Here - American Geriatrics Society

P OSTER
A BSTRACTS
curriculum between 2010–11 and 2011–12. Students met twice per
week for the following activities: (1) focus group sessions discussing
clinical and personal experiences with older adults; (2) interactive
group sessions with geriatric specialists; and (3) shadowing activities
with volunteering physicians and geriatric patients. Students participating
in 2011 – 2012 also participated in a first year introductory
course to geriatric patients and self-selected to participate during the
second year curriculum. Students are surveyed regarding interest in
geriatrics and examined using a geriatrics knowledge test pre and
post intervention. Weekly focus group sessions are recorded and analyzed
using grounded theory methodology.
RESULTS: Pre-intervention geriatric interest survey for
2011–12 show that 60% of students ‘strongly agree’ with the statement
“I understand the unique issues involved in care for the elderly,
compared to 22% of students from 2010–11. Furthermore, 20% of
participating students reported that they are interested in pursuing a
career in geriatrics during the 2011–12 curriculum; by contrast only
11% of students reported interest in geriatrics from 2010–11. Pre-Intervention
use of the Geriatrics Knowledge Test showed mean score
of 50% (sd = 11%) during 2011–12; no significant change from
2010–11 in which mean score was 48% (sd= 9%).
CONCLUSION: Current data suggests longer exposure
through a focused curriculum may improve interest and comfort with
older adults, both within geriatrics or other medical fields, although
study lacks power to comment on significance. Data collection, including
career interest surveys for the class of 2010-11 and post intervention
surveys for 2011–12, is in progress. Further investigation, including
use of a 2:1 matched comparison control group is also
pending, but may help eliminate selection bias and further validate
study results.
A70
Fulfilling an ACGME Competency: Impact of a Novel
Communication Skills Curriculum.
R. Ramaswamy, 1,2 A. Williams, 1,2 A. S. Kelley, 1 E. M. Clark. 2,1 1.
Brookdale Department of Geriatrics and Palliative Medicine, Mount
Sinai School of Medicine, New York, NY; 2. GRECC, James J. Peters
VA Medical Center, Bronx, NY.
Introduction: Effective communication is essential to health
care delivery, especially in care of the elderly, and is associated with
increased adherence to treatment and patient satisfaction. The
ACGME has designated communication skills as a core competency.
Following a needs assessment, we developed an evidence-based communication
skills curriculum with the objective to increase confidence
and expertise among Internal Medicine interns in communicating
with older patients.
Methods: The communication skills curriculum was integrated
in the 4-week Geriatrics block in the first year of Internal Medicine
residency training at the Bronx VA. Developed and facilitated by 2
geriatrics fellows, the curriculum consists of 2 small group sessions,
1.5 hours each, involving 2 interns at a time. The sessions include didactic
learning, discussion, role-play and self-study. Skills taught include
Active Listening, Ask-Tell-Ask and SPIKES [1]. Participants
complete questionnaires at baseline, after the course and at 3 months.
Baseline data include demographics, past training in communication
and self-identified communication challenges. Self-reported confidence
with specific communication tasks is also measured on a 4-
point Likert scale (1= minimal confidence, 4= high confidence).
Results: To date, 9 interns have completed the curriculum. Five
were ≥ 30 years old and 5 had medical school training in English.
Only 3 reported any prior training in communication skills. Respondents
found developing rapport and building trust with older patients
most challenging. Compared to baseline, the interns’ average overall
confidence in communicating with older patients increased by 25%
(from 3.0 to 3.75); comfort level in delivering bad news to an older patient
increased by 50% (from 2.0 to 3.0); comfort level in discussing
advance care planning with an older patient and in conducting a family
meeting both increased by 48% (from 2.11 to 3.13). SPIKES was
felt to be the most useful skill and 71% respondents preferred the
small group format as a safe way to learn and practice the skills.
Conclusion: Implementation of a structured, standardized communication
skills curriculum in Internal Medicine internship has
been effective in improving confidence and comfort in communicating
with older adults.
[1] Baile WF, et al., Oncologist 2000; 5:302–311.
A71
An Intervention to Improve Medical Students’ Interprofessional
Acumen.
R. M. Wright, 1 J. H. Lingler, 2 J. P. Pschirer, 3 J. F. Mahoney, 4
D. A. Nace. 1 1. Medicine/Division of Geriatrics, University of
Pittsburgh, Pittsburgh, PA; 2. School of Nursing, University of
Pittsburgh, Pittsburgh, PA; 3. School of Pharmacy, University of
Pittsburgh, Pittsburgh, PA; 4. School of Medicine, University of
Pittsburgh, Pittsburgh, PA.
Supported By: Josiah P. Macy Foundation
Health Resources and Services Administration (GACA)
Background: Teamwork and interdisciplinary collaboration are
essential to providing the best geriatric care but are challenging to
teach medical students. We compared pre- and post-course knowledge,
skills, and attitudes toward interprofessional (IP) teamwork
among medical students who underwent a multimodal, IP team education
intervention and among students who did not.
Methods: 197 3rd-year medical students, nurse practitioner
(NP)students, and pharmacy students, were divided into 6 IP teams
(intervention group) and 10 non-IP, medical student-only teams (controls).
Each IP team consisted of 4 or 5 self-selected medical students,
4 or 5 NP and 1 or 2 pharmacy students. All teams received a lecture
on transitions of care (TOC) and participated in a geriatric case TOC
simulation and debriefing session. IP team instruction included a lecture
on effective teamwork and IP competencies, a video demonstration
of ineffective IP teamwork, and self-assessment of videorecorded
teamwork. Before-and-after team performance surveys
assessed students on perceived IP teamwork knowledge, skills, and
attitudes. Paired t-test analyses assessed within-group pre- and posttest
differences.
Results: 18 (67%) IP and 83 (61%) non-IP medical students returned
both 28-item surveys. Both groups demonstrated significant
improvement on multiple items. Knowledge items that improved only
within the IP group were “teams are more responsive to the complex
needs of geriatric patients;” “team approach makes the delivery of
care more efficient;” and “I see caring for older patients as a unique
challenge.” Despite having lower pre-test ratings on 9 teamwork
skills items, IP students rated post-test skills on average as “very
good” or better for 10 of 11 skill items while non-IP students rated
their post-test skills as “very good” or better on only 4 out of 11 items.
Conclusion: Medical students generally considered themselves
knowledgeable but not skillful at working in teams. A multimodal, experiential
IP curriculum effectively improved knowledge, skills and
attitudes toward IP teamwork. Additional analyses from this rich
dataset will be presented. Future directions include testing for retention
and transfer of IP team concepts.
A72
Teaching Fall Risk Assessment to Medical Students Using Meals on
Wheels.
S. Chenna, K. M. Sink, K. Callahan, J. Demons, H. Atkinson.
Geriatrics, Wake Forest University, Winston Salem, NC.
BACKGROUND: The AAMC and John A. Hartford Foundation
have recommended a set of minimum geriatric competencies for
S40
AGS 2012 ANNUAL MEETING