Subject(s)
Cognition Disorders/complications , Continuity of Patient Care/organization & administration , Intellectual Disability/complications , Patient Transfer/organization & administration , Stress, Psychological/prevention & control , Aged , Communication , Cooperative Behavior , Female , Health Services Needs and Demand , Humans , Interprofessional Relations , Models, Nursing , Nursing Homes , Patient Care Planning/organization & administration , Patient Discharge , Stress, Psychological/etiologySubject(s)
Continuity of Patient Care/organization & administration , Geriatrics/organization & administration , Hospitalization , Nursing Homes/organization & administration , Patient Transfer/organization & administration , Total Quality Management/organization & administration , Advance Care Planning/organization & administration , Aged , Aged, 80 and over , Colonic Neoplasms/complications , Communication , Comorbidity , Dementia/complications , Fatal Outcome , Female , Geriatrics/education , Guideline Adherence , Health Services for the Aged/organization & administration , Humans , Interprofessional Relations , Needs Assessment , Outcome and Process Assessment, Health Care/organization & administration , Practice Guidelines as Topic , ResearchABSTRACT
Although there is a critical need to prepare physicians to care for the growing population of older adults, many academic medical centers lack the geriatric-trained faculty and dedicated resources needed to support comprehensive residency training programs in geriatrics. Because of this challenge at Columbia University, the Columbia Cooperative Aging Program was developed to foster geriatric training for medical interns. For approximately 60 interns each year completing their month-long geriatric rotations, an integral part of this training now involves conducting comprehensive assessments with "well" older people, supervised by an interdisciplinary team of preceptors from various disciplines, including cardiology, internal medicine, occupational therapy, geriatric nursing, psychiatry, education, public health, social work, and medical anthropology. Interns explore individual behaviors and social supports that promote health in older people; older people's strengths, vulnerabilities, and risk for functional decline; and strategies for maintaining quality of life and independence. In addition, a structured "narrative medicine" writing assignment is used to promote the interns' reflections on the assessment process, the data gathered, and their clinical reasoning throughout. Preliminary measures of the program's effect have shown significant improvements in attitudes toward, and knowledge of, older adults as patients, as well as in interns' self-assessed clinical skills. For academic medical centers, where certified geriatric providers are scarce, this approach may be an effective model for fostering residency geriatric education among interns.
