Medical Students as Teachers in Extended Care (MedTEC): Development of an interdisciplinary teaching program for medical students Amanda Lathia, MD, MPhil Cleveland Clinic Lerner College of Medicine Center for Geriatric Medicine

Needs Assessment Medical students on geriatric rotation Lacked formal training in levels of care Struggled with differentiating care levels Unable to identify appropriate levels for patients

Program Goals Develop knowledge, attitudes, and skills necessary to: Identify appropriate levels of care for older adults in the outpatient and inpatient settings

Program objectives The learner will be able to: List the levels of post acute and extended care Differentiate specific care levels Define components of successful transitions

Program Context 3rd year medical students Required month long rotation Family medicine/geriatric medicine 1 day at a facility offering long term, assisted living, and skilled nursing care

Program Structure Informal group discussion on levels of care Tour of facilities- assisted living, skilled nursing, long term care, and clinical dementia unit Preparation for in-service In-service for facility staff Patient interviews

Discussion on levels of care

Student led in-service

Tools Levels of care pocket card post-acute and long term care settings Informational pamphlet for patients

Program Assessment Pre and post program surveys Demographic information Multiple choice knowledge test Self-efficacy/attitude scale Program feedback Administered using REDCap Evaluate changes in self-efficacy/attitudes and knowledge REDCap is a secure, web-based application for building and managing online surveys and databases.

Confidence in care of hospitalized elders confident in my ability to provide appropriate care for older adults in the hospital. confident in my ability to provide appropriate care for older adults in the outpatient setting. knowledgeable about the different levels of post-acute and extended care in the community. knowledgeable about the discharge process and how to determine the most appropriate disposition for each patient upon discharge from the hospital. Personal contact with the post-acute care physician prior to hospital discharge is necessary. Question Key Confidence in care of hospitalized elders Confidence in care of elders in outpatient setting Knowledge of levels of care Knowledge of discharge process and ability to determine appropriate disposition Importance of personal contact with post-acute care physician

Future directions Assessment of program outcomes Use of students’ patient logs Identify appropriate level of care for patients seen in clinic Feedback from preceptors Long term follow up Use of control group Expansion of program to other trainees

Conclusions MedTEC Unique educational approach Improves knowledge of levels of care Improves attitudes/self-efficacy Model program model for building physician competency on managing medical and psychosocial conditions in different settings of care.

Acknowledgements Barbara Messinger-Rapport, MD, PhD HRSA, GACA Montefiore nursing facility Donald W. Reynolds FD~AGE Program Duke University mini-fellowships Mitchell Heflin, MD, MHS Sandro Pinheiro, PhD