Computer – Based Human Aging Curriculum: “The Geriatrics IQ”
Fadi H Ramadan, MD
Department of Medicine, State University of New York, Buffalo, New York
Introduction
Understanding human aging is a prerequisite to providing the best geriatric care. Age-related physiologic changes in different organ systems predispose older persons to specific diseases, or alter the presentation of disease. Strategies for disease treatment may need to be modified to accommodate for the age-related changes that occur in various organ systems. Age-related physiologic changes may contribute to geriatric syndromes.
Fig. 1. Examples of age-related physiologic changes, and their clinical significance
Statement of the problem and program objectives
PROBLEMS: (1) Age-related physiological changes in organ systems and geriatric syndromes are often not accounted for in the assessment and treatment of hospitalized older patients. This may lead to under-diagnosis of geriatric syndromes, and/or inappropriate therapeutic interventions; (2) Faculty have heavy clinical responsibilities, where teaching becomes an added burden .
OBJECTIVES: (1) enhance the geriatric assessment skills of medical residents, and improve their ability to recognize and document common age-related physiologic changes, and geriatric syndromes, and (2) reduce the time faculty physicians spend on teaching during in-patient clinical rounds.
Fig.
2. The residents should be able to recognize the kyphosis, the visual loss,
and the use of a cane as risk factors for falls, and the edentulism as a risk
factor for malnutrition
Description of the project/intervention
The Human Aging Curriculum consists of a CD-ROM, that contains: (1) age-related physiological changes in organ systems, (2) geriatric syndromes, (3) multiple-choice, True/False, fill-in-the-blanks self-assessment quizzes, and (4) quiz answers with critique.
Week – 1:
Collect H&P forms & D/C summaries (baseline) by Thursday, before distributing the CD-ROM, or discussing the curriculum.
Friday – 1: Distribute the CD-ROM to residents, provide a brief group – presentation of the curriculum, & present the objectives of the rotation and the curriculum.
Weeks – 2 to 4:
Daily (M – F = 5 sessions) 15 – minute bedside teaching sessions out of the Human Aging curriculum (findings are pointed out to the group, or asked to point them out, at the bedside, based on real cases) as part of the daily 3-hour in-patient rounds
Week – 4:
Collect H&P forms & D/C summaries (post-intervention) by Wednesday.
Friday – 4: Have the residents critique one H&P form, and a D/C summary that present examples of inadequate geriatric assessment. Residents submit a paper version of their answers to the questions contained in the curriculum
Fig. 4. Four demonstration slides from the Human Aging Curriculum. The left-hand slides are from the text section, the right upper slide is from the quiz section, and the right lower slide is from the answers section.
Findings to date/Evaluation to date
The curriculum was piloted over 2 consecutive geriatric rotations, involving 10 medical residents. A check list was used to examine their admission, and discharge notes for inclusiveness of geriatric terms (cataracts, edentulous, delirious, pressure ulcer, falls, etc.), in the physical examination, the assessment and plan, or the discharge diagnosis sections.
FINDINGS:
(1) Residents found the CD-ROM to be very valuable in improving their assessment skills, and stimulated interest in geriatrics.
(2) Increased participation occurred during rounds, where residents volunteered questions related to the curriculum.
(3) The faculty physician felt less pressured to teach during busy clinical rounds, and referred residents to the curriculum for questions that required more detailed discussions
(4) Residents used more geriatric terms in their notes, particularly in relation to skin, cognitive, and oral care assessments (from no terms used per note in the first week, to use of at least 2 terms per note by the fourth week)
Fig. 6. Number of geriatric terms used in all residents’ notes combined in the first week of the rotation (shown in red), compared to the last week of the rotation (shown in blue).
Key lessons learned so far and next steps
A self-study curriculum, in a CD-ROM format, improves geriatric assessment skills, and documentation of medical residents, and partially lifts the heavy burden of teaching from faculty during in-patient rounds. The CD-ROM needs to be tested in a bigger sample of residents, with more than one faculty member, and in different settings, to examine reproducibility of results obtained in this pilot.
Questions
Literature cited
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