Teaching Geriatrics at Texas Tech

1. 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

2. 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

3. 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

4. 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

5. Why Geriatrics?A Strategic Priority • TTUHSC and SOM strategic initiative for the 21st Century • 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

6. Curriculum Componentsfunded by the AAMC/Hartford Foundation • 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

8. Project Objectives • 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

9. Implementation Strategy • 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

10. MS Year IPositive 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

11. MS Year IIAging: 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 (web-based)

12. MS Year IIIGeriatric 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

13. MS Year IVGeriatric Care: Rural Challenges • 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)

14. Evaluation • Survey of Knowledge & Attitudes • Case Module evaluation • Educational Activity evaluation • Life History qualitative evaluation • Standardized patient assessment • Focus Groups • Faculty evaluations

15. Life History with a Healthy Ager • 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

16. Life History Student Evaluation

17. Life History Student EvaluationKey Findings • 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 • Differences among small groups (All=3.66) Low=2.9 • High=4.4

18. Heathy Ager Evaluation

19. Healthy Ager EvaluationTypical 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. • 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.

20. Marriage 84% Raising Children 66% Education 64% Family Crises 55% Children’s Achievement 40% World Events (Wars, Depression) 40% Spouse Illness/Death 36% Career Achievements 36% Retirement 36% Religion 35% Health Problems 32% Military Service 25% Other (Poverty) 33% Healthy AgerMajor Life Events

21. Most Often Mentioned Social Interactions & Relations 71% Educational Achievement 69% Work Ethic 59% Personal Development 59% Career Achievement 56% Least Often Mentioned Autonomy 31% Cultural Identity 25% Prestige 17% Economic Rewards 11% Authority 9% ___________ Generativity 87% Ego Integrity 87% Healthy Ager Values

22. Student Responseto Healthy Agers • Evidence of empathy between the Student and the Healthy Ager 46% • Evidence of explicit attitude change 46% • Evidence of implicit attitude change 8%

23. Case Modules 2 & 3MSI

24. Case Modules 4, 5 & 6MSII

25. Case Modules 4, 5 & 6MSII • Student assessment shows variation according to facilitator (using the #10 overall rating) • 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

26. Case Module 8Internal Medicine

27. Case Module 9Family Medicine

28. 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 • 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

29. 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

30. BenefitsExpected 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

31. BenefitsExpected 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

32. BenefitsUnexpected 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

33. 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

34. 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”