ABSTRACT
Outcomes: 1. Assess baseline knowledge, attitudes, and practices on EOL non-pain symptom management among internal medicine residents in a teaching hospital using a cross-sectional survey. 2. Develop a standardized inpatient EOL non-pain symptom management educational toolkit for internal medicine residents. Introduction: With palliative care gaining traction as a vital specialty to help patients living with serious illnesses comes the need for further training of healthcare professionals. Frontline providers such as medical residents can benefit from end-of-life (EOL) care training in symptom management. Method(s): There are three phases (over a period of 4 years) to this study: (1) administration of a needs assessment survey of baseline knowledge, attitudes, and practices on EOL non-pain symptom management;(2) development and implementation of a standardized inpatient EOL symptom management toolkit;and (3) a comparison of pre-and postassessment after the educational intervention. Result(s): The baseline survey had 66 participants. There were six non-pain symptoms that were elicited as important for further education and training. These were anorexia, nausea/vomiting, dyspnea, oral secretions, myoclonus, and delirium. Competency-based comfort and confidence levels were assessed using a Likert scale (1-5), with the highest number as the most comfortable. The residents were noted to be more comfortable with EOL communication compared to symptom management. Furthermore, residents who had had previous EOL care experiences with patients were more comfortable in symptom management. The educational intervention implemented at a later time revealed that there was an improvement in posttest scores for EOL symptom management. Discussion(s): This study highlights the needs and gaps in EOL symptom management training for medical residents. The implementation of a standardized inpatient EOL symptom management toolkit might serve as a potential intervention to address the needs and narrow gaps in medical training. This can serve as a possible template for other institutions to integrate an EOL care curriculum in medical residency. Limitations of the study include a small sample size, implementation during the COVID-19 pandemic, variable participant response rate, and interrupted timelines. The next steps include ongoing training for all residents, long-term follow-up postintervention, and institutional buy-in.Copyright © 2023
ABSTRACT
Background: Medical students and their future patients will benefit from positive attitudes towards older adults. The study fosters the development of intergenerational relationships -which have been shown to challenge ageist stereotypes -between pre-clinical medical students and older adults through the co-creation of legacy projects. Legacy projects materialize poignant moments in a person's life. Co-creating a legacy project requires active listening and collaboration, and serves as an ideal setting for the development of a meaningful relationship. Furthermore, understanding the effect of virtual settings on intergenerational relationship-building is paramount during the COVID-19 era. We investigate the feasibility of a structured, online intervention to deconstruct ageist attitudes among pre-clinical medical students. Methods: This study uses an interventional pre-post design questionnaire. Six pre-clinical medical students were randomly paired with six older adults (recruited from the Mount Sinai Department of Geriatrics and Palliative Medicine). Prior to meeting the older adults, the medical students attended three expert-led didactic sessions about ageism and intergenerational programs with access to concrete examples of legacy projects. The intergenerational dyads met six times with available guidance to create a legacy project together over the course of the meetings. Due to the COVID-19 pandemic, the dyads met over Zoom technology. Surveys addressing ageist beliefs were administered to pre-clinical medical students and older adult participants before and after the six sessions. Mid-intervention and post-intervention semi-structured interviews were also administered to participants from both age groups as an opportunity for them to debrief and reflect on their experience. Results: Results will be available in March pending the completion of the six sessions. Conclusions: Ageist attitudes represent a significant barrier to the provision of high quality medical care for older adults in the United States. Structured, zoom-based relationship-building through the creation of intergenerational legacy projects may serve as an opportunity to increase positive attitudes towards older adults among pre-clinical medical students.
ABSTRACT
Background: Catalyzed by the horrific death of George Floyd, a Black man, significant concrete efforts to engage workplaces in Diversity, Equity, & Inclusion (DEI) initiatives has gained prominence and administrative backing among workplaces in the United States. A diverse academic geriatrics & palliative medicine department in New York City began meeting weekly in Town Hall sessions to debrief & discuss workplace, local, & national concerns. Discussions focused on COVID19, the Black Lives Matter movement, structural racism, & patient care inequities. These events ignited greater DEI initiatives to meet departmental needs. This report serves to highlight key program components & lessons learned in launching a structured DEI initiative in the academic medicine setting. Methods: First, a new DEI core & department administration met 2-4 times/month to plan & review DEI program activities, vision, & mission. Confidential roundtable discussions about DEI issues & 1:1 interviews were conducted to assess needs. A monthly Humanities, Arts, & Books (HAB) Initiative provided a safe space for discussion & l earning. The HAB platform supported a longitudinal curriculum emphasizing (1) group discussion & self-reflection on DEI topics, (2) knowledge dissemination including a “Learning Pathway” series, & (3) skill-based workshops. With each event, we collected anonymous feedback via survey. Comments were systematically recorded & engagement evaluation was conducted in order to iteratively shape future sessions. Departmental administration was engaged to track DEI-focused measures of recruitment, career advancement, & retention. Finally, we centralized DEI activities on a departmental website, including an anonymous online feedback box. Results: Quantitative & qualitative assessment of DEI initiatives are forthcoming. Metrics include DEI & professional development surveys, departmental demographic & diversity measures, increase in DEI-related projects and grants, & individual participation DEI programs. Conclusions: Creating a strong and sustainable DEI initiative within an academic medical setting requires a passionate and diverse core to centralize efforts, deliberate backing by administration, & thoughtful dissemination of sensitive content in the midst of a highly charged social justice landscape.