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A BSTRACTS
Care Surgery, Emergency Medicine, Hospital Medicine, and the Office
of Graduate Medical Education completed the workshop. Feedback
was overwhelmingly positive. These high level academic leaders
in their specialty fields all acknowledged that the direct hands on
learning session enhanced their skills for recognizing and diagnosing
delirium as well as gave them the tools for teaching others. CON-
CLUSION: This curriculum provides an active learning environment
with SPs to teach FLs about delirium. These sessions may be replicated
in other settings and with other disciplines.
D67
Simulation Fosters Interprofessional Skills among Nursing,
Pharmacy and Medical Students.
L. C. Hutchison, 1,3 P. S. Ragsdale, 2 S. N. Berryman, 2 T. J. Bilbruck. 4 1.
College of Pharmacy, University of Arkansas for Medical Sciences,
Little Rock, AR; 2. College of Nursing, UAMS, Little Rock, AR; 3.
Donald W. Reynolds Institute on Aging, UAMS, Little Rock, AR; 4.
College of Medicine, UAMS, Little Rock, AR.
Background: Opportunities to learn effective team skills in the
entry-level curricula are sparse. We integrated human patient simulators
into an interprofessional education experience to train nursing,
pharmacy and medical students interprofessional skills in their geriatric
curricula.
Methods: Two unfolding cases provide simulations for nursing
students (N4s) in their geriatric course. N4s alternatively perform assessments
on the simulated patient or watch via remote camera. Following
this, pharmacy (P4s) and medicine (M4s) students join the N4s
for a simulated staff meeting. N4s present their findings and assessment,
answering questions from the other disciplines. The staff meeting
ends with a delineated plan of care for the patient. The case unfolds
with the patient’s arrival at the simulated emergency
department. N4s perform initial assessment of the simulated patient
and are joined by the P4s and M4s to continue assessment and implementation
of a new plan of care. The simulation ends with initiation
of antibiotics for treatment. At the conclusion of the simulation students
meet to discuss what went well and what could be improved.
Results: 69 students participated in 6 sessions of 9-13 students.
There were 53 N4s, 7 P4s, 3 post-graduate year 1 pharmacy residents
and 6 M4s.Student evaluations of the experience are shown in the table.
Conclusions: Combining high-fidelity simulations of geriatric
patients with interprofessional interactions was well-received by students
from nursing, pharmacy and medicine. This process allows students
from multiple professions to learn and practice different team
skills prior to beginning their professional practice.
D68
Hazards of Hospitalization: A Novel Geriatrics Curriculum for
Internal Medicine Interns.
L. Martinez, M. T. Heflin. Department of Medicine, Division of
Geriatrics, Duke University, Durham, NC.
Introduction: Older hospitalized adults are susceptible to complications,
termed “hazards of hospitalization” (HOH), which are associated
with poor patient outcomes including increased mortality.
Despite these adverse outcomes, house staff knowledge about their
patient’s risk factors for developing HOH is lacking. The goal of this
novel curriculum is to improve Internal Medicine (IM) intern knowledge
and skills about HOH in elderly inpatients in order to ultimately
improve patient care and patient outcomes.
Methods: We implemented this curriculum at our institution for
IM interns rotating on the Geriatrics Inpatient Consult service. Instructional
content and references are posted online and a pocketcard
is provided for review on 10 hazards (delirium, pressure ulcers,
urinary issues, functional decline, falls, polypharmacy,
dehydration/malnutrition, infection, depression, and goals of care).
For each patient the intern follows on the consult service, a topic
checklist is completed by the intern and reviewed by the Geriatrics
attending and/or fellow to ensure all HOH have been discussed. They
are also directly observed performing the Confusion Assessment
Method (CAM). Knowledge and self-efficacy towards HOH are
measured in pre- and post-tests (knowledge) and pre- and post- self
efficacy surveys (5 point Likert scale: 1= No confidence to 5=Completely
confident).
Results: To date, 8 learners have completed the curriculum. All
demonstrated increased confidence in their ability to manage HOH
after completion of the curriculum, with the most dramatic increases
seen in delirium (pre 2.50 to post 4.00), urinary issues (2.10 to 3.60),
and functional decline (2.00 to 3.75). Interns are able to more accurately
define HOH as well as identify the correct components of the
CAM. Prior to the rotation, all interns either strongly disagreed (5/8)
or disagreed (3/8) that they felt confident in performing the CAM
compared to afterwards in which all either agreed (1/8) or strongly
agreed (7/8).
Conclusion: Implementation of this curriculum has demonstrated
improvement in intern knowledge and self-efficacy regarding
HOH. While a relatively small number of interns have participated to
date, we anticipate reaching up to 38 by the end of the current academic
year. Next steps include measuring application of these principles
through review of documentation of HOH in older adults cared
for by interns in future inpatient rotations.
D69
Incorporating Evidence-Based Medicine in a Geriatric Medicine
Clerkship.
M. van Zuilen, 1 J. C. Palacios, 1,2 M. J. Mintzer. 1,2 1. University of
Miami Miller School of Medicine, Miami, FL; 2. GRECC, VA Health
Care System, Miami, FL.
INTRODUCTION:
As part of a 4-week geriatric medicine clerkship, students at the
UMMSM complete an evidence-based medicine assignment on a
clinical question arising during rounds in the medical, psychological,
social, economic, or functional domains. This paper presents the structure
and components of this assignment, student performance data,
and feedback from students.
METHODS:
During the clerkship orientation, students receive an overview
of the EBM assignment with sample PICO questions from several
domains. They are instructed to frame a clinical question for one of
their patients, search for the best evidence, critically appraise the validity
and clinical relevance of the evidence, and apply it to their patient.
Students submit a structured critical appraisal of topic form and
deliver a 10-minute slide presentation to their peers and course faculty,
followed by a brief Q&A and feedback session. To promote
group participation, student peers ask questions before faculty members
comment and provide feedback. An 8-item evaluation form is
used to rate students’ performance with 5 scorable categories (unsatisfactory
– excellent) for each item. Although we evaluate the basic
EBM skills (framing a question and conducting a search), emphasis is
placed on the critical appraisal and the discussion of patient specific
factors (risks, values, preferences) in applying the evidence.
RESULTS:
Since 2010, 203 students have completed the EBM assignment.
Although most clinical questions pertained to the medical domain,
students have also addressed issues in the psychological, social, economic
and functional domains. The overall quality of the presentations
has been high (average score is 89.8; range is 68-100). The main
contributors to poor performance are formulating a question that is
not clinically meaningful and failing to address patient specific fac-
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AGS 2012 ANNUAL MEETING