Mitchell T. Heflin

The Effect of Comorbid Illness on Receipt of Cancer Screening by Older People

OBJECTIVES: To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people.

Patterns and predictors of smoking cessation in an elderly cohort

OBJECTIVES: To identify subject characteristics that predict smoking cessation and describe patterns of cessation and recidivism in a cohort of elderly smokers.

Educational interventions to improve recognition of delirium: a systematic review.

Delirium is a common and serious condition that is underrecognized in older adults in a variety of healthcare settings. It is poorly recognized because of deficiencies in provider knowledge and its atypical presentation. Early recognition of delirium is warranted to better manage the disease and prevent the adverse outcomes associated with it. The purpose of this article is to review the literature concerning educational interventions focusing on recognition of delirium. The Medline and Cumulative Index to Nursing and Allied Health Literature (CINHAL) databases were searched for studies with specific educational focus in the recognition of delirium, and 26 studies with various designs were identified. The types of interventions used were classified according to the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model, and outcomes were sorted according to Kirkpatricks hierarchy. Educational strategies combining predisposing, enabling, and reinforcing factors achieved better results than strategies that included one or two of these components. Studies using predisposing, enabling, and reinforcing strategies together were more often effective in producing changes in staff behavior and participant outcomes. Based on this review, improvements in knowledge and skill alone seem insufficient to favorably influence recognition of delirium. Educational interventions to recognize delirium are most effective when formal teaching is interactive and is combined with strategies including engaging leadership and using clinical pathways and assessment tools. The goal of the current study was to systematically review the published literature to determine the effect of educational interventions on recognition of delirium.

A qualitative study of physicians’ experiences with online learning in a masters degree program: Benefits, challenges, and proposed solutions

Background: In response to challenges to faculty development (e.g. time away from clinical, teaching, and other responsibilities; lack of mentors; and limited resources) online learning has become an important venue to provide education for physicians in curriculum development, instruction, assessment, evaluation, educational leadership, and education scholarship. Online learning however has its own unique challenges. Little is known about clinician-educators’ experiences while participating in online programs and few studies have focused on their approaches to facilitate online learning. Aim: To explore the experiences of physicians pursuing a degree in higher education with online learning, including motivations for choosing this format, barriers encountered, and ideas for facilitating learning in the online environment. Method: All students (n = 71) enrolled in online courses in the University of Illinois at Chicago Masters of Health Profession Education Program were surveyed in the spring of 2006. Responses were analysed using a qualitative approach. Results: Of the 48 students who completed the survey (response rate 68%) 45 (94%) were physicians. The online format is convenient, flexible, and may be beneficial for learning. Students’ responses raise issues inherent to online learning that must be addressed to optimize student-centered learning. These issues relate to: clarity of communication; difficulties in negotiating team work and in building relationships; technical demands; learning style preferences, and time commitment. Students provided recommendations for strategies to address these issues such as how to communicate clearly, facilitate teamwork, and optimize time management. Member checking supported the analysis. Conclusions: Online education programs meet the needs of physicians but have associated challenges. Further research is needed to explore the potential value of student suggested ways to optimize the online learning experience.

Exploring Predictors of Complication in Older Surgical Patients: A Deficit Accumulation Index and the Braden Scale

To determine whether readily collected perioperative information might identify older surgical patients at higher risk of complications.

‘So you want to be a clinician-educator …’: Designing a clinician-educator curriculum for internal medicine residents

Background: Despite a growing demand for skilled teachers and administrators in graduate medical education, clinician-educator tracks for residents are rare and though some institutions offer ‘resident-as-teacher’ programs to assist residents in developing teaching skills, the need exists to expand training opportunities in this area. Methods: The authors conducted a workshop at a national meeting to develop a description of essential components of a training pathway for internal medicine residents. Through open discussion and small group work, participants defined the various roles of clinician-educators and described goals, training opportunities, assessment and resource needs for such a program. Results: Workshop participants posited that the clinician-educator has several roles to fulfill beyond that of clinician, including those of teacher, curriculum developer, administrator and scholar. A pathway for residents aspiring to become clinician educators must offer structured training in each of these four areas to empower residents to effectively practice clinical education. In addition, the creation of such a track requires securing time and resources to support resident learning experiences and formal faculty development programs to support institutional mentors and leaders. Conclusion: This article provides a framework by which leaders in medical education can begin to prepare current trainees interested in careers as clinician-educators.

Faculty development for the 21st century: Lessons from the Society of General Internal Medicine-Hartford Collaborative Centers for the Care of Older Adults

In this review of a recent set of faculty development initiatives to promote geriatrics teaching by general internists, nontraditional strategies to promote sustained change were identified, included enrolling a limited number of “star” faculty, creating ongoing working relationships between faculty, and developing projects for clinical or education program improvement. External funding, although limited, garnered administration support and was associated with changes in individual career trajectories. Activities to enfranchise top leadership were felt essential to sustain change.

Health care utilization before and after an outpatient ED visit in older people.

BACKGROUND Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population. OBJECTIVES The goals of this study were to examine the relationships between health care use before and after an ED visit among older adults. METHODS This retrospective cohort study examined health care use among 308 patients 65 years or older discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician [PCP], specialist, ED, and hospital) and risk of return ED visits. RESULTS Older ED patients in this study had visited other types of providers frequently in the previous year (median number of PCP and specialist visits, 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits, 7.0 vs 4.0; P < .001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (hazard ratio, 2.20; 95% confidence interval, 1.15-4.21), in models adjusted for demographics and health status. CONCLUSION Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals.

The Donald W. Reynolds Consortium for faculty development to advance geriatrics education (FD∼AGE): A model for dissemination of subspecialty educational expertise

Purpose Most U.S. medical schools and training programs lack sufficient faculty expertise in geriatrics to train future physicians to care for the growing population of older adults. Thus, to reach clinician–educators at institutions and programs that have limited resources for enhancing geriatrics curricula, the Donald W. Reynolds Foundation launched the Faculty Development to Advance Geriatrics Education (FD~AGE) program. This consortium of four medical schools disseminates expertise in geriatrics education through support and training of clinician–educators. The authors conducted this study to measure the effects of FD~AGE. Method Program leaders developed a three-pronged strategy to meet program goals: FD~AGE offers (1) advanced fellowships in clinical education for geriatricians who have completed clinical training, (2) mini-fellowships and intensive courses for faculty in geriatrics, teaching skills, and curriculum development, and (3) on-site consultations to assist institutions with reviewing and redesigning geriatrics education programs. FD~AGE evaluators tracked the number and type of participants and conducted interviews and follow-up surveys to gauge effects on learners and institutions. Results Over six years (2004–2010), FD~AGE trained 82 fellows as clinician–educators, hosted 899 faculty scholars in mini-fellowships and intensive courses, and conducted 65 site visits. Participants taught thousands of students, developed innovative curricula, and assumed leadership roles. Participants cited as especially important to program success expanded knowledge, improved teaching skills, mentoring, and advocacy. Conclusions The FD~AGE program represents a unique model for extending concentrated expertise in geriatrics education to a broad group of faculty and institutions to accelerate progress in training future physicians.

Development and Implementation of a Formalized Geriatric Surgery Curriculum for General Surgery Residents

Despite the growth of the elderly population, most surgical training programs lack formalized geriatric education. The authors’ aim was to implement a formalized geriatric surgery curriculum at an academic medical center. Surgery residents were surveyed on attitudes toward the care of elderly patients and the importance of various geriatric topics to daily practice. A curriculum consisting of 16 didactic sessions was created with faculty experts moderating. After curriculum completion, residents were surveyed to assess curriculum impact. Residents expressed increased comfort in accessing community resources. A greater percentage of residents recognized the significance of delirium and acute renal failure in elderly patients. Implementing a geriatric surgery curriculum geared toward surgery residents is feasible and can increase resident comfort with multidisciplinary care and recognition of clinical conditions pertinent to elderly surgical patients. This initiative also provided valuable experience for geriatric surgery curriculum development.