The Reinforcement Process in CompetencyBased Geriatrics Education

1
BEYOND DISEASE MANAGEMENT RESIDENTS AS
REINFORCERS OF MEDICAL STUDENT COMPETENCIES FOR
GERIATRIC SYNDROMES
M Milanez, MA Paniagua, MH van Zuilen, and BA Roos
The Geriatrics Institute, University of Miami
Miller School of Medicine, VAMC GRECC, and the
Stein Gerontological Institute, Miami, FL
The work reported on this poster was supported by
the authors institutions, the D. W. Reynolds
Foundation, and the state of Florida Teaching
Nursing Home Program. The investigators retained
full independence in the conduct of this work.
Background and Purpose The Geriatrics
Education for Residents in Internal Medicine
(GERI) rotation was created with the intent of
educating, then enlisting internal medicine
residents as reinforcers of competencies in
geriatric syndromes. The University of Miami
Development of Physician Competency in Geriatric
Syndromes program, funded by the D. W. Reynolds
Foundation, provided the impetus for this
initiative. Our goal is to increase residents
self-efficacy to manage common syndromes that
affect older patients, so that they reinforce
positive attitudes, behaviors, and knowledge in
their contact with medical students during other
rotations.
DWR PROJECT AIM Enlist Reinforcers (Primary Care
Residents and Practicing Physicians) and Enhance
Their Geriatrics Awareness

• The Reinforcement Process in Competency-Based
  Geriatrics Education
• MS1-4 complete a longitudinal geriatrics
  curriculum
• PGY1 interns complete the GERI rotation
• During PGY2/3, residents interact with medical
  students during non-geriatrics rotations
• Residents reinforce geriatrics competencies

Methods We introduce the interns to the set of
competency statements established by the Florida
Consortium for Geriatric Medical Education for
several critical syndromes, such as delirium and
falls. At the same time, we address the ACGME
competencies, systems-based practice and
practice-based learning and improvement, by
exposing the residents to different venues of
care, such as Home-Based Primary Care, Inpatient
Hospice, and the Geriatric Evaluation and
Management Unit, and involving them in
interdisciplinary tasks. In order to foster
active learning (self-directed), we request the
interns each day to choose a competency they
consider relevant for the care of a patient they
have recently seen and develop related learning
activities. We are collecting data on the
effectiveness of the GERI rotation through focus
groups, open-ended questionnaires, direct
observation of the interns by geriatric medicine
fellows and faculty members, and post-rotation
feedback from the participating interns and their
attending physicians.

• Focus of the GERI Rotation
• Assessment of frail persons
• Familiarity with geriatric syndromes
• Assessment tools for falls and dementia
• Systems-based practice (venues of care)
• Identification of ethical and legal issues
• Interdisciplinary team participation

Non-geriatrics UME GME
Competent Care of the Frail Older Patient
Geriatrics UME
Geriatrics GME
Conclusions Overall the rotation has been well
received by the interns. Some interns clearly
developed their own learning objectives for the
competencies they chose others used the
competencies simply as a content overview of
geriatrics topics. Although a few interns tended
to retain a disease management approach in the
care of geriatric patients, most quickly embraced
the idea of syndrome management. The role of
residents as reinforcers of competencies in
geriatrics offers great promise. Housestaff may
convey competencies to other learners in other
settings and thereby potentially improve the care
of older individuals. Investigation into refining
this reinforcement of competent geriatric care
has begun.
Focus on Core Competencies in Falls, Delirium,
and Dementia
Geriatric Syndromes

• Additional Training Activities for Reinforcers
• Immersion workshop with chief residents
• CME program to faculty for GME
• Online training program on geriatric syndromes
  for primary care residents that includes
  assessments of knowledge and documentation of
  training

Institutional and Community Venues
Disease Management