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Implementing New Expanded Geriatrics Curriculum in Family Medicine Residency Program

This article discusses the successful implementation of a new geriatrics curriculum in a family medicine residency program, aimed at developing a strong interest in geriatrics and improving geriatric care. The curriculum includes longitudinal care, home visits, consultations, skilled nursing facility experiences, family counseling, and compassionate caregiving. Results show increased teaching time and positive feedback from residents. Future plans include expanding the curriculum and exploring cross-cultural geriatrics.

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Implementing New Expanded Geriatrics Curriculum in Family Medicine Residency Program

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  1. 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

  2. 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

  3. 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.

  4. Curriculum Design: • Longitudinal - residents caring for panel of SNF patients for 24-36 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.

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

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. Results

  12. 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

  13. 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)

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

  15. 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.

  16. References: • Blanchette P, Flynn B. Geriatric Medicine: An Approaching Crisis. Generations, Spring 2001, Vol XXV, No. 1: 80-84 • Counsels SR. Curriculum Recommendations for Resident Training in Geriatrics Interdisciplinary Team Care. JAGS 1999; 47:1145-1148. • 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; 4:560-569. • Sullivan GM. Curriculum Recommendations for Resident Training in Home Care. JAGS;1998; 46:910-912.

  17. THANK YOU

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