1. Chief Resident Immersion Training (CRIT) University of Rochester Division of Geriatrics & Aging

2. Principal Investigators Annie Medina-Walpole MD Paul Katz MD Don Bordley MD

4. History Initial program developed at Boston University Medical Center with funding from the Donald W. Reynolds Foundation - 2003 Initial program developed at Boston University Medical Center with funding from the Donald W. Reynolds Foundation - 2003 National dissemination project funded by the John A. Hartford Foundation and the Association of Directors of Geriatric Academic Programs - 2007 National dissemination project funded by the John A. Hartford Foundation and the Association of Directors of Geriatric Academic Programs - 2007

5. Overall Goal of Program Foster collaboration among disciplines in the management of complex older patients Foster collaboration among disciplines in the management of complex older patients

6. Secondary Goals Incorporate geriatric principles into teaching and administrative roles as Chief Residents Incorporate geriatric principles into teaching and administrative roles as Chief Residents Develop leadership/teaching skills around the care of complex older patients Develop leadership/teaching skills around the care of complex older patients Enhance leadership/teaching skills required in the Chief Resident role Enhance leadership/teaching skills required in the Chief Resident role Develop an achievable project to be carried out during the Chief Residency year Develop an achievable project to be carried out during the Chief Residency year Have fun and foster collegiality Have fun and foster collegiality

7. Who is Invited? All Chief Residents for 2008 – 2009 academic year involved in the care of older patients All Chief Residents for 2008 – 2009 academic year involved in the care of older patients All Program Directors All Program Directors Families and Significant Others Families and Significant Others Division of Geriatrics Faculty Division of Geriatrics Faculty

8. Three Modules Modules Modules Case Case Small Group Breakout Small Group Breakout Mini-Lectures Mini-Lectures Interspecialty Clinical Pearls Interspecialty Clinical Pearls

9. Geriatric Topics Within Modules Decision Making / Capacity Decision Making / Capacity Preoperative Assessment in the Older Patient Preoperative Assessment in the Older Patient An Approach to Dementia An Approach to Dementia Delirium in the Elderly Delirium in the Elderly Polypharmacy Polypharmacy Functional Assessment Functional Assessment Discharge Planning Discharge Planning

10. Leadership Training Topics The Reluctant Learner The Reluctant Learner Giving Feedback Giving Feedback Teaching in a Small Group Teaching in a Small Group Conflict Resolution Conflict Resolution

11. Chief Resident Project Chiefs meet 1:1 with faculty to develop a project / action plan that focuses on management of complex older patients Chiefs meet 1:1 with faculty to develop a project / action plan that focuses on management of complex older patients Project should be achievable in first 6 months Project should be achievable in first 6 months Projects may focus on trainee education, improvement of clinical care, institutional changes, administration or patient education Projects may focus on trainee education, improvement of clinical care, institutional changes, administration or patient education Projects should fit with interest of participant and needs of residency program Projects should fit with interest of participant and needs of residency program Subspecialty collaboration is encouraged to create joint projects Subspecialty collaboration is encouraged to create joint projects

12. Examples of Chief Resident Projects Medication use/polypharmacy on a rehab unit Medication use/polypharmacy on a rehab unit ADL assessment: training residents to use a validated tool in assessing cognitively impaired and vulnerable patients ADL assessment: training residents to use a validated tool in assessing cognitively impaired and vulnerable patients MMSE to predict post-CABG delirium MMSE to predict post-CABG delirium MMSE and CAM to diagnose dementia and delirium MMSE and CAM to diagnose dementia and delirium Gait assessment and falls risk in neurological patients Gait assessment and falls risk in neurological patients Utilization of pre and post-testing using online Wikipedia during intern report Utilization of pre and post-testing using online Wikipedia during intern report

13. Friday Agenda Check in and pre-test 4:00 pm Check in and pre-test 4:00 pm Evening Session 6:00 – 8:00 pm Evening Session 6:00 – 8:00 pm Dinner Dinner Announcement of Chief Resident Project / Action Plan Announcement of Chief Resident Project / Action Plan

14. Saturday Agenda Breakfast: 1:1 discussion with faculty mentor on project / action plan Breakfast: 1:1 discussion with faculty mentor on project / action plan Modules I and II Modules I and II Leadership/Teaching Skills Leadership/Teaching Skills Lunch Lunch Afternoon free Afternoon free Dinner with family and faculty Dinner with family and faculty

15. Sunday Agenda Breakfast: 1:1 discussion with faculty mentor on project / action plan Breakfast: 1:1 discussion with faculty mentor on project / action plan Module III Module III Leadership/Teaching Skills Leadership/Teaching Skills Announcement of Projects Announcement of Projects Post-test Post-test Lunch Lunch Wrap-up Wrap-up

16. “To be seventy years young is sometimes far more cheerful and hopeful than to be forty years old” Oliver Wendell Holmes