Transcript overview of program and outcomes - 639.5 KB

Teaching Geriatrics
at Texas Tech
Assessing the Geriatrics
Curriculum
Lynn Bickley, M.D.
Associate Professor, Internal
Medicine & Neuropsychiatry
Betsy Goebel Jones, Ed.D.
Assistant Professor, Family &
Community Medicine
Teaching Geriatrics
at Texas Tech
Introduction: Why Geriatrics
 The Geriatrics Curriculum at Texas Tech

Overview
 Strategy for Implementation and Evaluation
 MSI: The Healthy Ager
 MSII: Cases 4,5,6….ICM and Pathology
 MSIII: Cases 8 and 9….Internal Medicine
and Family Medicine Clerkships

Outcomes: Expected and Unexpected
 Conclusions: The Opportunities Ahead

Why Geriatrics?
The Demographic Imperative
34 million Americans ≥age 65 in 2000
 70 million Americans ≥age 65 in 2030
 ≥300,000 older Americans today in West
Texas, including 30% Hispanic and 10%
African-American

Why Geriatrics?
What Makes it Special
Geriatrics: the health and social care of
the elderly
 Core values: respect, variety, optimal
function, relationships, interdisciplinary
 Older people are…

understanding… “not everything can be
cured”
 appreciative…one caretaker makes a
difference
 interesting

Why Geriatrics?
A Strategic Priority

TTUHSC and SOM strategic initiative for
the 21st Century
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HSC Institute for Healthy Aging since
2000

Administration on Aging: $2 million

AAMC/Hartford Foundation: $100,000

The Garrison Center April 2002: a unique
120-bed nursing home
Curriculum Components
funded by the AAMC/Hartford Foundation
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12 problem-based learning (PBL) case modules
spread throughout all 4 years
A geriatrics-based educational activity in each
year
Enhanced lectures in the basic sciences
Grand Rounds on geriatrics topics in clinical
rotations and residency programs
Evaluation
Project Objectives

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To embed project administration in the overall
infrastructure of the Institute for Healthy Aging
To recognize faculty through a new Dean’s
Teaching Scholars program
To integrate the geriatrics curriculum into
current courses and rotations, informed by
continuous and creative curriculum feedback,
evaluation, and remodeling.
To ensure sustainability through close
coordination with Deans, faculty and course
directors committed to geriatrics
Implementation Strategy
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Key leaders included in grant-writing team
Key leaders selected from appropriate courses
and clerkships
Case modules chosen as vehicle most easily
adapted to current courses and rotations
Case modules also pilots for small-group
learning
Comprehensive evaluation adopted to promote
“continuous improvement” and feedback from
students and faculty
Half-time project coordinator included in budget
MS Year I
Positive Aging:
The Goal of the Life Cycle
CM1: Life Histories for Healthy Aging
 CM2: Struggle in a Ranching Family
Lecture Series (8 lecture hours on healthy
aging topics)
 CM3: Healthy Aging: Nutrition & Weight
Loss
 Enhanced lectures in the basic sciences
 Survey of knowledge & attitudes

MS Year II
Aging: Rural & Cultural Variations in
Health & Disease
CM4: Breast Mass
 CM5: Anemia/Colon Cancer
 CM6: Prostate Conditions
 Geriatrics Primary Care Day/Rural
Physicians Roundtable
 Enhanced lectures in the basic sciences
 Survey of knowledge & attitudes (webbased)

MS Year III
Geriatric Care:
Functional Assessment and Ethics
CM7: Prostate Cancer, Death & Dying
(Psych)
 CM8: HTN, Stroke, Incontinence (IM)
 CM9: Falls, Functional Assessment,
Assistive Devices (FM)
 CM10: Osteoporosis, HRT, Sexuality (OB)
 In-patient functional assessment
 Survey of knowledge & attitudes
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MS Year IV
Geriatric Care:
Rural Challenges
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CM11: Dementia, Alzheimer’s Disease,
Depression (Neuro)
CM12: Pneumonia, Delirium, Medications
(Neuro)
Participation in the Alzheimer’s network
Geriatrics Grand Rounds
Geriatrics OSCE
Survey of knowledge & attitudes (web)
Evaluation
Survey of Knowledge & Attitudes
 Case Module evaluation
 Educational Activity evaluation
 Life History qualitative evaluation
 Standardized patient assessment
 Focus Groups
 Faculty evaluations

Life History with a Healthy Ager
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Groups of two students are each paired with a
Healthy Ager in the Community
Preparation includes a model interview and
small-group role-play
Student groups interview the healthy ager and
each student writes a 3-5 page paper about the
ager and experience
Small-group debriefing experience
Evaluation
Life History Student Evaluation
5
4.5
4
3.5
3
2.5
2
1.5
1
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2000
2001
Life History Student Evaluation
Key Findings
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Students tended to be more happy about the
interview experience itself and what they
learned about healthy aging
Students tended to be less happy about the
mechanics of the exercise
Overall evaluation split by ethnicity (All=3.66)
Black=5.0 • Hispanic=3.8 • Asian=3.61 • White=3.64 • Other=4.0

Overall evaluation split by gender
(All=3.66)
Females=3.72 • Males=3.62
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Differences among small groups
Low=2.9 • High=4.4
(All=3.66)
Heathy Ager Evaluation
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Female
Male
39
38
15
18
2000
2001
3
1
10
7
4
7
36
2000
45
2001
Overall Rating
Won't
participate
again
49
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
54
5
4.667
4.682
2000
2001
4.5
4
3.5
Will
participate
again
3
2.5
2
1.5
1
2000
2001
Hispanic
Black
White
Healthy Ager Evaluation
Typical Comments

I enjoyed visiting with the students and it was very interesting to
be able to communicate my feelings concerning contact with
doctors. I am glad to be a part of the project for medical students.
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I would hope that all medical students would be required to have
more than one interview of this type before graduating. I think its
important that they see the wide variations in "seniors." I enjoyed
the visit with "my" students. Thank you for the opportunity to be
involved in this program.

This interview is good for both students and myself. Students can
learn a lot from our experiences, while at the same time it is
refreshing to learn from them. I feel young students have a lot to
offer to this society, and by doing interviews such as this one,
they can get a better perspective of how we live and what our
needs are.
Healthy Ager
Major Life Events
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Marriage
84%
Raising
Children
66%
Education
64%
Family Crises 55%
Children’s
Achievement 40%
World Events
(Wars, Depression)
40%
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Spouse Illness/
Death
Career
Achievements
Retirement
Religion
Health
Problems
Military Service
Other (Poverty)
36%
36%
36%
35%
32%
25%
33%
Healthy Ager Values
Most Often Mentioned
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Social Interactions
& Relations
Educational
Achievement
Work Ethic
Personal
Development
Career
Achievement
Least Often Mentioned
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71%
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Autonomy
Cultural Identity
Prestige
Economic Rewards
Authority
69%
59%
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59%
___________
Generativity
Ego Integrity
56%
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31%
25%
17%
11%
9%
87%
87%
Student Response
to Healthy Agers

Evidence of empathy between the
Student and the Healthy Ager
46%
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Evidence of explicit attitude change 46%
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Evidence of implicit attitude change
8%
Case Modules 2 & 3
MSI
5
Rating
4
3
2
1
CM CM CM CM CM CM CM CM CM CM CM CM CM
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t1 t2 t3 t4 t5 t6 t7 t8 t9 e
po ey is rall rall
siti su
ve es
vie in a
wp gin
oin g
t
Case Modules 4, 5 & 6
MSII
5
4.5
4
3.5
3
2.5
2
1.5
1
O
ro
es
ow
iv
ct
p
m
up
e
bj
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ts
S
G
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O
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10 rat
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In
9
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ic
th
t
E
8
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M
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C
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7
S
ic
as
B
or
6
at
lit
ci s
Fa ce
5
ur
o
es
R
ID
4
3
2
1
CM6
er
CM5
CM4
Case Modules 4, 5 & 6
MSII
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Student assessment shows variation according
to facilitator (using the #10 overall rating)
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CM4: Mean=4.01
Low group=2.9; High group=4.4
CM5: Mean=3.95
Low group=2.455; High group=4.63
CM6: Mean=3.97
Low group=2.8; High group=4.67
Students are generally more positive about the
process than content
Case Module 8
Internal Medicine
5
Lubbock IM Year 1
4.5
4
Lubbock IM Year 2
3.5
3
2.5
Amarillo IM
2
1.5
El Paso IM
1
Overall Rating (out of 5)
Case Module 9
Family Medicine
5
Lubbock FP Year 1
4.5
4
Lubbock FP Year 2
3.5
3
2.5
Amarillo FP
2
1.5
El Paso FP
1
Overall Rating (out of 5)
Geriatrics Knowledge and
Attitude Data

Student Scores on the Knowledge Portion

2000
MSI 69.18%
MSIII
68.49%
 2001
MSI 66.23%
MSIII
69.92%
Students tend to overestimate the size of the elderly
population and the percentage in long-stay institutions;
they tend to see the elderly as unhappy, lonely, poor
and increasingly religious
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Student Scores on the Attitude Portion

2000
2.719 (4=most positive)
 2001
2.731 (4=most positive)
Students show personal interest in being with older
persons but doubt that physicians pay more attention to
elderly patients than to younger ones
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Geriatrics Curriculum:
Lessons Learned
More integration of science of aging
 More on ethics
 More on functional assessment and
clinical management
 More interdisciplinary learning
 More facilitator training (or add team
learning)
 Smooth mechanics
 Student response to new curriculum

Benefits
Expected Benefits
Increased student awareness and
knowledge of geriatrics
 More positive student attitudes about
geriatric care
 Involved a broad cross-section of faculty,
with recognition of 6 Dean’s Teaching
Scholars each year and presentations at
the AAMC

Benefits
Expected Benefits
Concentrated student exposure to healthy
agers in a home or community
environment in Year 1 of medical school
 Faculty gained experience in small-group
learning with cases designed to integrate
basic science and clinical care in aging
 A cohesive curricular plan addressing
core issues in geriatric medicine,
including different types of curricular
experiences

Benefits
Unexpected Benefits
Faculty receptiveness and flexibility
 Extended support from the Office of Faculty
Development
 Synergy with other HSC geriatrics initiatives
 Collaborative networking of basic science
and clinical faculty
 Template established for curriculum
development
 Networking with other medical schools in
geriatrics and curriculum innovation

Conclusions and
Future Directions
Evaluation is critical to “iron out the bugs”
and show direction for faculty
development
 “Institutional learning” has paved the way
to new collaboration across our 4 schools
essential to the interdisciplinary nature of
geriatrics
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Conclusions and
Future Directions
Geriatrics clerkship, consult service
 Geriatrics fellowship
 Strengthen the Institute for Healthy Aging
 Geriatrics Assessment Clinics
 The Garrison Center: Make it special!
 Support for educational, clinical, and
basic science research to “make Tech the
best in geriatrics”
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