Academic detailing to teach aging and geriatrics.

Geriatric education is a required component of internal medicine training. Work hour rules and hectic schedules have challenged residency training programs to develop and utilize innovative teaching methods. In this study, the authors examined the use of academic detailing as a teaching intervention in their residents' clinic and on the general medicine inpatient wards to improve clinical knowledge and skills in geriatric care. The authors found that this teaching method enables efficient, directed education without disrupting patient care. We were able to show improvements in medical knowledge as well as self-efficacy across multiple geriatric topics.

Endophthalmitis: an unusual presentation of bacteremia.

Life-threatening diseases can present in benign ways. In this study, a case of endogenous bacterial endophthalmitis, associated with methicillin-resistant Staphylococcus aureus bacteremia, is presented. The patient's only presenting complaint was pain and redness in his left eye. Ultimately, the patient was diagnosed with an infected pacemaker wire. He did well after treatment with appropriate antibiotics and removal of the infected pacemaker. Endophthalmitis is an unusual complication of systemic bacterial infections with severe consequences if left unrecognized. Patients at high risk for bacteremia (ie, intravenous drug users and hemodialysis patients) who present with ocular complaints should have a thorough funduscopic examination to rule out endophthalmitis. Delay of diagnosis and inappropriate antibiotics are associated with poor outcomes, such as blindness.

Aging Q3: an initiative to improve internal medicine residents' geriatrics knowledge, skills, and clinical performance.

A growing number of older adults coupled with a limited number of physicians trained in geriatrics presents a major challenge to ensuring quality medical care for this population. Innovations to incorporate geriatrics education into internal medicine residency programs are needed. To meet this need, in 2009, faculty at the Medical University of South Carolina developed Aging Q(3)-Quality Education, Quality Care, and Quality of Life. This multicomponent initiative recognizes the need for improved geriatrics educational tools and faculty development as well as systems changes to improve the knowledge and clinical performance of residents. To achieve these goals, faculty employ multiple intervention strategies, including lectures, rounds, academic detailing, visual cues, and electronic medical record prompts and decision support. The authors present examples from specific projects, based on care areas including vision screening, fall prevention, and caring for patients with dementia, all of which are based on the Assessing Care of Vulnerable Elders quality indicators. The authors describe the principles driving the design, implementation, and evaluation of the Aging Q(3) program. They present data from multiple sources that illustrate the effectiveness of the interventions to meet the knowledge, skill level, and behavior goals. The authors also address major challenges, including the maintenance of the teaching and modeling interventions over time within the context of demanding primary care and inpatient settings. This organized, evidence-based approach to quality improvement in resident education, as well as faculty leadership development, holds promise for successfully incorporating geriatrics education into internal medicine residencies.