Abstract
BackgroundPrognosis is a critical consideration in caring for older adults with multiple chronic conditions, or “multimorbidity”. Clinicians are not adequately trained in this area. We describe an innovative curriculum that teaches internal medicine residents how to incorporate prognosis in the care of older adults with multimorbidity.MethodsThe curriculum includes three small-group sessions and a clinical exercise; it focuses on the assessment, communication, and application of prognosis to inform clinical decisions. The curriculum was implemented with 20 first-year residents at one university-based residency (intervention group). Fifty-two first-year residents from a separate residency affiliated with the same university served as controls.Evaluation included three components. A survey assessed acceptability. A pre/post survey assessed attitude, knowledge, and self-reported skills (Impact survey). Comparison of baseline and follow-up results used paired t-test and McNemar test; comparison of inter-group differences used t-test and Fisher’s exact test. A retrospective, blinded pre/post chart review assessed documentation behavior; abstracted outcomes were analyzed using Fisher’s exact test.ResultsThe curriculum was highly rated (4.5 on 5-point scale). Eighteen intervention group residents (90 %) and 29 control group residents (56 %) responded to the Impact survey. At baseline, there were no significant inter-group differences in any of the responses. The intervention group improved significantly in prognosis communication skills (5.2 to 6.6 on 9-point scale, p < 0.001), usage of evidence-based prognostic tools (1/18 to 14/18 responses, p < 0.001), and prognostic accuracy (1/18 to 9/18 responses, p = 0.005). These responses were significantly different from the control group at follow-up.Of 71 charts reviewed in each group, prognosis documentation in the intervention group increased from 1/25 charts (4 %) at baseline to 8/46 charts (17 %) at follow-up (p = 0.15). No prognosis documentation was identified in the control group at either time point. Inter-group difference was significant at follow-up (p = 0.006).ConclusionWe developed and implemented a novel prognosis curriculum that had significant short-term impact on the residents’ knowledge and communication skills as compared to a control group. This innovative curriculum addresses an important educational gap in incorporating prognosis in the care of older adults with multimorbidity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0488-x) contains supplementary material, which is available to authorized users.
Highlights
Prognosis is a critical consideration in caring for older adults with multiple chronic conditions, or “multimorbidity”
We describe the development and evaluation of a novel curriculum that teaches internal medicine residents how to incorporate prognosis to inform clinical decisions in primary care of older adults with multimorbidity
If overall prognosis documentation was present, we examined if the prognosis estimate was qualitative (e.g. “good”, “poor”) or quantitative (e.g. “10-year mortality risk is 93 %”), whether any literature or evidence-based tool was cited in deriving the prognosis, whether the prognosis was communicated, and whether it affected a clinical decision
Summary
Prognosis is a critical consideration in caring for older adults with multiple chronic conditions, or “multimorbidity”. We describe an innovative curriculum that teaches internal medicine residents how to incorporate prognosis in the care of older adults with multimorbidity. Older adults often have multiple chronic conditions, or multimorbidity, which is associated with increased morbidity and mortality [1,2,3]. Existing curricula on prognosis are limited to palliative care or oncology; [21,22,23,24,25,26] we have not found any described curriculum that teaches assessing, discussing, and incorporating prognosis to frame clinical decisions in the care of older adults with multimorbidity. We describe the development and evaluation of a novel curriculum that teaches internal medicine residents how to incorporate prognosis to inform clinical decisions in primary care of older adults with multimorbidity
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