Multidisciplinary Training in Geriatric Health Care for Preclinical Students

This report of the development, implementation and evaluation of a multidisciplinary clinical preceptorship in geriatric health care for preclinical students. Though the collaboration of two postsecondary schools, students and faculty from four health care disciplines were represented in the preceptorship. Students attended didactic presentations, reviewed cases, and, in multidisciplinary teams of three and four, rotated through 13 clinical and community based sites which represented a broad array of services to the aged. Evaluation of the preceptorship by students, faculty, and site supervisors was very positive. The issues faced in developing and presenting multidisciplinary training of this nature are discussed.     

A Multidisciplinary Clerkship in Geriatric Medicine

A multidisciplinary clerkship was developed as a required course for third year medical students. The drawbacks of traditional medical education as it applies to the field of geriatrics are reviewed. The development of a week-long clerkship in geriatric medicine is described with special focus on a multidisciplinary geriatric home assessment required of all students. Evaluation of the clerkship and the home assessment is described.     

Complexity in Graduate Medical Education: A Collaborative Education Agenda for Internal Medicine and Geriatric Medicine

Internal medicine residents today face significant challenges in caring for an increasingly complex patient population within ever-changing education and health care environments. As a result, medical educators, health care system leaders, payers, and patients are demanding change and accountability in graduate medical education (GME). A 2012 Society of General Internal Medicine (SGIM) retreat identified medical education as an area for collaboration between internal medicine and geriatric medicine. The authors first determined a short-term research agenda for resident education by mapping selected internal medicine reporting milestones to geriatrics competencies, and listing available sample learner assessment tools. Next, the authors proposed a strategy for long-term collaboration in three priority areas in clinical medicine that are challenging for residents today: (1) team-based care, (2) transitions and readmissions, and (3) multi-morbidity. The short-term agenda focuses on learner assessment, while the long-term agenda allows for program evaluation and improvement. This model of collaboration in medical education combines the resources and expertise of internal medicine and geriatric medicine educators with the goal of increasing innovation and improving outcomes in GME targeting the needs of our residents and their patients.     

Education in Geriatric Medicine:

The Texas Consortium of Geriatric Education Centers was establisged in 1985. The primary goal of the Consortium is the continued professional development of health professions faculty in gerontology and geriatrics. This article describes a multi-level program of institutional development which has been initiated to accomplish this goal. The components of the program include a strategic planning document (Institutional Action Plan), and a professional development program for faculty (Personal Action Plan). Since October 1985 a total of 63 health professions faculty from 9 academic institutions have enrolled in the two-year program. As designated trainees, these individuals are expected to complete a seven-unit Learning Module in Geriatrics, attend two content-intensive multidisciplinary institutes, and prepare a structured plan for the introduction of aging content within educational experiences provided students in health-related disciplines. The design of the instructional program provided faculty trainees is also described.     

California Geriatric Education Center Logic Model: An Evaluation and Communication Tool

A logic model is a communications tool that graphically represents a program's resources, activities, priority target audiences for change, and the anticipated outcomes. This article describes the logic model development process undertaken by the California Geriatric Education Center in spring 2008. The CGEC is one of 48 Geriatric Education Centers across the nation, funded by the U.S. Health Resources Services Administration, Bureau of Health Professions. Engaging this diverse group of stakeholders to develop a logic model has added substantial value to program planning, implementation, and evaluation of key performance outcomes.     

Emergency Medical Service Attitudes Toward Geriatric Prehospital Care and Continuing Medical Education in Geriatrics

OBJECTIVES: To understand the opinions of emergency medical service (EMS) providers regarding their ability to care for older adults, the domains of geriatric medicine in which they need more training, and the modality through which continuing education could be best delivered.
DESIGN: Qualitative study using key informant interviews.
SETTING: Prehospital EMS system in Rochester, New York.
PARTICIPANTS: EMS providers, EMS instructors and administrators, emergency physicians, and geriatricians.
MEASUREMENTS: Semistructured interviews were conducted using an interview guide that addressed knowledge and skill deficiencies, recommendations for improvement of geriatrics continuing education, and delivery methods of education.
RESULTS: Participant responses were generally congruous despite the diverse backgrounds, and redundancy was achieved rapidly. All participants perceived a deficit in EMS education on the care of older adults, particularly related to communications with patients and skilled nursing facility staff. All desired more geriatric continuing education for EMS providers, especially in communications and psychosocial issues. Education was desired in various modalities.
CONCLUSION: Further geriatric continuing education for EMS providers is needed. Some specific topics relate to medical issues, but a large proportion involve communications and psychosocial issues. Education should be delivered in a variety of modalities to meet the needs of the EMS community. Emerging on-line video technologies may bridge the gap between learners preferring classroom-based modailities and those preferring self-study modules.     

A Case Study in Interdisciplinary Education in Geriatric Health Care:

This article reports on the intewllectual, educational and organizational problems encountered in providing interdisciplinary education to professionals in geriatric health care based on the development of a Summer Institute within the University of North Carolina (Chapel Hill) Geriatric Education Center. The quality of individual presentations, the pattern of sessions within a program, the size of the faculty, the number of topics in the curriculum are discussed and recommendations regarding interdisciplinary education programs are given.     

Physician Assistant Training and Practice in Geriatric Medicine

This study reports on an increasing educational emphasis by physician assistant (PA) programs on didactic and clinical experiences in geriatrics. Of a random sample of physician assistants known to be caring for elderly patients, some physician assistants may see a large number of elderly patients depending on their practice setting. When asked to rate the importance of various topics to a physician assistant's scope of practice with elderly patients, there was exceptional congruence in the relative weights of the items given by educators and practicing physician assistants.     

Educating Medical Students in Geriatric Medicine: the Christchurch Experience

Abstract. A five week program in geriatric medicine for fourth (first clinical) year medical students is described which is not only regarded as valuable by the students but has been shown to result in lasting beneficial effects on attitudes to the elderly. The program structure differs from some other courses in geriatric medicine. Possible reasons for its value and effectiveness include (1) teaching by committed and specialised staff, (2) seeing the elderly within a therapeutic environment which includes sufficient time for students to see the benefits of intervention, (3) the involvement of allied health professionals, (4) small group and patient based teaching and (5) a community focus which includes seeing people in their own homes and which emphasises the importance of the social context in a person's illness.     

Advancing Geriatric Education: Development of an Interprofessional Program for Health Care Faculty

To improve the health care of older adults, a faculty development program was created to enhance geriatric knowledge. The University of Alabama at Birmingham (UAB) Geriatric Education Center leadership instituted a one-year, 36-hour curriculum focusing on older adults with complex health care needs. Content areas were chosen from the Institute of Medicine Transforming Health Care Quality report and a local needs assessment. Potential preceptors were identified and participant recruitment efforts began by contacting UAB department chairs of health care disciplines. This article describes the development of the program and its implementation over three cohorts of faculty scholars (n = 41) representing 13 disciplines, from nine institutions of higher learning. Formative and summative evaluation showed program success in terms of positive faculty reports of the program, information gained, and expressed intent by each scholar to apply learned content to teaching and/or clinical practice. This article describes the initial framework and strategies guiding the development of a thriving interprofessional geriatric education program.     

Medical Student Perceptions of Cost-Conscious Care in an Internal Medicine Clerkship: A Thematic Analysis

Background

Although as much as 87 % of all healthcare spending is directed by physicians, studies have demonstrated that they lack knowledge about the costs of medical care. Similarly, learners have not traditionally received instruction on cost-conscious care.

Objective

To examine medical students'' perceptions of healthcare delivery as it relates to cost consciousness

Design

Retrospective qualitative analysis of medical student narratives

Participants

Third-year medical students during their inpatient internal medicine clerkship

Main Measures

Students completed a reflective exercise wherein they were asked to describe a scenario in which a patient experienced lack of attention to cost-conscious care, and were asked to identify solutions and barriers. We analyzed these reflections to learn more about students’ awareness and perceptions regarding the practice of cost-conscious care within our medical center.

Key Results

Eighty students submitted the assignment between July and December 2012. The most common problems identified included unnecessary tests and treatments (n = 69) and duplicative tests and treatments (n = 20.) With regards to solutions, students described 82 scenarios, with 125 potential solutions identified. Students most commonly used discussion with the team (speak up, ask why) as the process they would use (n = 28) and most often wanted to focus lab testing (n = 38) as the intervention. The most common barriers to high-value care included increased time and effort (n = 19), ingrained practices (n = 17), and defensive medicine or fear of missing something (n = 18.)

Conclusions

Even with minimal clinical experience, medical students were able to identify instances of lack of attention to cost-conscious care as well as potential solutions. Although students identified the hierarchy in healthcare teams as a potential barrier to improving high value care, most students stated they would feel comfortable engaging the team in discussion. Future efforts to empower learners at all levels to question value decisions and to develop and implement solutions may result in improved healthcare.