1. A GEM of a GME Geriatric Medicine Experience Overview

INTRODUCTION

We created a resident-focused, interprofessional graduate medical education (GME) rotation in a Veterans Affairs Geriatric Evaluation and Management (GEM)/subacute rehabilitation and long-term and clinical learning environments (CLEs). In planning the rotation, we sought to influence dynamic interplays between patient, faculty, and learner within the CLE and provide an array of resources and activities to help residents achieve the following learning outcomes:

• Provide Age-Friendly™ healthcare, focusing on the 5Ms: Mobility, Mind, Medications, Multicomplexity, and Matters Most
• Integrate with and learn from, with, and about the interprofessional geriatrics care team
• Practice mindful awareness abilities

IMPLEMENTATION

Educational Resource

We sought to create a patient-centered, scaffolded constructivist CLE, an environment in which the patient benefits from the learner being active, constructing meaning from experience, pursuing understanding by reasoning about gaps in their knowledge, and being a sense-maker. The curriculum included ample educational resources aligned with learning objectives: readings, daily didactic activities, and planned interactions with other health professionals. Residents were expected to demonstrate, through presentations on rounds and patient notes, success in meeting the learning goals related to the “5Ms” of Age-Friendly healthcare, interprofessional education and collaboration, and mindful awareness. We supported fellows’ ability to practice (through direct patient care and by having first-line responsibility for supervising residents), expand upon (by exploring gaps in their knowledge base), and teach (by developing their bedside and didactic teaching skills) the residents’ core curriculum.

Program Evaluation

We surveyed confidence, knowledge, attitudes, and open-response experiences of 53 internal medicine, family medicine, and subspecialty geriatrics trainees on 2-4-week rotations from 11/2021 to 11/2022.

RESULTS

• Trainees demonstrated increased confidence in managing geriatric syndromes, interprofessional collaboration, and mindful awareness
• 57% improvement in confidence in trainees’ ability to collaborate and work effectively with an interprofessional team that included social workers, pharmacists, rehabilitation therapists, dietitians, and other health professionals
• Improved knowledge

DISCUSSION

Subacute rehabilitation and long-term care settings present underutilized opportunities for geriatric education and interprofessional teaming. Purposeful design of the curriculum and multiple approaches to optimizing trainees’ cognitive load were critical to creating a successful clinical learning environment. Support from stakeholders across the programs, professions, and administration was essential. Limitations included a small sample size that limited power.

Views and content are those of the authors and do not reflect the official policy or position of VA or any other agency of the United States Government.