Here - American Geriatrics Society

P APER
A BSTRACTS
age increased, the overall rate of catheterization for all older inpatients
declined from 19.9% to 11.9%, a 40% reduction. The greatest
improvement was seen on the ACE Unit, where the rate of catheterization
declined from 20.4% to 9.7%, a 53% reduction. The catheter
utilization ratio decreased from 68% to 20%, while the average
catheter days per patient declined from 11.7 to 2.8 days per patient
across all inpatient units. Conclusions: This study demonstrates the
dramatic and sustained improvements in catheter utilization that can
be achieved with the support of a multi-modal educational intervention
in improving patient safety and quality care efforts around the
appropriate use of urinary catheters in a variety of inpatient settings.
P35
A Geriatrics rotation as a Medicine elective: A smart option for
medical students?
A. Nguyen , 1 E. Duthie, 1 E. Duthie, 2 K. Denson, 2 J. Franco. 2 1.
Institute for Health and Society, Medical College of Wisconsin,
Milwaukee, WI; 2. Internal Medicine, Medical College of Wisconsin,
Milwaukee, WI.
Background: Medical schools must look at innovative ways to
ensure that graduates achieve basic competencies in geriatrics and
encourage new physicians to consider the subspecialty. Our objectives
are to: 1) assess the impact of a month-long geriatrics rotation,
as part of the internal medicine clerkship, on M3 students’ knowledge,
skills, and attitudes toward geriatric practice and career choice;
and 2) assess knowledge outcomes by comparing mean NBME internal
medicine shelf exam scores between students who completed the
geriatrics rotation and students who completed the internal medicine
ward rotations.
Methods: This study was conducted at a medical school where a
month-long geriatrics evaluation and management (GEM) rotation
fulfills a graduation requirement in internal medicine. One-hour
focus groups were conducted with two cohorts: 1) students who rotated
through GEM and 2) students who did not. Thematic analyses
using the principles of grounded theory were performed to compare
group responses between the two cohorts. One focus group of 4-6
participants was conducted for each cohort. Independent t-test was
performed to compare mean NBME internal medicine shelf exam
scores between all GEM (n=124) and non-GEM (n=1318) students
who matriculated between 2005 and 2011. ANOVA was used to compare
the means after controlling for Step 1 exam scores.
Results: Focus groups revealed differences in reported comfort
and attitudes toward geriatric care with the GEM cohort reporting
higher levels of confidence with geriatric assessment skills. Mean
NBME internal medicine shelf exam scores between GEM students
[mean (SD)=73.66 (±7.2)] and non-GEM students [mean (SD)=73.60
(±7.4)] were not statistically significant (p=0.938). Controlling for
Step 1 scores did not produce statistically significant differences
(p=0.371).
Conclusion: Completing an internal medicine ward rotation requirement
using a geriatrics rotation is an innovation that medical
schools should consider. Comparisons of NBME scores show that
GEM students perform just as well on the internal medicine board
exam as their non-GEM colleagues but were more comfortable
with elder care. Evaluating geriatrics curricula will add to understanding
of student perspectives about geriatrics as a career field
and allow curriculum developers to identify areas of strength and
areas for improvement.
P36
Case Presentation as a Direct Observation Method to Evaluate
Internal Medicine Residents’ Systems-Based Practice Competency.
K. Ouchida, S. Ramsaroop, S. Mehta, L. Logio, R. Adelman,
E. Siegler. Medicine, Weill Cornell Medical Center New York
Presbyterian Hospital, New York, NY.
PURPOSE: Of the 6 core competencies the Accreditation
Council of Graduate Medical Education requires, systems-based
practice (SBP) often poses the greatest challenge for curriculum development
and evaluation. A redesigned geriatrics rotation for internal
medicine (IM) residents incorporates a SBP module with direct
exposure to health care sites and services utilized by older adults. This
study describes the use of a case presentation to evaluate IM residents’
knowledge of the health care system and ability to navigate it.
METHODS: Starting June 2011, all PGY-2 IM residents (N=48)
complete a 1-week SBP module as part of the required 4-week geriatrics
rotation. The module combines structured exposures to community-based
programs, supervised patient care on house calls and in
a transitional care clinic, and self-directed learning. Residents present
an older continuity patient to the geriatrics interdisciplinary team,
which then models a collaborative problem-solving approach. One
faculty member takes notes and emails residents a summary of the
identified problems and the team’s “action plan.” The problems and
recommendations were analyzed to generate a list of themes for coding.
Discrepancies in coding were resolved by discussion until consensus
was reached.
RESULTS: To date 21 (44%) IM residents have presented cases.
Presentations generated 19 types of biopsychosocial issues (mean 3.8
per patient) and 12 types of recommendations (mean 5.4). Lack of social
support (15.1%), care coordination challenges (13.9%), and negative
illness behaviors such as refusal of care (10.1%) represent the
most frequently identified problems. The interdisciplinary team’s recommendations
most often focused on care coordination strategies
(15%), community resources (14.2%), medical treatment or workup
(14.2%) and goals of care (13.3%). The case presentation received
one of the highest ratings from residents on the module evaluation
(4.75 out of 5).
CONCLUSIONS: A case presentation represents an effective
strategy for directly observing and evaluating IM residents’ systemsbased
practice competency. Presentations reveal residents’ struggles
with the health care system and comprehension of their older patients’
needs, and offer exposure to geriatric approaches through
practical advice. This evaluation method is feasibly implemented and
well-received by residents.
P37
Replicating a Chief Resident Immersion Training in Geriatrics
(CRIT).
S. Levine, 1 L. Caruso, 1 B. Brett, 2 H. Auerbach, 1 A. Jackson, 1
A. Burrows, 1 S. Chao. 1 1. Boston Univerisity Medical Center
(BUMC), Boston, MA; 2. Brett Consulting Group, Boston, MA.
Supported By: John A. Hartford Foundation, Association of
Directors of Geriatric Academic Programs (ADGAP)
Background: Chief residents (CRs) play crucial roles in resident
and student training and in quality patient care. They typically receive
minimal formal education in geriatrics, teaching skills and leadership.
With support from the John A. Hartford Foundation and ADGAP,
BUMC disseminated its successful 2-day offsite CRIT program, addressing
these deficiencies, to demonstrate national replicability.
Methods: Through a competitive RFP, 12 institutions in 3 cohorts
were selected to implement CRIT across specialties for 2 years
each. The modular curriculum included an unfolding case discussed in
small groups, evidence-based mini-lectures on geriatrics topics, and
interactive seminars on teaching and leadership skills. 1-to-1 consults
helped CRs develop an action project. Social opportunities were provided
to develop relationships. Faculty mentors were invited to increase
institutional “buy-in.” BUMC’s support to each institution included
attending BUMC’s CRIT. National evaluation of CRIT
included a self-report pre-survey, a 12-item pre- and immediate post-
CRIT knowledge test, and a 6-month follow-up survey, administered
by each institution. Results across institutions and cohorts were
merged for analysis.
Results: Over 3 years in 12 institutions, 301 CRs and 86 faculty
mentors participated in CRIT, representing 29 specialties. Response
AGS 2012 ANNUAL MEETING
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