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The Curriculum for the Hospitalized Aging Medical Patient Program: a Collaborative Faculty Development Program for Hospitalists, General Internists, and Geriatricians

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The Curriculum for the Hospitalized Aging Medical Patient Program: a Collaborative Faculty Development Program for Hospitalists, General Internists, and Geriatricians PROFESSIONAL DEVELOPMENT The Curriculum for the Hospitalized Aging Medical Patient Program: A Collaborative Faculty Development Program for Hospitalists, General Internists, and Geriatricians 1 Paula M. Podrazik, MD BACKGROUND: The University of Chicago Curriculum for the Hospitalized Aging 1 Stacie Levine, MD Medical Patient (CHAMP) faculty development program (FDP) is targeted at hos- 2 Sandy Smith, PhD pitalists and other internists who teach residents and students in the hospital set- 3 Don Scott, MD, MPH ting. The aim of CHAMP is to increase the quantity and quality of teaching of 1 Catherine E. DuBeau, MD geriatric medicine pertinent to the inpatient setting. 1 Aliza Baron, MA METHODS: Hospitalist and general internist faculty members who attend on the 4 Chad Whelan, MD University of Chicago Medicine teaching service were invited to participate. The 4,5 Julie Johnson, MSPH, PhD CHAMP FDP consisted of twelve 4-hour sessions. Two hours of each session cov- 6 Sandy Cook, PhD ered inpatient geriatrics content, and 2 hours addressed improving clinical teach- 4 Vineet Arora, MD, MA ing (both general teaching skills and challenges specific to the inpatient wards) 4,7 David Meltzer, MD, PhD and teaching the Accreditation Council for Graduate Medical Education core 8 Greg Sachs, MD competencies with geriatrics content. The evaluation included a self-report sur- vey of the impact on the graduates’ teaching and clinical practice. 1 Section of Geriatrics, Department of Medicine, RESULTS: The FDP was piloted in early 2004 with a core group of geriatrics and University of Chicago, Chicago, Illinois. hospitalist faculty. Three subsequent cohorts totaling 29 hospitalist and general 2 Department of Family Medicine, University of internal medicine faculty members completed the FDP by the fall of 2006. Fac- Chicago, Chicago, Illinois. ulty participants evaluated the program positively, and significant improvements in knowledge, attitudes to geriatrics, and perceived behavior in teaching and 3 General Internal Medicine, Southern Illinois Uni- versity School of Medicine, Springfield, Illinois. practicing geriatrics skills were found. CONCLUSIONS: The integration of teaching techniques and geriatrics content was 4 Section of General Internal Medicine, Depart- enthusiastically accepted by University of Chicago hospitalists and general inter- ment of Medicine, University of Chicago, Chicago, Illinois. nists who teach residents and medical students in the inpatient setting. The pro- gram has potential for widespread suitability to all teaching faculty who care for 5 American Board of Medical Specialties, Evan- the older hospitalized patient. Journal of Hospital Medicine 2008;3:384–393. ston, Illinois. VC 2008 Society of Hospital Medicine. 6 Duke-National University of Singapore Graduate Medical School, Singapore. KEYWORDS: hospitalist as educator, geriatric patient, practice-based learning and 7 Departments of Economics and Public Policy improvement, quality improvement. Studies, University of Chicago, Chicago, Illinois. 8 General Internal Medicine, Department of Medi- cine, Indiana University, Indianapolis, Indiana. crucial arena of innovative educational programs for the care A of the elderly must include the hospital setting, a place of great cost, morbidity, and mortality for a population currently occupying approximately half of US hospital beds.1 With a marked acceleration in the number of persons living to an advanced age, there is a clear imperative to address the health- care needs of the elderly, particularly the complex and frail.2–4 An educational grounding that steps beyond the traditional organ-based models of disease to a much broader patient-cen- tered framework of care is necessary to aid physicians in advanced clinical decision-making in the care of older patients. 384 ª 2008 Society of Hospital Medicine DOI 10.1002/jhm.348 Published online in Wiley InterScience (www.interscience.wiley.com). Organizing the medical care of the older patient Dean at the University of Chicago Pritzker School within existing systems of care and a team care of Medicine. The core group piloted the FDP for management network must also be improved. themselves in spring 2004, and the FDP was Curricular materials and methods are widely offered to target learners annually from 2004 to available for teaching geriatric medicine,5–7 but 2006. most are geared toward outpatient care and man- agement, with few addressing the care of the hos- CHAMP Participants pitalized, older medical patient.8–10 There is even The targeted faculty learners for the CHAMP FDP less published on curricular materials, methods, were hospitalists and general internists who and tools for such teaching outside of specialized attend on an inpatient medicine service for 1 to 4 hospital-based geriatric units by non–geriatrics- months yearly. CHAMP Faculty Scholars were trained faculty.11–13 Furthermore, the evaluation of self-selected from the eligible faculty of the Uni- geriatrics educational programs in the hospital versity of Chicago. Approximately one-third of the setting has not been done with the ultimate CHAMP Faculty Scholars held significant adminis- assessment, the linking of educational programs trative and/or teaching positions in the Depart- to demonstrated changes in clinical practice and ment of Medicine, residency program, or medical patient care outcomes. school. Overall, general internist and hospitalist To address these needs, we designed and faculty members of the University of Chicago are implemented the Curriculum for the Hospitalized highly rated inpatient teachers with a 2004-2007 Aging Medical Patient (CHAMP) Faculty Develop- average overall resident teaching rating of 3.79 ment Program (FDP). CHAMP was funded by a (standard deviation 5 0.53) on a scale of 1 to 4 (4 grant from the Donald W. Reynolds Foundation 5 outstanding). For each yearly cohort, we sought Aging and Quality of Life Program with a match- to train 8 to 10 Faculty Scholars. The Donald W. ing commitment from the University of Chicago Reynolds Foundation grant funds supported the Department of Medicine. At the core of CHAMP time of the Faculty Scholars to attend the CHAMP are principles of care for the older patient in the FDP 4 hours weekly for the 12 weeks of the course hospital setting, with an emphasis on identifying with release from a half-day of outpatient clinical and providing care for the complex and frail el- duties per week for the length of the FDP. Scholars derly with nongeriatrician inpatient medicine fac- also received continuing medical education credit ulty as the primary teachers of these materials. for time spent in the FDP. The overall educational goals of the CHAMP FDP are the following: (1) to train hospitalists and gen- eral internists to recognize opportunities to teach CHAMP Course Design, Structure, and Content geriatric medicine topics specific to the care of Design and Structure the hospitalized older patient; (2) to create teach- The CHAMP FDP consists of twelve 4-hour ses- ing materials, tools, and methods that can be used sions given once weekly from September through in the busy medical inpatient setting at the bed- November of each calendar year. Each session is side; (3) to create materials and tools that facili- composed of discrete teaching modules. During tate teaching the Accreditation Council for the first 2 hours of each session, 1 or 2 modules Graduate Medical Education (ACGME) core com- cover inpatient geriatric medicine content. The petencies14 during ward rounds; and (4) to remaining 2 hours are devoted to modules con- increase the frequency and effectiveness with sisting of the Stanford FDP for Medical Teachers: which this geriatrics content is taught in the hos- Improving Clinical Teaching (first 7 sessions)15,16 pital setting. This article describes the develop- and a course developed for the CHAMP FDP ment and refinement of the CHAMP FDP and named ‘‘Teaching on Today’s Wards’’ (remaining 5 evaluation results to date. sessions). In addition to the overarching goals of the CHAMP FDP, each CHAMP module has specific METHODS learning objectives and an evaluation process The CHAMP FDP was developed by a core group based on the standard precepts of curriculum of geriatricians, hospitalists, general medicine fac- design.17 Further modifications of the CHAMP ulty, and PhD educators from the Office of the content and methods were strongly influenced by Curriculum for the Hospitalized Aging Medical Patient / Podrazik et al. 385 subsequent formal evaluative feedback on the TABLE 1 course content, materials, and methods by the Outline of the Geriatric Topics of the Curriculum for the Hospitalized Faculty Scholars in each of the 4 FDP groups to Aging Medical Patient Faculty Development Program date. Theme 1: Identify the frail/vulnerable elder Identification and assessment of the vulnerable hospitalized older patient Dementia in hospitalized older medical patients: Recognition of and screening Geriatrics Content for dementia, assessment of medical decision-making capacity, implications for The FDP geriatrics content and design model the treatment of nondementia illness, pain assessment, and improvement of the posthospitalization transition of care were developed as follows: reviewing existing pub- Theme 2: Recognize and avoid hazards of hospitalization 5,6,8,18 lished geriatrics curricular materials, includ- Delirium: Diagnosis, treatment, risk stratification, and prevention ing high-risk areas of geriatric hospital care;19–22 Falls: Assessment and prevention
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