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P OSTER
A BSTRACTS
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Hospice and Palliative Medicine Toolkit of Assessment Methods.
L. J. Morrison, 1,2 E. Carey, 3 E. Chittenden, 4,5 S. Block. 4,6 1. Baylor
College of Medicine, Houston, TX; 2. The Methodist Hospital,
Houston, TX; 3. Mayo Clinic, Rochester, MN; 4. Harvard Medical
School, Boston, MA; 5. Massachusetts General Hospital, Boston, MA;
6. Dana Farber Cancer Institute, Boston, MA.
Supported By: Dr. Morrison’s work was supported by funds from
the Division of State, Community, and Public Health, Bureau of
Health Professions (BHPr), Health Resources and Services
Administration (HRSA), Department of Health and Human
Services (DHHS), under grants K01 HP 00077 and K01 HP 00117,
Geriatric Academic Career Award. The information or content and
conclusions are those of the author and should not be construed as
the official position or policy of, nor should any endorsements be inferred
by the BHPr, HRSA, DHHS or the U.S. Government.
Background: Hospice and Palliative Medicine (HPM) was recognized
as an ACGME subspecialty in 2006. As existing fellowship
programs transitioned to the ACGME framework, the HPM Competencies
Project Workgroup defined competencies and measureable
outcomes in line with the ACGME Outcome Project (1). The final
step was to develop an assessment toolkit to guide HPM fellow evaluation.
Methods: The Workgroup reviewed candidate assessment tools
organized by ACGME competency domain from within and outside
the field. This included known unpublished tools, published tools, and
tools from evaluation websites. HPM educators were invited to submit
tools in a call to the field. In reviewing instruments, the Workgroup
used characteristics of a good instrument (1,2) and developed
criteria to inform HPM-specific tool selection.
Results: Sixty-four tools were identified, but most had very poor
fit with criteria. Very few were specific to HPM. Many key HPM subcompetencies
were not evaluable with the instruments. Most importantly,
tool validation was lacking. We identified, by consensus, the
two best assessment methods for each ACGME competency domain
and 18 instruments for inclusion in the Toolkit. Ten were newly created
by the Workgroup and eight were adapted from existing tools.
The Workgroup developed the Master Assessment Table. This new
tool lists the most important, representative subcompetencies for
each ACGME competency per Workgroup consensus. These are considered
exemplar skills that will reflect broader mastery of the entire
competency domain. Recommended assessment methods are also indicated.
Conclusions: The Toolkit of Assessment Methods provides guidance
to HPM fellowship directors and faculty in assessing competency-based
performance for fellows. Psychometric evaluation is
needed. New tools are also needed to address competency areas not
covered by existing tools. Despite these limitations, the Toolkit has
the potential for broad application and can be used flexibly to guide
assessment of learners by ACGME competency domain across levels,
disciplines, and fields.
References:
1. ACGME Outcome Project Web site. Available at:
www.acgme.org/Outcome. Accessed December 5, 2011.
2. Epstein RM. Assessment in medical education. N Engl J Med.
2007;356:387-396.
D65
Training health professionals to screen, manage and report age
related driving disorders (ARDDs).
L. Hill, 1 J. Rybar, 1 T. Styer, 1 R. Coimbra, 2 K. Patrick. 1 1. Family and
Preventive Medicine, UCSD, San Diego, CA; 2. Surgery, University of
California, San Diego, San Diego, CA.
Supported By: State of California Office of Traffic Safety
Background: Older adults have a higher prevalence of health
and functional impairments that interfere with their ability to drive
safely. If left unaddressed, these problems pose a risk of driving-related
injury, not only to the individuals themselves, but also to their
families and to others who share the road with them. Physicians and
other health professionals receive little training on research and management
of ARDDs. Research suggests that the topic is often avoided
by both parties, and that physicians are not aware of the AMA guidelines,
posted online since 2003, or the mandated reporting required in
some states. The purpose of this report is to describe the results of a
professional training curriculum addressing this issue.
Methods: The curriculum was developed and administered over
the last 4 years to 1202 health professionals. The training was developed
and modified from the American Medical Association (AMA)
2003 guidelines for physicians (http://www.nhtsa.dot.gov/people/injury/olddrive/OlderDriversPlan).
Training was provided in a variety
of formats, from in-office seminars to grand rounds. The interactive
program included pocket guides, case studies, resources and videos.
Results: Confidence in the ability to screen seniors increased
from 17% to 72%. The change from baseline screening to intent to
screen increased from 27% to 55%. Ninety one percent of participants
agreed or strongly agreed that they had a better understanding
of California’s mandated reporting laws post training. Ninety two
percent of participants post training agreed or strongly agreed that
they had a better understanding of the medical conditions and medications
that may impair older adults’ ability to drive safely.
Attitudes on California’s mandated reporting laws for lapses of
consciousness (LOC) were favorable, though baseline comprehensive
of the laws was low. While California is one of only 9 states that
mandates LOC reporting (including dementia), physicians felt supported
by the laws.
Conclusions: Physicians responded favorably to training on
ARDDs and mandated reporting, with increases in understanding
and intent to change behavior.
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An Innovative Approach to Teaching Delirium Using Standardized
Patients.
L. Wilson, E. Roberts, A. Caprio, G. Winzelberg, J. Busby-Whitehead.
UNC Chapel Hill, Chapel Hill, NC.
Supported By: Supported by: The Donald W. Reynolds Foundation
BACKGROUND: Delirium is a serious, under-diagnosed medical
condition that affects up to 1/3 of hospitalized elders. Physicians
from specialties outside of Geriatrics need the skill set to prevent, diagnose,
evaluate, and treat delirium. Attending physicians in specialty
fields may have the opportunity to teach their learners about delirium,
but they may not have the knowledge base for this task. PUR-
POSE: To develop an innovative curriculum using standardized patients
(SPs) for specialty faculty learners (FLs) in order to solidify
their knowledge and increase their confidence in teaching about
delirium. METHODS: FLs designated as Reynolds Specialty Faculty
Scholars on the UNC-CH Donald W. Reynolds Foundation grant,
“Next Steps in Physicians’ Training in Geriatrics,” participated in this
workshop. Small groups of FLs rotated through 3 different stations of
delirious SPs. Prior to “seeing” each patient, the FLs reviewed the
“chart,” learning the SP’s past medical history, recent labs and vitals,
and medication administration record. Using this information, they
determined a pretest probability that the SP would have delirium and
identified predisposing and precipitating factors for this condition.
One FL in each group interviewed the patient using the Confusion
Assessment Method to diagnose delirium while being observed by
others in the group and a consulting Geriatrician. A family member
of the SP answered questions to provide information about the SP’s
baseline functional status and risk factors for delirium. After the interview,
the FLs developed a management plan and identified a oneminute
teaching point from the case to instruct learners about delirium.
The consulting Geriatrician provided feedback and made
recommendations. OUTCOMES: Eighteen FLs from Hematology-
Oncology, Physical Medicine and Rehabilitation, Trauma and Critical
AGS 2012 ANNUAL MEETING
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