Abstract
BackgroundThe impact of geriatric medicine educational programs on patient level outcomes, as opposed to educational measures, is not well studied. We aimed to determine whether completion of a mandatory geriatrics rotation changed the clinical behaviors of clerks caring for older patients admitted to a medical clinical teaching unit.MethodsWe reviewed the charts of 132 older (>70y) patients, admitted to one medical clinical teaching unit (CTU) during 2005, and cared for by a clinical clerk, for documented functional assessment, cognitive assessment, recognition of medications that cause confusion, and early removal of indwelling urinary catheters. Performance of these outcomes was compared between clerks who had completed a mandatory 2-week geriatrics rotation immediately before the medical CTU rotation (n = 62) and those who completed geriatrics immediately after (n = 74). Patient outcomes were also measured and compared between groups.ResultsCompared to clerks without prior geriatric exposure, clerks with geriatrics exposure were almost 3 times as likely to assess function of their older patients within two days of assuming care (27% vs. 12%, OR: 2.73, 95% CI: 1.12 to 6.66). There were no significant differences in the other clinical behaviors. Patients cared for by geriatrics-exposed clerks were less likely to die or be institutionalized (10% vs. 31%, OR: 0.24, 95% CI: 0.09 to 0.63), and they had shorter lengths of stay by an average of -7.14 days (95% CI: -12.2 to -2.07). Adjustment for baseline differences in age and cognitive impairment did not alter the results.ConclusionsClinical clerks who had completed a mandatory geriatrics rotation were more likely to document functional status upon assuming care of their older medical CTU patients, and there was also an association with better clinical outcomes. This highlights the value of including a geriatric medicine rotation as part of the core clerkship curriculum.
Highlights
The impact of geriatric medicine educational programs on patient level outcomes, as opposed to educational measures, is not well studied
Patients cared for by the clerks without geriatrics exposure were slightly older, less likely to come from long term care institutions, more likely to have a prior diagnosis of cognitive impairment, and more likely to have an admitting diagnosis of delirium or confusion
This study found that clinical clerks who had completed a mandatory geriatrics rotation were more likely to document the functional status of older patients during their medical clinical teaching unit (CTU) rotation
Summary
The impact of geriatric medicine educational programs on patient level outcomes, as opposed to educational measures, is not well studied. We aimed to determine whether completion of a mandatory geriatrics rotation changed the clinical behaviors of clerks caring for older patients admitted to a medical clinical teaching unit. It is widely recognized that the number of frail elderly patients with complex health care needs is large and growing. Some medical schools have responded to this by introducing a mandatory clerkship rotation in geriatric medicine [1]. Educational programs in geriatric medicine have been shown to improve performance on knowledge tests, OSCE stations, faculty evaluations, attitudinal scales. The primary objective of this study was to answer the question: “Does completion of a mandatory geriatrics rotation change the clinical behaviors of clerks caring for older patients admitted to a medical CTU?”
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