Abstract
BackgroundIn 2014, the University of Toronto Faculty of Medicine implemented a 4-week “Orthogeriatrics” rotation for orthopaedic surgery residents. We sought to assess the rotation’s impact on trainees’ knowledge, attitudes, and behaviours toward caring for older adults, and explore areas for improvement.MethodsWe used a mixed methods concurrent triangulation design. The Geriatrics Clinical Decision-Making Assessment (GCDMA) and Geriatric Attitudes Scale (GAS) compared knowledge, attitudes, and behaviours between trainees who were or were not exposed to the curriculum. Rotation evaluations and semi-structured interviews with trainees and key informants explored learning experiences and the curriculum’s impact on resident physician growth and development in geriatric competencies.ResultsAmong trainees who completed the GCDMA (n = 19), those exposed to the rotation scored higher in knowledge compared to the unexposed cohort (14.4 ± 2.1 vs. 11.3 ± 2.0, p < 0.01). The following themes emerged from the qualitative analysis of 29 stakeholders: Increased awareness and comfort regarding geriatric medicine competencies, appreciation of the value of orthogeriatric collaboration, and suggestions for curriculum improvement.ConclusionsThese results suggest that the Orthogeriatrics curriculum strengthens knowledge, behaviour, and comfort towards caring for older adults. Our study aims to inform further curriculum development and facilitate dissemination of geriatric education in surgical training programs across Canada and the world.
Highlights
In 2014, the University of Toronto Faculty of Medicine implemented a 4-week “Orthogeriatrics” rotation for orthopaedic surgery residents
We suspect that the low number of respondents was due to the voluntary nature of these assessments and that, an effort was made to give residents protected time to complete them during their Academic Half Day, perhaps they had clinical duties that prevented them from participating
The data were qualitatively analyzed using grounded theory to Knowledge and attitudes Junior residents scored statistically significantly higher on the Geriatrics Clinical Decision-Making Assessment (GCDMA) when compared to senior residents (14.4 ± 2.1 vs. 11.3 ± 2.0, p = 0.009)
Summary
In 2014, the University of Toronto Faculty of Medicine implemented a 4-week “Orthogeriatrics” rotation for orthopaedic surgery residents. Compared to other orthopaedic injuries, they are more strongly associated with mortality after one year,[2, 3] postoperative delirium,[4] loss of independence,[5, 6] and prolonged mobility limitations[2]. Orthogeriatric care involves the interdisciplinary management of elderly patients with fragility fractures, [8,9,10,11] including geriatricians and specialized allied health teams on admission [12]. Literature comparing geriatric consult models with orthogeriatric ward-based care showed the latter was associated with reduced surgical wait times, [13] postoperative falls and complications, [14, 15] hospital length of stay, [13, 16, 17] as well as shortand long-term mortality [16, 18]. Surgical trainees reported a lack of formal teaching and comfort involving perioperative management of older surgical patients [19]
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