium faculty collaboratively designed and implemented a psychosocial educational conference for geriatrics fellows. Cumulative participation at the conferences included 146 geriatrics fellows from 20 academic institutions taught by interdisciplinary Consortium faculty. Formal evaluations from the participants indicated that the conference: a) positively affected fellows' knowledge of, interest in, and comfort with psychosocial issues; b) would have a positive impact on the quality of care provided to older patients; and c) encouraged valuable interactions with fellows and faculty from other institutions. The Consortium, as an educational model for psychosocial learning, has a positive impact on geriatrics fellowship training and may be replicable in other localities.     

Building psychosocial programming in geriatrics fellowships: a consortium model

Geriatric psychosocial problems are prevalent and significantly affect the physical health and overall well-being of older adults. Geriatrics fellows require psychosocial education, and yet to date, geriatrics fellowship programs have not developed a comprehensive geriatric psychosocial curriculum. Fellowship programs in the New York tristate area collaboratively created the New York Metropolitan Area Consortium to Strengthen Psychosocial Programming in Geriatrics Fellowships in 2007 to address this shortfall. The goal of the Consortium is to develop model educational programs for geriatrics fellows that highlight psychosocial issues affecting elder care, share interinstitutional resources, and energize fellowship program directors and faculty. In 2008, 2009, and 2010, Consortium faculty collaboratively designed and implemented a psychosocial educational conference for geriatrics fellows. Cumulative participation at the conferences included 146 geriatrics fellows from 20 academic institutions taught by interdisciplinary Consortium faculty. Formal evaluations from the participants indicated that the conference: a) positively affected fellows' knowledge of, interest in, and comfort with psychosocial issues; b) would have a positive impact on the quality of care provided to older patients; and c) encouraged valuable interactions with fellows and faculty from other institutions. The Consortium, as an educational model for psychosocial learning, has a positive impact on geriatrics fellowship training and may be replicable in other localities.     

General internal medicine and geriatrics: building a foundation to improve the training of general internists in the care of older adults

Internists--"doctors for adults"--provide most of the medical care given to older Americans, especially those with serious chronic disease. Nonetheless, the United States lacks an adequate physician workforce with mastery in caring for older persons and with expertise in building knowledge about how best to provide this care. This supplement aims to strengthen the physician workforce by fostering incremental and sustained improvements in the training of internal medicine residents in the care of older adults and in the development of geriatrics-oriented general internal medicine faculty. It identifies 3 major barriers to these improvements: lack of adequately trained teachers and mentors, the belief that explicit training in geriatrics has little to offer the generalist, and inadequate funding. Three strategies offer particular promise in overcoming these barriers: engaging directors of internal medicine residency programs, funding centers to promote collaboration between teaching and research programs in general internal medicine and geriatrics, and providing substantial incremental funding on the national level to pay for the time required to care for frail older patients and to teach and do research about this care. The barriers and strategies identified in this supplement may also inform efforts to enhance the skills of practicing physicians and improve training and faculty development in family medicine and other disciplines.     

Are Internal Medicine Residency Programs Adequately Preparing Physicians to Care for the Baby Boomers? A National Survey from the Association of Directors of Geriatric Academic Programs Status of Geriatrics Workforce Study

Patients aged 65 and older account for 39% of ambulatory visits to internal medicine physicians. This article describes the progress made in training internal medicine residents to care for older Americans. Program directors in internal medicine residency programs accredited by the Accreditation Council for Graduate Medical Education were surveyed in the spring of 2005. Findings from this survey were compared with those from a similar 2002 survey to determine whether any changes had occurred. A 60% response rate was achieved (n=235). In these 3-year residency training programs, 20 programs (9%) required less than 2 weeks of clinical instruction that was specifically structured to teach geriatric care principles, 48 (21%) at least 2 weeks but less than 4 weeks, 144 (62%) at least 4 weeks but less than 6 weeks, and 21 (9%) required 6 or more weeks. As in 2002, internal medicine residency programs continue to depend on nursing home facilities, geriatric preceptors in nongeriatric clinical ambulatory settings, and outpatient geriatric assessment centers for their geriatrics training. Training was most often offered in a block format. The mean number of physician faculty per residency program dedicated to teaching geriatric medicine was 3.5 full-time equivalents (FTEs) (range 0-50), compared with a mean of 2.2 FTE faculty in 2002 (P相似文献   

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.     

Geriatric Training Needs of Family Physicians

Family physicians provide the majority of medical care to the elderly population throughout the country. These physicians require accessible Continuing Medical Education (CME) programs that meet their specific educational needs. This study provides information on the perceived training needs and preferred training modalities reported by a sample of community based family medicine faculty preceptors in a Southeastern state. Respondents preffered short courses focusing on organ system diseases common in the elderly population but also wanted more training in managing some of the more complex nonmedical problems that can adversely affect the delivery of medical care. Findings have implications for CME planners who want to provide family physicians training in geriatrics and gerontology that will positively impact their care of the elderly.     

The geriatrics excellence in teaching series: an integrated educational skills curriculum for faculty and fellows development

Geriatricians need to acquire skills in teaching and curriculum development to educate physicians caring for the growing population of adults aged 65 and older. To meet this challenge, educators in the Duke University Center for the Study of Aging and Human Development introduced a monthly seminar series to promote the development of geriatrics faculty and fellows as clinician educators. Ten educational skills development seminars were incorporated into geriatrics grand rounds in the first year of the program. These sessions were implemented using a variety of active learning strategies to expose participants to innovative adult learning-centered approaches for enhancing learning and instruction in medical education. Participants assessed all sessions using a feedback form and were surveyed at the end of the series to measure their overall satisfaction with the program and ascertain its effect on their roles as educators. Participants rated individual sessions highly, and respondents to the survey at the end of the course agreed that the Geriatrics Excellence in Teaching Series provided them with resources for use in their teaching practices and attested to having already applied knowledge and skills learned in the series in their teaching practices. Key elements for the program's success included an upfront needs assessment to prioritize topics, interactive sessions promoting skill development through actual practice of various strategies, open discussions to identify challenges and solutions, and a convenient and customary time slot. This format can be replicated with other geriatrics programs, providing a needed opportunity for faculty and fellows to learn about education principles.     

Innovative generalist programs Academic health care centers respond to the shortage of generalist physicians

Academic health care centers increasingly are exploring innovative ways to increase the supply of generalist physicians. The authors review successful innovations at representative academic health centers in the areas of recruitment and admissions, undergraduate medical education, residency training, and practice support. Lessons learned focus on those areas that have demonstrated improvements in the number and quality of physicians trained in family practice, general pediatrics, and general internal medicine. Successful recruitment of generalism-oriented applicants requires identification and tracking of rural, minority, and other special groups of students at the high school and college levels. Academic health care centers that provide early, sustained, community-based, ambulatory experiences for medical students and residents encourage trainees to maintain and choose generalist careers. Finally, academic health care centers that link with community providers and with state government encourage the retention of generalist physicians through continuing education and teaching networks.     

Geriatrics training and education for nongeriatrician faculty: the Dean's Faculty Scholars in Aging Program

The University of South Carolina School of Medicine in Columbia implemented the Dean's Faculty Scholars in Aging (DFSA) Program in 2001 to strengthen the knowledge of geriatrics of nongeriatrician faculty members. The primary indicator of strengthening physicians' geriatrics knowledge was the development of new educational experiences by physicians in the DFSA Program. Twenty-six nongeriatrician faculty in seven departments were recruited to participate as scholars. Most scholars were in key educational positions, including assistant deans, department chairs, and clerkship and residency directors. Scholars received special training to develop geriatrics educational experiences based on their medical specialty and interests. Training encouraged cross-departmental collaboration. Scholars also had access to resources, including professional geriatric educators. Funds were available to support development of educational experiences and for a small amount of salary support. Since the program was implemented, 36 new geriatric experiences have been developed, 29 of the 36 were implemented, and 11 of the 36 were evaluated. Experiences included an elective for residents in the care of older patients in the emergency room and a required hospice rotation in the psychiatry clerkship for third-year medical students. All scholars developed a geriatrics educational experience, and most implemented one. This suggests that scholars demonstrated successful progress in geriatrics training.     

Innovative generalist programs

Academic health care centers increasingly are exploring innovative ways to increase the supply of generalist physicians. The authors review successful innovations at representative academic health centers in the areas of recruitment and admissions, undergraduate medical education, residency training, and practice support. Lessons learned focus on those areas that have demonstrated improvements in the number and quality of physicians trained in family practice, general pediatrics, and general internal medicine. Successful recruitment of generalism-oriented applicants requires identification and tracking of rural, minority, and other special groups of students at the high school and college levels. Academic health care centers that provide early, sustained, community-based, ambulatory experiences for medical students and residents encourage trainees to maintain and choose generalist careers. Finally, academic health care centers that link with community providers and with state government encourage the retention of generalist physicians through continuing education and teaching networks.     

Paul B. Beeson career development awards in aging research and U.S. medical schools aging and geriatric medicine programs

Established in 1995, the Paul B. Beeson Career Development program provides faculty development awards to outstanding junior and midcareer faculty committed to academic careers in aging-related research, training, and practice. This study evaluated the effect of 134 Beeson Scholars on their medical schools' aging and geriatric medicine programs and on the field of aging research from 1995 to 2007. Quantitative and qualitative survey data from multiple sources, including the American Geriatrics Society/Association of Directors of Geriatric Academic Programs' Geriatrics Workforce Policy Studies Center, National Institutes of Health (NIH) rankings of research funding, and other governmental databases were used to compare 36 medical schools with Beeson Scholars with 34 similar medical schools without Beeson scholars and to examine the influence of Beeson Scholars on the field of geriatrics and aging. Most Beeson Scholars remained at the institution where they trained during their Beeson award, and 89% are still practicing or conducting research in the field of geriatrics and aging. Twenty-six (19.4%) of the scholars have led institutional research mentoring awards, 51 (39%) report leadership roles in institutional program project grants, and 13 (10%) report leadership roles in the Clinical and Translational Science Award programs at their institutions. Beeson Scholars are more likely than a matched sample of non-Beeson NIH K awardees to study important geriatric syndromes such as falls, cognitive impairment, adverse drug events, osteoporosis, and functional recovery from illness. Total Beeson Impact Years (the total number of years all Beeson Scholars have worked at each school) is positively correlated with more geriatrics research faculty, after controlling for NIH funding rank (P=.02). Beeson Scholars have made positive contributions to the development of academic geriatrics research programs at U.S. medical schools.     

北京协和医院老年医学教育初探

中国的老年医学尚处于起步阶段,缺乏老年医学教育体系,与发达国家的老年医学教育存在很大的差距.本文总结了近2年来北京协和医院老年医学科在继续教育、住院医教育、人员培训、教材编写、社区及患者教育等方面的工作成果.并在普及老年医学理念、完善继续教育途径与方式等方面取得了初步成绩,对于我国老年医学多层次教育形成了初步设想.呼吁中国老年医学教育规范化,建立资格考试和准入制度,完善职业晋升途径.