Impact of a mandatory geriatric medicine clerkship on the care of older acute medical patients: a retrospective cohort study

BMC Medical Education

Sharon Marr¹  Heather McLeod¹  Alexandra Papaioannou¹  George Ioannidis¹  Joye StOnge¹ 

[1]Division of Geriatrics, Department of Medicine, McMaster University, Hamilton, Ontario, Canada

关键词: Clinical competence;    Patient outcome assessment;    Activities of daily living;    Clinical clerkship;    Medical education;    Geriatrics;   

Others  :  1135752
DOI  :  10.1186/1472-6920-13-168

 received in 2013-05-02, accepted in 2013-12-12,  发布年份 2013

【 摘 要 】

Background

The impact of geriatric medicine educational programs on patient level outcomes, as opposed to educational measures, is not well studied. We aimed to determine whether completion of a mandatory geriatrics rotation changed the clinical behaviors of clerks caring for older patients admitted to a medical clinical teaching unit.

Methods

We reviewed the charts of 132 older (>70y) patients, admitted to one medical clinical teaching unit (CTU) during 2005, and cared for by a clinical clerk, for documented functional assessment, cognitive assessment, recognition of medications that cause confusion, and early removal of indwelling urinary catheters. Performance of these outcomes was compared between clerks who had completed a mandatory 2-week geriatrics rotation immediately before the medical CTU rotation (n = 62) and those who completed geriatrics immediately after (n = 74). Patient outcomes were also measured and compared between groups.

Results

Compared to clerks without prior geriatric exposure, clerks with geriatrics exposure were almost 3 times as likely to assess function of their older patients within two days of assuming care (27% vs. 12%, OR: 2.73, 95% CI: 1.12 to 6.66). There were no significant differences in the other clinical behaviors. Patients cared for by geriatrics-exposed clerks were less likely to die or be institutionalized (10% vs. 31%, OR: 0.24, 95% CI: 0.09 to 0.63), and they had shorter lengths of stay by an average of -7.14 days (95% CI: -12.2 to -2.07). Adjustment for baseline differences in age and cognitive impairment did not alter the results.

Conclusions

Clinical clerks who had completed a mandatory geriatrics rotation were more likely to document functional status upon assuming care of their older medical CTU patients, and there was also an association with better clinical outcomes. This highlights the value of including a geriatric medicine rotation as part of the core clerkship curriculum.

【 授权许可】

   
2013 St. Onge et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Warshaw GA, Bragg EJ, Thomas DC, Ho ML, Brewer DE: Are internal medicine residency programs adequately preparing physicians to care for the baby boomers? A national survey from the association of directors of geriatric academic programs status of geriatrics workforce study. J Am Geriatr Soc 2006, 54(10):1603-1609.
• [2]Lindberg MC, Sullivan GM: Effects of an inpatient geriatrics rotation on internal medicine residents’ knowledge and attitudes. J Gen Intern Med 1996, 11:397-400.
• [3]Hall K, Riesenberg LA, Stein LK, Biddle WB: Longitudinal effectiveness of a medical school geriatrics clerkship. Acad Med 1997, 72(10):28-30.
• [4]Struck BD, Bernard MA, Teasdale TA: Effect of a mandatory geriatric medicine clerkship on third-year students. J Am Geriatr Soc 2005, 53(11):2007-2011.
• [5]Maurer MS, Costley AW, Miller PA, McCabe S, Dubin S, Cheng H, Varela-Burstein E, Lam B, Irvine C, Page KP, Ridge G, Gurland B: The Columbia cooperative aging program: an interdisciplinary and interdepartmental approach to geriatric education for medical interns. J Am Geriatr Soc 2006, 54(3):520-526.
• [6]Supiano MA, Fitzgerald JT, Hall KE, Halter JB: A vertically integrated geriatric curriculum improves medical student knowledge and clinical skills. J Am Geriatr Soc 2007, 55:1650-1655.
• [7]Goldman LN, Wiecha J, Hoffman M, Levine SA: Teaching geriatric assessment: use of a hybrid method in a family medicine clerkship. Fam Med 2008, 40(10):721-725.
• [8]Diachun L, Bussel LV, Hansen KT, Charise A, Rieder MJ: “But I See Old people everywhere”: dispelling the myth that eldercare is learned in nongeriatric clerkships. Acad Med 2010, 85:1221-1228.
• [9]Charlson ME, Pompei P, Ales KL, MacKenzie R: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40(5):373-383.
• [10]Parmar J: Core competencies in the care of older persons for Canadian medical students. Can J Geriatr 2009, 12(2):70-73.
• [11]Leipzig RM, Granville L, Simpson D, Brownell-Anderson M, Sauvigne K, Soriano RP: Keeping granny safe on July 1: a consensus on minimum geriatrics competencies for graduating medical students. Acad Med 2009, 84:604-610.
• [12]Investigators ACOVE: Assessing care of vulnerable elders-3 quality indicators. J Am Geriatr Soc 2007, 55(Suppl 2):464-487.
• [13]Kingston M: Determining the professional attributes of a hospitalist: experience in one Australian metropolitan hospital. Int Med J 2005, 35(5):305-308.
• [14]Covinsky KE, Palmer RM, Fortinsky RH, Counsell SR, Stewart AL, Kresevic D, Burant CJ, Landefeld CS: Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with Age. J Am Geriatr Soc 2003, 51(4):451-458.
• [15]Inouye SK, Peduzzi PN, Robinson JT, Hughes JS, Horwitz RI, Concato J: Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 1998, 279:1187-1193.
• [16]Chen FM, Bauchner H, Burstin H: A call for outcomes research in medical education. Acad Med 2004, 79:955-960.
• [17]Glick TH: Evidence-guided Education: patients’ outcome data should influence our teaching priorities. Acad Med 2005, 80:147-151.
• [18]Dauphinee WD: Educators must consider patient outcomes when assessing the impact of clinical training. Med Educ 2012, 46:13-20.
• [19]Prystowsky JB, Bordage G: An outcomes research perspective on medical education: the predominance of trainee assessment and satisfaction. Med Educ 2001, 35:331-336.
• [20]Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A: A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J 2005, 173(5):489-495.
• [21]Lang P-O, Heitz D, Hédelin G, Dramé M, Jovenin N, Ankri J, Somme D, Novella J-L, Gauvain JB, Couturier P, Voisin T, DeWazière B, Gonthier R, Jeandel C, Jolly D, Saint-Jean O, Blanchard F: Early markers of prolonged hospital stays in older people: a prospective, multicenter study of 908 inpatients in French acute hospitals. J Am Geriatr Soc 2006, 54(7):1031-1039.
• [22]Oliver D: ‘Acopia’ and ‘social admission’ are not diagnoses: why older people deserve better. J R Soc Med 2008, 101:168-174.
• [23]Wenger NS, Solomon DH, Roth CP, MacLean CH, Saliba D, Kamberg CJ, Rubenstein LZ, Young RT, Sloss EM, Louie R, Adams J, Chang JT, Venus PJ, Schnelle JF, Shekelle PG: The quality of medical care provided to vulnerable community dwelling older patients. Ann Intern Med 2003, 139:740-747.