Geriatrics for surgeons: infusing life into an aging subject.J Surg Educ. 2008 Mar-Apr; 65(2):91-4.JS
Geriatric patients have specific medical and social needs for which surgeons must become adept at caring. In an effort to improve the care of the elderly, we have committed to developing a geriatric component for our surgical curriculum that is part of our PGY2-protected block curriculum. Competencies covered by this curriculum plan include medical knowledge, systems-based practice, professionalism, patient care, practice-based learning, and communication skills.
The geriatrics curriculum is imbedded in our current protected block curriculum and includes 5 separate sessions during the PGY2 year. During the protected block curriculum, the residents (N = 7) are relieved of all clinical activity, including call. A needs assessment survey assessed the residents' perceptions of the residency program's current focus on geriatric principles. The geriatric portion of this curriculum uses small-group instructional methods consistent with adult learning principles that include practice-based learning, case-based learning, patient simulation using Objective Structured Video Examination (OSVE), and didactic sessions. Faculty instruction is a shared responsibility between geriatricians and general surgeons. The longitudinal geriatrics curriculum includes approximately 10 hours of learner activities over a single-year period.
The curriculum will be evaluated by assessing participant knowledge through the use of multiple-choice testing. Resident performance on OSVEs will likewise be assessed. This method will allow for assessment of higher decision making and clinical reasoning. Finally, a family meeting OSCE will be used to assess professionalism and communication skills further. Overall, all 6 competencies will be assessed using our specific assessment tools. The curriculum content and instructional delivery will be evaluated using longitudinal and session evaluation forms. RESULTS AND EXPERIENCE TO DATE: The geriatrics curriculum will be implemented fully over 2 years. Three sessions will be introduced during the 1st year, and 2 more will be implemented in the 2nd year. The needs assessment survey results demonstrated a lack of sufficient educational focus on geriatrics topics and a low comfort level in caring for the elderly patient. The 1st session of the curriculum has taken place with positive results. The 1st session was a case-based session that focused on critical care and end-of-life issues in the elderly. Although the medical knowledge data are limited thus far, the average pretest score was 57% compared with the 86% posttest score. The resident evaluations (N = 7) of the session demonstrated an average 4.7 (1-5 Likert scale) for content and a 3.9 (1-4 Likert scale) for instructional delivery. CONCLUSION AND NEXT STEPS: Elderly surgical patients have multiple challenges. Specific geriatric training for surgical trainees is lacking. Over the next 2 years, the curriculum will be developed and evaluated even more for its ability to provide adequate instruction in the specific care of the elderly surgical patient. The ultimate goal is to improve the care of the elderly surgical patient.