Two-and-half years of Experience in Implementing New Expanded Curriculum in Geriatrics for the Family Medicine Residency Program. O Pishchalenko, MD, PhD, N Palafox, MD, MPH, P Blanchette, MD, MPH Departments of Geriatric Medicine and Family Medicine, JABSOM, UH

Purpose:  Develop a strong Geriatric Medicine curriculum & Cross-cultural Geriatrics of the Pacific  Attain the highest standards of excellence in delivering quality geriatric care  Develop FM physicians with a strong interest in expanding the geriatrics part of their practice  Improve performance in geriatrics on ABFM certifying examinations

Development: A new curriculum was designed based on:  National experts experience by literature review  Interviews with key faculty and residents  Needs assessment based on previous experience, resident performance, problems, and potential solutions  New curriculum was designed to enhance previous longitudinal geriatric clinical and didactic experiences.

Curriculum Design:  Longitudinal - residents caring for panel of SNF patients for months in 100-bed SNF and home visits.  Integrated - relevant geriatric issues and cases discussed during existing rotations:  clinic and in-hospital geriatric case discussions  problem-solving conferences  discharge planning rounds  meetings with community agencies staff.

Curriculum Design : Clinical experiences conducted by the Faculty geriatrician:  Block rotation  Home visits  Consultations  Skilled Nursing Facility  Family Counseling  Compassionate care-giving

Curriculum Design :  Block rotation:  concentrated efforts to master the basics of Geriatric Medicine  acquired knowledge and skills to be utilized throughout the rest of the training program.  Home visits:  assess and provide high quality home care  facilitate keeping elderly patients at home

Curriculum Design :  Consultations: comprehensive geriatric medical and preoperative assessments.  Skilled Nursing Facility longitudinal experience:  special challenges and differences of SNF care  role of the medical staff  understanding complex SNF regulations  importance of multi-disciplinary team work  in- training sessions to the nursing staff.

Curriculum Design :  Family Counseling:  consideration of elders history and legacy & multi-cultural issues of the Pacific  inter-generational issues, family & social network, spiritual context  permanent placement in institutional care, advance directives, DPOA, sibling rivalries.  Compassionate caregiving:  addresses emotional and spiritual needs while providing quality medical care.

Results  Teaching time increased by 33%  Developed from three to four-week block rotation for the 3rd year residents  Evaluation was performed through anonymous 1 to 5 Likert scale (5 being most favorable) plus comments.

Results  Overall rotation rating: 4.35 /5  Content relevance to future practice: 4.29 /5  Usefulness of clinical experience: 4.57 /5  Residents especially appreciated:  one-on-one tutoring & feedback  detailed discussions of patients seen  discussions on specific geriatric topics  teaching to service ratio.

Results

 Suggestions for restructuring were:  more home visits  see and discuss more complex patients  expand topics on behavioral issues, psychotropic medications, and end-of-life & ethics  more active role in multi-disciplinary team meetings

Results  The short four-week rotation plus busy FM clinic schedule could explain the perception of high quality but excessive reading assignments  Opinions were virtually split (3.28) if rotation should be geared for the R1/R2 levels (instead of R3)

Discussion:  Residents unanimously agreed that:  new curriculum improved their confidence and skills in taking care for elderly  rotation should continue & expand

Discussion:  Ongoing & Future Projects:  expand geriatric curriculum despite already busy schedule  add end-of-life & ethics courses  establish continuity ambulatory Geriatrics Clinic  continue exploring cross-cultural Geriatrics of the Pacific.

References:  Blanchette P, Flynn B. Geriatric Medicine: An Approaching Crisis. Generations, Spring 2001, Vol XXV, No. 1:  Counsels SR. Curriculum Recommendations for Resident Training in Geriatrics Interdisciplinary Team Care. JAGS 1999; 47:  Gold G. Education in Geriatrics: A Required Curriculum for Med. Students. The Mount Sinai JoM, 1993; Vol.60, No.6.  Reuben DB, at al. The Critical Shortage of Geriatrics Faculty. JAGS 1993; 4:  Sullivan GM. Curriculum Recommendations for Resident Training in Home Care. JAGS;1998; 46:

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