ABSTRACT #5

Improving The Ambulatory Curriculum For Geriatric Fellows

Caitlyn Kuwata, Helen Fernandez

PURPOSE AND GOALS: Geriatricians expertly care for older adults using the 5Ms, i.e. the domains of mind, mobility, medications, multi-complexity, and matters most. To ensure geriatrics medicine fellows are competent in these domains, the Entrustable Professional Activities (EPAs) and ACGME Milestones in Geriatrics focus on individual skills that can be demonstrated in the inpatient and outpatient settings. Given the vulnerable nature of the older adult population and their desire to receive care in the community, their needs are best served in the outpatient setting. This project’s goal is to improve the ambulatory curriculum of the Geriatrics Fellowship at Mount Sinai to produce graduates who can deliver high quality care in the ambulatory setting.

METHODS: A needs assessment survey gauged the geriatric fellows’ self-efficacy with the ambulatory domains. The survey was created by synthesizing the literature, the Geriatric (EPAs) and the ACGME Milestones. The content and face validity of the questions were reviewed by experts in ambulatory geriatrics and education. To assess for clarity and understanding, the survey was evaluated by the chief fellows. Additional needs assessments will be elicited from semi-structured interviews of recent graduates of the fellowship.

EVALUATION PLAN: An electronic survey was sent to 21 geriatrics or integrated geriatrics/palliative medicine fellows. They ranked the top 3 clinical and administrative topics they felt most and least prepared to manage independently. Additional questions focused on barriers to practicing in the ambulatory setting and potential curricular interventions that could be implemented.

SUMMARY OF RESULTS: 52% fellows responded to the survey. 46% were planning to practice outpatient geriatrics upon graduation. The clinical topics that fellows felt most prepared to manage were: discussing clinical course of dementia, addressing caregiver distress, performing a comprehensive geriatric exam. The clinical topics that fellows felt least prepared to manage were: indications for durable medical equipment, recognizing elder abuse, diagnosing various dementias, hazardous driving, dizziness, managing behavior disturbance of dementia, evaluation/management of weight loss. Administratively, fellows felt least prepared to do billing, efficient documentation, and time management during clinic. Barriers reducing comfort level with outpatient practice were: paperwork management, balancing inpatient and outpatient duties, and lack of administrative support. Interventions identified as most helpful to implement were: the use of evidence-based guidelines in clinic, increased interdisciplinary team involvement, protected time to debrief with preceptors in clinic.

REFLECTIVE CRITIQUE: This project to improve the ambulatory curriculum for the geriatric fellowship revealed multiple ways the educational experience can be enhanced. There are areas for improving curricular content in both clinical and administrative knowledge. There are also external administrative factors that need to be addressed.