Here - American Geriatrics Society

P OSTER
A BSTRACTS
A83
Preparing to Care for an Aging Population: Medical Student
Reflections on their Clinical Mentors within a New Geriatrics
Curriculum.
T. W. Farrell, 1 R. R. Shield, 3 A. Nanda, 2 S. Campbell, 3 T. Wetle. 4 1.
Division of Geriatrics, University of Utah School of Medicine, Salt
Lake City, UT; 2. Division of Geriatrics, Warren Alpert Medical
School of Brown University, Providence, RI; 3. Center for
Gerontology and Healthcare Research, Warren Alpert Medical School
of Brown University, Providence, RI; 4. Public Health Program,
Warren Alpert Medical School of Brown University, Providence, RI.
Supported By: This work was supported by a grant from the Donald
W. Reynolds Foundation.
Background:
Mentoring relationships between faculty and medical students
are increasingly recognized as key contributors to medical students’
developing clinical expertise and approaches to specific patient populations.
Reflective writing techniques such as journaling help provide
insights into the process by which medical students are mentored in
clinical settings and develop into practicing physicians. However,
medical students’ reflections about their experiences with physician
mentors have rarely been studied.
Methods:
From 2007 to 2010, we collected and analyzed 405 medical student
journal entries regarding students’ experiences with a new geriatrics
curriculum at the Warren Alpert Medical School of Brown University,
including both formal and informal mentored experiences in
community and hospital settings. Thirty preclinical and clinical volunteer
medical student journalers from all class years participated in
this journaling project. We employed qualitative analytic techniques
in which rigor and saturation of categories were achieved. Using an iterative
interdisciplinary team process, key themes were identified relating
to students’ experiences with their clinical mentors.
Results:
Three major themes regarding mentoring emerged from the
journals: (1) Exposure to clinical mentors challenged students’ preconceptions
regarding older adults and geriatric medicine; (2) Students
learned new subject matter and techniques from observing
their mentors; and (3) Students provided both positive and negative
assessments of their mentors.
Conclusions:
Opportunities exist to improve current approaches to clinical
mentoring of medical students learning to care for older adults. Such
mentorship may be particularly relevant to promoting medical students’
interest in older persons and geriatrics. Reflective journaling
provides important insights into the process by which medical students
draw upon mentored clinical experiences during their training.
A84
A New Strategy for Teaching Residents Roles of
Interprofessional Teams.
T. C. James, 1 G. R. Westmoreland, 1 C. Arenson, 2 S. R. Counsell. 1 1.
Section of Geriatrics, Indiana University School of Medicine,
Indianapolis, IN; 2. Family and Community Medicine, Thomas
Jefferson University, Philadelphia, PA.
Supported By: HRSA GACA
Background: New models of interprofessional care have been
shown to improve outcomes for seniors at high risk for functional decline.
However, Internal Medicine (IM) residents have few opportunities
to learn the roles of interprofessional teams (IPTs). The Minnesota
Complexity Assessment Method (MCAM) tool evaluates
person-specific factors that interfere with usual decision-making and
can highlight roles for IPTs.
Methods: For this mini-course, IM residents completed an online
audio PowerPoint lecture describing the MCAM tool and roles of
the IPT. IM residents met with the geriatrician faculty member who
demonstrated how to use the MCAM tool. Residents practiced using
the MCAM tool on a case scenario then were given a real patient to
assess using the MCAM tool. During the IPT conference the MCAM
tool was applied to a patient the resident had researched in preparation
for the meeting. Evaluation included pre- and post-tests assessing
attitudes about IPTs and qualitative responses to questions pertaining
to usefulness of the mini-course.
Results: Twenty IM residents completed the mini-course. Results
comparing pre- and post-tests demonstrate movement towards
greater understanding of IPT care. There were higher average agreement
ratings in the post-test compared to the pre-test for: “interdisciplinary
health professionals know each other’s roles,” “I know when
my patient needs an interdisciplinary team” and “interdisciplinary information
tells us about disease progression;” and lower average
agreement for items “working with colleagues in my own profession
is more efficient” and “the goal of interdisciplinary teams is to support
physician care plans.” Residents agreed that the mini-course was
useful to their practice (40% agreed and 60% strongly agreed) and
that MCAM was a useful tool (70% agreed, 25% strongly agreed and
5% undecided). Residents stated they will look for opportunities to
collaborate with IPTs.
Conclusions: For IM residents, using the MCAM tool for evaluation
of patient complexity in an IPT setting appears to be a successful
strategy to highlight the roles of IPT care. Response to this minicourse
suggests that residents may be receptive to additional
opportunities for learning about, from, and with other health professionals
to improve outcomes for at risk seniors.
A85
Quality Improvement Curriculum for Geriatrics Fellows Using Lean
Methodology.
G. Gupte, 1 J. A. Eng, 2,1 M. Young, 2 R. M. Zitnay, 2 K. James, 2
M. Sissoko, 2 W. Suen. 2 1. Boston University School of Public Health,
Boston, MA; 2. Section of Geriatrics, Boston University Medical
Center , Boston, MA.
Supported By: HRSA: Geriatric Academic Career Award
John A. Hartford Foundation
BACKGROUND: Practice-based learning and improvement
(PBLI) and systems-based practice (SBP) are two out of the six competencies
required by the Accreditation Council for Graduate Medical
Education. However, few curricula exist as examples of how to
teach and evaluate PBLI and SBP. “Lean” is a quality improvement
philosophy replicated in many industries that focuses on maximizing
customer value while minimizing waste throughout a system, using
tools such as process mapping and identification of waste. The authors
describe a curriculum that uses Lean techniques as a framework
to teach and evaluate fellows in PBLI and SBP.
METHODS. Five Geriatric medicine fellows chose to participate
in a project aimed at improving the routine laboratory ordering
process in their home care practice. The fellows met monthly with the
QI mentors to discuss the ongoing project. The interactive sessions included
introducing and applying the Lean tools of process mapping
and identification of waste, identifying stakeholders, designing a pilot
data collection process, brainstorming solutions, and pilot-testing the
solution. Post-curriculum survey and reflection pieces were administered
and analyzed.
RESULTS. All five fellows worked together to complete a QI
project. The fellows enjoyed the interactive curriculum, gained experience
in systematically performing a QI project, identified challenges
involved in the process, and had an increased understanding of the
stakeholders and the system in which they work. The project was
completed within the year-long geriatric fellowship curriculum.
CONCLUSIONS.The year-long QI project using Lean management
principles and tools allowed for a hands-on, interactive QI experience
that fulfilled the PBLI and SBP competencies for Geriatric
AGS 2012 ANNUAL MEETING
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