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Interdisciplinary Team Care Geriatrics Curriculum Overview

The University of Hawaii's interdisciplinary team care geriatrics curriculum provides medical students with comprehensive training in geriatric care through a series of courses and clinical experiences. The curriculum includes skill development in areas such as medication management, pain and symptom management, and communication within an interdisciplinary team approach. Students also engage in clinical rotations in various care settings to enhance their understanding of geriatric care. Overall, the program aims to equip students with the necessary skills and knowledge to provide high-quality care for elderly patients.

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Interdisciplinary Team Care Geriatrics Curriculum Overview

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  1. University of Hawaii Donald W. Reynolds Foundation Next Steps Grant Interdisciplinary Competencies Misty Yee, MS Katherine Kim, MPH Kamal Masaki, MD

  2. Interdisciplinary Team Care Geriatrics Curriculum for Medical Students

  3. RED=IDT+GERI BLUE=GERI JABSOM Curriculum 2011-12 MD1 (9 wks) MD2 (12 wks) MD3 (12 wks) MD4 (12 wks) Cardio & Pulmonary Renal & Hematologic GI & Endo MS1 Health & Illness Community Health MD7 (13 wks) MD6 (15 wks) MD8 (10 wks) MD5 (8 wks) MS2 Locomotor, Neuro, & Behavioral Problems Summer Selectives The Life Cycle Consolidation Transition to Clerkship (2 wks) Clerkships: Family Practice, Internal Medicine, Ob-Gyn, Pediatrics, Psychiatry, Surgery MS3 Colloquia: IDT Topics GERI (4 wks) Senior Seminars (3 wks) Electives (24 wks) EM (4 wks) MS4

  4. Pre-Clinical Years MS1 Community Health Course (Longitudinal) Wellness Initiative for Seniors in Hawaii (WISH) • Care Home Companionship • Community Activities • Physician Shadowing MS2 Life Cycle GERI Subunit (3 weeks) • PBL Tutoring: 3 GERI paper cases • Colloquia: 7 GERI/IDT topics • Clinical Skills Preceptorship: 2 half-days GERI

  5. Clinical Years MS3 Transition to Clerkship • Basic history taking, physical exam and case presentation MS4 Required 4 week GERI+PALL Rotation • Framework: The Geriatric Interdisciplinary Care Summary (GICS) • Interactive Workshops, Clinical Experiences, Written Assignments, Examinations

  6. GICS Swiss-Cheese Model of Geriatrics A Systematic Approach to the Management of Geriatric Syndromes Developed by: Miho Kojima Bautista, MD; Director, Geriatric Clerkship; University of Florida EIGHT MAIN CATEGORIES

  7. MS4 IDT Workshops Three 4-hour Friday Sessions GERIATRICS PALLIATIVE IDT Medication Management Hazards of Hospitalization 3D’s Transitions in Care/Psychosocial Support Pain & Symptom Management Communication Introduction to GICS Review of GICS Debrief IDT Meetings 7

  8. MS4 IDT Clinical Experiences PALLIATIVE GERIATRICS IDT 3-4 full days 3 or 4 wk blocks •Get to know team members •Participate in IDT meetings • Team Observation Tool • GICS • Long-Term Care • Hospital • Outpatient • Inpatient hospice • Outpatient hospice • Palliative Care Consult We want to see students become Team Players! 8

  9. MS4 IDT Written Assignments IDT Principles PALLIATIVE IDT GERIATRICS •Interdisciplinary Introductions • GICS • Patient log • Geriatric GICS parts I & II • Pain Note • Journal • Insight of the month • Words that Work 9

  10. Interdisciplinary Introduction

  11. MS4 Examinations OSCE: Standardized Patient (SP) Curriculum • 7 station Clinical Skills Exam • 2 New SP Cases –Case 1: Ted Lee (fall) Goal: Focused H & P –Case 2: IDT Meeting with SW & Nurse Goal: Create Discharge Plan Written Exam • 50 MCQ Exam (5 IDT)

  12. Interdisciplinary Team Care Geriatrics Curriculum for Allied Health Professional Faculty and Students

  13. Allied Health Faculty Development Course • Goal: Help faculty develop IDT Geri curricula for their own students Year Long Course Faculty from: • UH School of Nursing and Dental Hygiene • UH School of Nursing • Community College Health Sciences Department - Dental Assistant - Emergency Medical Technician - Exercise and Sport Science - Medical Assisting - Nursing • • - OT Assistant - PT Assistant - Radiology Tech - Respiratory Tech

  14. Allied Health Faculty Development Course • Core Competencies: • Health Promotion and Safety • Evaluation and Assessment • Care Planning and Coordination (including end-of-life care) • Interdisciplinary Team Care • Caregiver Support • Healthcare Systems and Benefits

  15. Infusion of Geriatrics and Inter-Professional Relationships into Allied Health Curriculum • • Global integration into every aspect of curriculum Focused in specific areas (eg. pharmacology – “Administration of Medications” course within MEDA program – special considerations for geriatric patients Concepts of Teamwork – using GICS •

  16. Evaluation

  17. Comprehensive Evaluation Summary for Required Geriatrics Rotation July 2011 to Present Scale: 1=poor, 5=excellent Medical Students # Residents Average Geriatrics Seminars # Average The 3D's, Review of GICS, Interdisciplinary Team Care 4.3 47 9 4.3 Written Assignments # Average 4 4 3.9 # 7 Average 4.1 46 Interdisciplinary Introduction 46 7 3.4 GICS 47 7 3.4 Team Observation Tool Was it helpful to receive feedback on geriatric GICS? 3.9 44 5 3

  18. Required Geriatrics Rotation Overall Evaluation Scale: 1=poor, 5=excellent Medical Students Residents Overall Training # Average # Average Geriatric Medicine Experience 47 4.8 8 4 Palliative Medicine Experience 47 4.7 5 3.8 Interdisciplinary Team Training Experience 34 4.3 5 3.6

  19. Required Geriatrics Rotation IDT Attitudes and Skills Scale: 1=strongly disagree, 5=strongly agree Medical Students PRE Residents PRE Attitudes and Skills Talking to the patient’s caregivers and families is usually a waste of my time I am confident that I can function as a member of an interdisciplinary team Eligibility determination for hospice and home care is best left to the social worker Participation on an interdisciplinary team will help me grow professionally # POST # POST 48 1.8 1.7 9 1.3 1.1 35 3.3 4.3 7 2.7 4 48 3.1 2.6 9 2.8 2 35 3.9 4.4 7 3.6 3.9

  20. Required Geriatrics Rotation IDT Attitudes and Skills Scale: 1=strongly disagree, 5=strongly agree Medical Students # PRE Residents PRE Attitudes and Skills POST # POST An interdisciplinary team approach is an important way to care for older adults in the current healthcare environment When caring for an older adult with complex medical and psychosocial problems, the patient and family members are an important part of the interdisciplinary healthcare team I am comfortable collaborating with other healthcare professionals in creating a plan of care for patients 35 3.9 4.5 7 3.6 4 35 4.1 4.5 7 3.6 3.7 35 3.6 4.3 7 3.6 3.7

  21. Kapiolani Community College Faculty Train the Trainer Course in Geriatrics • Year-long course for health professions faculty • Statistically significant improvements in attitudes and skills scores for all 10 sessions • All 10 sessions showed some improvements in knowledge scores • Statistically significant improvements in knowledge scores for 4 of 10 sessions, with borderline significant improvements in 2 additional sessions

  22. KCC Evaluations – Attitudes & Skills Attitudes and Skills Composite Mean Scores scale 1-5: 1=strongly disagree, 5=strongly agree Session 1: Overview Pre mean Post mean P Change value 4.43 4.98 0.55 0.008 Session 2: Nutrition 3.78 4.75 0.98 0.0006 Session 3: Assessment and Preventive Care 4.16 4.89 0.73 0.004 Session 4: Neurology 3.69 4.69 0.99 0.007 Session 5: Oral Health 3.37 4.37 1.00 0.04 Session 6: Psychiatry 3.57 4.80 1.23 0.002 Session 7: Pharmacology 3.80 4.85 1.05 0.0002 Session 8: Transitions of Care 3.88 4.70 0.83 0.008 Session 9: Cultural Aspects/ Health Literacy 4.20 5.00 0.80 0.0004 Session 10: Palliative Care 3.60 4.95 1.35 0.02

  23. KCC Evaluations – Knowledge Scores Knowledge Questions Mean Scores (Percent Correct) Pre mean Post mean P Change value Session 1: Overview 67% 82% 16% 0.02 Session 2: Nutrition 83% 90% 8% 0.5 Session 3: Assessment and Preventive Care 70% 84% 84% 0.03 Session 4: Neurology 79% 94% 15% 0.03 Session 5: Oral Health 87% 93% 7% 0.6 Session 6: Psychiatry 56% 72% 16% 0.08 Session 7: Pharmacology 58% 75% 18% 0.02 Session 8: Transitions of Care 78% 80% 3% 0.4 Session 9: Cultural Aspects/ Health Literacy 72% 74% 2% 0.7 Session 10: Palliative Care 55% 75% 20% 0.09

  24. Transforming the Culture of Healthcare Education supports the Community Students graduate and serve in the community Enhances Training Sites Supports Mentoring of Students

  25. Mahalo

  26. Geriatrics Interdisciplinary Care Summary Check one: Initial Visit - Week 1 Follow-Up Visit - Week 2 Disciplines to Address the Problem(s) Complete on Wk 1. Revise on Wk 2. Problem(s) Complete on Wk 1. Revise on Wk 2. Treatment Plans(s) Complete on Wk 1. Revise on Wk 2. Assessment of Progress from Week 1 Complete only on Wk 2. Domain Physical Med & Rehabilitation 1. NEW 1. Cognitive 1. Emotional Ex: MD, psychiatrist, pharmacist, nursing staff, social worker 1. Medical/Surgical 1. Nutritional

  27. Treatment Plans(s) Complete on initial visit & add in more after IDT and family input Follow-up Disciplines to Address the Problem(s) Complete on initial visit. Problem(s) Complete on initial visit (Assessment of Progress) Complete only on Wk 2 or 3. Domain 1. Environmental 1. Social/Caregiver Economic 1. 1. Barriers to Treatment Plans: Complete on Wk 1. Revise after IDT meeting. Talk to the patient, family/caregiver, and each member of the interdisciplinary care team. 2. Patient’s goals after discussing above Treatment Plans: Complete on Wk 1. Revise after IDT meeting. Have a meeting with the patient. 3. Family and/or caregiver’s goals after discussing above Treatment Plans: Complete on Wk 1. Revise after IDT meeting. Schedule a patient/family/caregiver meeting if appropriate. 4. Social Worker/Case Manager’s goals after discussing above Treatment Plans: For patients who do not have an active or present family/caregiver. Complete on Wk 1. Revise after IDT meeting. Discuss with social workers/case managers in the interdisciplinary care team. INITIAL VISIT GICS (include IDT meeting) Supervising Faculty Signature/Date:___________________________ FINAL GICS (wk 2/3) Supervising Faculty Signature/Date:__________________________________

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