Undergraduate Medical Education (UME)Human Genetics (MS1): Genetics course faculty, together with faculty from the Division of Geriatric Medicine, and a Reynolds grant supported 2nd-year medical student collaborated with the Alzheimer’s Association and a volunteer patient participant to develop content for a 1-hour lecture entitled “The Genetics of Alzheimer’s Disease” for 125 MS1 students. This session included a genetics and Alzheimer’s Disease didactic overview followed by a presentation by a patient with early Alzheimer’s disease who described his experience with the disease, and a question and answer period with students. Epidemiology and Biostatistics (MS2): Geriatric faculty reviewed and selected a menu of peer-reviewed manuscripts focusing on studies involving older adults. Following planning meetings with the Epidemiology and Biostatistics Course director, two articles were integrated into the course for second-year medical students and one was chosen for review by students (Inouye et al.’s (1999) NEJM, A Multicomponent Intervention to Prevent Delirium in Hospitalized Older Patients). Approximately 22 students participated in 2-hour small group discussions relating to this important study.Foundational Geriatrics Standardized Patient (SP) Interviewing Skills Sessions (MS1): Division of Geriatric Medicine faculty members collaborated with faculty from the Physician, Patient, and Society 1 (PPS 1) Course to develop a geriatrics-focused case utilizing a geriatric SP to provide an opportunity for MS1 students to practice their interviewing skills. The case involves an elderly patient with multiple morbidities and taking multiple medications, and who is responsible for caring for a functionally impaired spouse. These sessions took place in the UMMS Simulation Center and were recorded utilizing the B-Line system. This was an elective opportunity with 15 students each completing one half-hour session with SPs and debriefing with course faculty. Physician, Patient and Society I Course (MS1): Students participated in a 4-hour session at the Worcester Senior Center during which each MS1 student interviewed an older adult and attended an interactive panel with 3 geriatricians focused on the challenges of providing high quality care for older adults, as well as medication management issues relevant to seniors. Geriatrics Interclerkship (MS3): This was a mandatory day-long annual event for 107 MS3 students. The program included a 3-hour didactic morning session. Students selected 2 small group sessions from among the following: dementia, delirium, and depression; the older driver; incontinence; medications; and the finances of geriatric care. This was followed by a 4-hour afternoon session in an assisted living facility where students conducted in-home interviews with older adults, followed by debriefing sessions with geriatrician faculty.Health Policy and the Practice of Medicine Interclerkship (MS3): This is a mandatory day-long event for 107 MS3 students. A geriatric component was added to the faculty-facilitated small group discussions, which featured a case focused on the Medicare Part D benefit (“A Medicare Dilemma”). Geriatric Teaching Days (students, residents, and faculty): This 2-day event included a student-faculty dinner, Department of Medicine Grand Rounds, and meeting with Medical School faculty to strategize on integration of geriatric content across the continuum, and featured the leader of our Brown School of Medicine Reynolds partner, Dr. Richard Besdine. Twenty students participated in an interactive student-faculty dinner session, during which Dr. Besdine made a presentation entitled “Geriatrics Education and the Future of Medicine.”Core Clinical: Medicine Clerkship Longitudinal Exercise (MS3): As part of the 3rd year Medicine Clerkship, students are asked to identify a geriatric inpatient who they can visit after discharge from the hospital and perform a functional and mental status assessment. Modifications in the exercise were made so that in January 2010, an additional component regarding medication use was added. Students were asked to review their patient’s medications including adherence, side effects, cost, drug interactions and ease of administration. Additionally they were asked to educate the patient and family members regarding the benefits, rationale, and risks of any new medications and report back to the patient’s primary care provider any concerns. The Medication Management competency, #3, is addressed through this initiative. Geriatrics Longitudinal Integrated Themes Website (MS1-MS4): Work has begun with the UMMS curriculum web design management staff to develop a Geriatrics Longitudinal Integrated Theme (LITs) website. This website will serve as a portal to promote accessibility to integrated geriatrics curriculum content, visibility, dissemination, tracking and archiving of geriatrics educational activities.
INTEGRATED GERIATRICS CURRICULUM: The goal of the Integrated Geriatrics Curriculum is to integrate geriatrics content through targeted opportunities throughout the four years of the medical school curriculum consistent with collaboration with the UMMS Learner-centered Integrated Curriculum redesign framework. Human Anatomy (MS1): Modeled after an innovative program developed by our Reynolds partner Brown Alpert Medical School, we have implemented our own Geriatrics and Anatomy initiative. This included a 1-hour lecture delivered to 125 MS1 students, “Aging and Anatomy and Geriatrics”, by Dr. Sarah McGee to MS1students in September 2009. This was followed by geriatrics “treasure hunts” led by 9 geriatricians partnered with anatomy course faculty during 2 anatomy lab sessions. Geriatricians worked side-by-side with students in 2-hour sessions to identify and discuss findings related to aging and disease in each cadaver. Geriatric faculty dedicated an hour to prepare for the anatomy laboratory sessions. Competency addressed through this initiative: #17- identify at least 3 physiologic changes of aging for each organ system and their impact on the patient, including their contribution to homeostenosis.
Integrated Geriatrics Learning Communities (LC): Planning for the development of Learning Communities (LC) is on track and is occurring in tandem with the LInC implementation. Integration of geriatric curriculum and involvement of geriatrician faculty as LC leaders is being encouraged. Building on several telephone consultations with our Reynolds partner, the University of Arizona, UMMS LC co-director Dr. David Hatem, along with members of the UMMS-Reynolds AGE core team, Drs. Michele Pugnaire and Sarah McGee, and Project Director Mary Ellen Keough completed a site visit in October 2009 to that campus to learn from their LC leadership and support team on how to establish LCs and incorporate geriatrics content.
INTEGRATED GERIATRICS ASSESSMENT: The goal of the Integrated Geriatrics Assessment is to assess student competencies in geriatrics in all four years, within and across the diverse curricular components of the geriatrics integrated curriculum.Foundational: Exam item bank (MS1, MS2): We have ongoing discussions with Brown, our Reynolds partner school, regarding adapting materials from the Brown exam item bank, and will be working with UMMS Foundational Studies faculty to develop, pilot and implement exam questions related to newly developed aging content. Foundational: Standardized Patient checklists (MS1 through MS4): Wendy Gammon, Director of the Standardized Patient (SP) Program, in collaboration with Division of Geriatric Medicine faculty, is creating items for the SP checklist based on pilot learner sessions with varied levels of learner, conducted during grant year 1. This checklist will be available in February 2010.Geriatrics Medicine Intraclerkship OSCE (Objective Structured Clinical Examinations-formative) (MS3): A case employing standardized patients and focused on the presentation and differential diagnosis of depression in an older adult was developed collaboratively by the Director of the Medicine Clerkship, Division of Geriatric Medicine faculty, and the Director of the Standardized Patient Program. After the 20-minute OSCE encounter, students debriefed in small groups with geriatricians. This OSCE was first used in July 2009, repeated in October 2009, and will continue each subsequent block. To date, 50 students and 6 geriatricians have participated in the 20-minute OSCE station, followed by a 1-hour debrief session; this exercise is expected to reach all 100 students by end of Academic Year 09-10. Competencies addressed through this initiative: #5 to formulate a differential diagnosis and implement initial evaluation in a patient who exhibits dementia, delirium or depression; #7 to perform and interpret a cognitive assessment in older adults for whom there are concerns regarding memory or function.Sub-Internship OSCE (MS4): Two 4th year students conducted a pilot run-through of a geriatrics-focused, end-of-life simulation case developed through efforts of geriatrics faculty, the Simulation Center engineer, the Standardized Patient Program director, the Sub-Internship director, and two geriatric SPs. This case was adapted from a simulation case developed by our Reynolds partner school, Harvard, as part of their 4th year clinical skills assessment. The case is under revision in collaboration with Dr. Fabiny from Harvard, and will be piloted with UMMS 4th year students in February 2010. End-of-Third-Year Assessment (EOTYA) Geriatrics OSCE (MS3): The EOTYA serves as a capstone measure of students’ clinical skills competencies in geriatrics, and is a required, high-stakes clinical skills assessment conducted at the end of the 3rd year of medical school. In December 2009, the EOTYA Evaluation Group agreed to include a geriatrics OSCE case for the 2010 EOTYA (.75 hours contact time). The Director of the EOTYA, Dr. Sarah McGee, is collaborating with Clerkship Directors, the Director of the Standardized Patient Program, and the Senior Director of the Division of Research and Evaluation to develop this case for implementation in June 2010. Core Clinical: Medicine Clerkship Longitudinal Exercise (previously referred to as Medicine Clerkship Reflective Write-up) (MS3): As part of the Medicine Clerkship Longitudinal Exercise, students complete a questionnaire regarding selected geriatric inpatient’s functional and mental status and the quality of the discharge plan. Enhancements to this exercise were developed and were implemented in January 2010; students selecting the pharmacology option of the exercise complete a newly developed questionnaire regarding the assessment of the patient’s medication management.
GERIATRICS ADVOCACY PROGRAM (GAP): This program offers a menu of diverse and invigorated geriatrics-related activities and programs for those students seeking enhanced experiences in geriatrics.Geriatrics Interest Group (GIG) (MS1-MS2): Building on the existing GIG, organized and run by 1st and 2nd year students since 2001, two new student leaders were identified through a competitive application process. Under the supervision and guidance of Division of Geriatric Medicine faculty members, Drs. Gary Blanchard and Sarah McGee, these student leaders have devoted their efforts to several initiatives. For example, GIG leaders have worked with fellow students to organize and conduct elder community health screenings. In 2009, screenings for osteoporosis, blood pressure, and hearing were conducted. Current GIG activities include production of a newsletter; organizing a presentation on depression in the elderly by a geriatric psychiatrist identified and recruited by the GIG leaders; and increasing student participation in the Elder Patient Navigator Program (see below).The Elder Patient Navigator Program: This program pairs elderly patients with 1st and 2nd year medical students who accompany older adult patients into the exam room for their doctor’s visit. Following the visit, the student “navigator” meets with the patient to review and clarify key points about their medical visit. Designed to augment elderly patients’ comprehension of their complex health conditions, bolster patient-physician communication, and enhance student communication skills, the Navigator Program is currently available to older patients in the cardiovascular clinic. Drs. Blanchard and McGee supervise this effort and meet regularly with the Navigator leaders. Approximately 11 students have trained as Navigators and assisted patients with their visits. One student Navigator leader conducted community presentations about the program at a Latino community center; and to community-based faculty from agencies who provide placements in their geriatrics-focused community programs. Future plans include expansion of both clinical locations and numbers of students trained as Navigators, and creating more longitudinal experiences for students The Elder Patient Navigator Program was presented at the October 2009 annual Reynolds Grantee Meeting Marketplace. Competencies addressed through this initiative included: #3 Medication Management; #15 Health Care Planning and Promotion; and #20 Advanced Illness.
Additional UME activities Scholarly Activities:
Dr. Sarah McGee participated as a panelist in the “Virtual Patients and Simulations in Geriatric Education” workshop during the October 2009 Reynolds Grantee Annual Meeting.
The UMMS-Reynolds AGE core team submitted 3 abstracts to the May 2010 Annual Meeting of the American Geriatrics Society:
• G Blanchard, et al The Navigator Program: Patient Support Instructs Geriatrics Medical Education
• R Celli, et al: Enhancement to Curriculum on Genetics in Alzheimer Disease: A Medical Student’s Initiative
• S McGee, et al: Challenges and Strategies When Working with “Geriatric” Standardized Patients (SPs)
• March 26: Child and Elder Abuse seminar elective attended by 77 students
• June 24: End of Life seminar attended by 25 students.
• November 19: Mandatory Nutrition in Older Adults lecture presented to 125 MS1 students