What was known Residents need to understand the medical and biopsychosocial aspects of caring for older adults.;What is new An expanded geriatric medicine experience for second-year internal medicine residents explored inpatient and ambulatory care, and provided a systems-based practice module.;Limitations Single institution study and small sample reduce generalizability; knowledge gains were not sustained in the postimplementation year.;Bottom line A focused geriatrics rotation is feasible, was highly rated by learners, and improved clinical geriatrics knowledge. Assessing geriatrics competencies remains challenging.;Editor's Note: The online version of this article contains a handout describing each activity in the module.;Introduction Geriatrics training is mandatory for internal medicine (IM) residents.1 Despite curricula and guidelines, creating a learning experience that meets residents' needs remains a challenge. Equally difficult is measuring the effectiveness of this rotation; in addition to knowledge, impact on attitude is a high priority.2 Resident-level assessments of geriatrics knowledge are few, limited in scope, and often outdated. The University of Michigan Geriatrics Clinical Decision-Making Assessment Instrument,3 although well-crafted, includes palliative care content and dates back to 2006. Attitudinal scales4–6 may not elicit honest answers.7 A recent academic geriatric and palliative care curriculum was associated with enhanced geriatric knowledge but not enhanced attitudes8; it is unclear whether the true effect of the program was being measured. The Accreditation Council for Graduate Medical Education's promotion of competency in systems-based practice (SBP) dovetails well with geriatrics content, but a hospital-based experience provides residents with little practical exposure. The challenges of incorporating SBP into resident education have been described.9,10 In geriatrics, experiences outside the usual care sites are essential, and this requires planning and cooperation with community partners.11,12 Since 2003, the New York Presbyterian Hospital Weill Cornell Campus (NYPH-WCC) has had an Acute Care of Elders (ACE) Unit13 serving as the site for IM resident learning along with physician assistant students, nursing students, social work interns, and medical students. When the IM geriatrics rotation began a decade ago, extra administrative support enabled interns to make 1 posthospital visit during their 4-week block. Over time, the service became busier and the interns were unable and unwilling to leave, despite growing educational emphasis on transitions and ambulatory care. Changes in duty hour regulations in 2011 necessitated restructuring of resident training. The IM geriatrics rotation was modified to include a dedicated 1-week SBP module whose goals were to facilitate residents' exposure to non–acutely ill elderly patients and the community-based programs that help maintain their physical and emotional health. This article describes the rotation and the initial evaluation of its effectiveness.;Methods Rotation Description A 4-week geriatrics rotation is required for all IM postgraduate year (PGY)–2 residents at NYPH-WCC. Each resident has 3?weeks of inpatient geriatrics (2?weeks of day coverage and 1?week of night coverage providing direct care for 8 to 10 patients with medical illnesses from the community and nursing homes) and 1?week (5?weekdays) in an outpatient SBP module (SBP-OM). The PGY-1 residents do not participate, while PGY-3 residents are assigned to the rotation to ensure adequate coverage, but do not repeat the SBP experience. The inpatient team is led by a faculty geriatrician. The home base is the 19-bed ACE unit, but the unit is not closed and the team is not strictly geographic. The SBP-OM represents a multicomponent intervention with exposures to different sites of care and resources available to older adults. These exposures include observation, direct patient care, team meet
展开▼
