Transcript UPenn Interdisciplinary Geriatric Fellowship Program

University of Pennsylvania
Interdisciplinary
Geriatric Fellowship Program
Division of Geriatric Medicine
Section on Geriatric Psychiatry
Department of Oral Medicine
HRSA-sponsored
Departments, Principal Faculty
Division of Geriatric Medicine
• Dr. Jerry Johnson, PI
Section of Geriatric Psychiatry:
• Dr. Joel Streim, Co-PI
Department of Oral Medicine:
• Dr. Martin Greenberg, Co-PI
Administration
Natasha Charles MSEd
215-573-7219
[email protected]
What does Title VII Geriatrics Health
Professions Funding Support?
The geriatric health professions program is financed under the
interdisciplinary, community-based linkages section of the
Health Resources and Services Administration (HRSA) and
currently supports three initiatives.
• The Geriatric Academic Career Award (GACA) supports the
development of newly trained geriatric physicians into academic
medicine
• The geriatric faculty fellowships are designed to train physicians,
dentists, and behavioral and mental health professionals who decide
to teach geriatric medicine dentistry and psychiatry.
• The Geriatric Education Center (GEC) program provides grants to
support collaborative arrangements involving several health
professions schools and health care facilities to provide
multidisciplinary training in geriatrics.
Overall Goal and Objectives
 Overall Goal: Prepare fellows for roles as clinician
educator faculty and for certification in geriatric
medicine or psychiatry.
 Aims
 Exhibit the clinical, teaching, administrative and
research knowledge and skills needed to function
in the academic medical center setting.
 Exhibit the ability to care for ethnically and socioeconomically diverse patient populations
 Exhibit the ability to educate trainees from diverse
backgrounds to practice culturally appropriate
geriatric care
What is it?
• Two year fellowship training program for
prospective clinical educator faculty
• Integrated program with core, shared
curriculum as well as discipline-specific
curriculum
• Interdisciplinary including medicine,
psychiatry, dentistry
Who? The Trainees
•
Geriatric Internal Medicine
or Family Medicine Physicians
•
Geriatric Dentists
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Geriatric Psychiatrists
Those planning academic careers as educators
Why This Program?
• Acute faculty shortages in all 3 Disciplines
• Demographic Imperative
• Substantial patient need at the intersection
of these disciplines
Medicine, Psychiatry, Dentistry:
Odd Partners?
• How does a dentist learn to care for a patient with AD?
• Many psychotropic medications cause dry mouth that
then leads to dental problems
• A person unable to chew is at risk of malnourishment or
tube feeding and associated problems
• Is weight loss due to disease process, mood, or
problems in eating?
UPenn GIF Program
• 126 conference hours in a year spread
across the themes of the curriculum.
• Weekly conferences covered 7 curriculum
themes and one sub-theme.
• Faculty recruited from the Division of
Geriatric Medicine, across the University
and from collaborating institutions and
agencies.
GIF Conferences
• 3 hour conference on Friday afternoons.
– Friday 1:00-4:00 PM
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Cases
Board Review
Fellow Presentation
Faculty/Outside Speaker Presentation
Major Themes and Skills
• Health Equity and
Literacy
• Educational Expertise
• Administrative skill
• Interdisciplinary Care and
Teaching
• Research Skills
• Clinical competency, core
and discipline specific
• Communication (crosses
all themes) Skills
• Palliative Care
Health Equity
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Introductory seminar on culture and its relevance
Health education in the community seminar
Visit to West Philadelphia communities
U Penn Geriatric Education Center sponsored
annual conference (2008 and 2009) - Health
Equity and Literacy
• Complementary/alternative medicine and belief
systems
• Cultural differences in preferences for advance
planning directives, and palliative care
• Spirituality
Collaboration with
Geriatric Education Center Course
The course focused on:
• Available methods for the assessment of health
literacy skills
• Culturally based misunderstandings that
complicate care
• Teaching strategies for effective communication
with older patients and families that lead to
improved health outcomes
• Selection and assessment competencies for
health professionals in responding to patients
with limited health literacy in clinical practice
Interdisciplinary Care and
Teaching
• Five seminars on methods issues:
– Teams and teamwork
– Team member roles and responsibilities
– Team communication and conflict resolution
– Care-planning in team practice
– Multiculturalism
• Five seminars on the site-specific aspects of team
practice in: the acute care hospital, the outpatient
practice, home care practices, day care, and the nursing
facility.
• An eleventh seminar will focus on teaching skills
required to present team materials in presentations to
residents and students.
• Once a month clinical presentations by a fellow
Theme: Education
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Adult Education/Models and Framework
Models of Medical Education
Evaluation
Teaching in Clinical Settings
– Small Group Learning
• bedside or walking rounds
• how to identify “teachable moments”, reinforce and correct
trainees’ concepts and information
• Stanford Clinical Teaching Curriculum
Theme: Administration
This portion of the curriculum will use bi-monthly seminars
and precepted experiences. Topics covered are:
 Administration of long-term care: medical
directorships, Reporting (MDS), and external
monitoring (eg JCAHO)
 Quality improvement approaches – inpatient,
outpatient, nursing homes
 Evidence from health services and epidemiologic
research
 QI project
Theme: Collaborator Rounds
• Purpose: To gain an understanding of the assessment
approaches and interventions used by collaborating
professionals.
• The professionals would include: social worker, physical
therapist, audiologist, speech therapist, low vision
specialist, neuropsychologist, pharmacist, occupational
therapist, nurse, dietician, and others as identified.
• In each case, the rounds would include:
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Introduction to the training and functions of the discipline
Overview of patient assessment
Observation/shadowing in clinic
Exposure to basic treatment modalities
Case presentation and discussion
Theme: Research
Bi-monthly seminars and precepted
experiences together with conduct of a research
project. Topics include:
 Introduction to research methods: clinical,
quantitative, qualitative study design
 Issues re research on aging; generalizing
from studies on younger population
 Principles of community participatory
research
Communications Skills
(across all themes)
• Tailoring communication for older adults
• Delivering bad news by telephone
• Communicating with older adults with sensory loss
communicating with cognitively impaired elders
• Conflict resolution modes with elders and their families
• Cultural competence in discussing advanced directives
• Death and Dying
• Family discussion of futile treatment in patients with
advanced dementia
• Sexuality
• Health Equity and Literacy
Other
• Clinical
– Core clinical competency topics: 6 topics
– Palliative care 6 seminars
– Liaison Rounds with collaborating
professionals
Fellow Evaluations
of Educational Session
Evaluation:
 Topic and faculty
 Achievement of objectives for the theme
 Timing of topic within curriculum
 Faculty – teaching across sessions and in
clinical rotations
 Additions/changes to curriculum
Fellow Focus Group
(mid year and at end of Fellowship)
Sample comments:
 ”[t]his experience has broadened our thinking,
made it more likely that we will think of other
contributors to [solving] patient problems,
made the learning more interesting.”
 “[my] history taking is more inclusive”
 Fellows report they consult each other more
often and more readily than they would have
without the shared time and learning.
Conclusions
 Interdisciplinary fellowship expands scope of
clinical thinking and improves facility with
referral and consultation
 Fellows discover previously neglected
opportunities for improved diagnosis and
management, especially with collaborating
professionals
 Exposure of non-funded fellows to the
curriculum increases interest in teaching and
academic careers