Richard B. Rosher

Tangling with the barriers to culture change: creating a resident-centered nursing home environment.

In this study, the author examines the relationship between staff perceptions of organizational culture and their work-related attitudes in assisted living. Data were collected from 317 staff in 61 facilities using self-administered questionnaires. Staff who had more favorable perceptions of organizational culture reported greater job satisfaction, coworker satisfaction, and organizational commitment. Among the dimensions of organizational culture, perceptions of teamwork had the strongest influence on satisfaction with coworkers, and perceptions of organizational morale had the strongest influence on job satisfaction and organizational commitment. Those who want to improve staff attitudes should focus on creating organizational cultures that promote teamwork and high organizational morale.

Effect of the “Half-Full Aging Simulation Experience” on Medical Students' Attitudes

Abstract Forty-nine third-year medical students participated in the “Half-Full Aging Simulation Experience.” The purpose of this program was to allow students to experience the functional decline that may occur with normal aging, while learning how function can be improved by simple environmental adaptations. Student attitudes were measured before and after the simulation experience. A significant change was detected on the instrumental sub-scale of the Aging Semantic Differential Scale. This sub-scale measures attitudes related to the older adults ability to improve, change, and pursue goals.

THE EDEN ALTERNATIVE: IMPACT ON STUDENT ATTITUDES

ABSTRACT Nursing homes as clinical sites for student learning have the potential to produce negative attitudes toward aging. The purpose of the study reported in this paper was to determine the impact of the Eden Alternative on the attitudes of students toward elders residing in nursing homes. Prior to beginning implementation of the Eden Alternative, 61 students completed the Health Professional Beliefs and Opinions about Elders. At 2 years after implementation of the Eden Alternative, 73 students completed the same survey. The second group reflected significantly more positive attitudes toward elders living in nursing homes.

Systems-based practice assessed with a performance-based examination simulated and scored by standardized participants in the health care system: feasibility and psychometric properties.

Background: Systems-based practice is one of the six general competencies proposed by the Accreditation Council for Graduate Medical Education in their Outcome Project. However, little has been published on its assessment—possibly because the systems-based practice competency has been viewed as difficult to define and measure. Purpose: The purpose of this study was to determine whether a full performance-based examination of systems-based practice cases simulated and scored by standardized participants in the health care system could feasibly be constructed and implemented that would provide reliable and valid measurements. Methods: In the 1st year of the project (2008), four systems-based practice cases were developed and pilot tested with 13 residents. Videotapes of residents were studied to develop an instrument for subsequent assessment of performance by standardized participants. In the 2nd year (2009), the examination was expanded to a full 12 cases, which were completed by 11 second-year residents, and psychometric analyses were performed on the scores. Results: The generalizability coefficient for the full 12-case examination based on scoring by standardized participants was .71, which is nearly equal to that based on scoring by faculty physician observers, which was .78. The correlation between total scores obtained with standardized participants and physician observers was .78. Conclusions: A performance-based examination can provide a feasible and reliable assessment of systems-based practice. However, attempts to evaluate convergent validity and discriminant validity—by correlating systems-based practice performance assessments with mean global ratings of residents on the 6 competencies by faculty throughout training—were unsuccessful, due to a lack of independence between the rated dimensions.

Aging Couple Across the Curriculum

Aging Couple Across the Curriculum is a unique program designed around a couple who “age” a decade with each year of medical school. In these half-day sessions, students encounter the aging couple through a standardized patient experience. Interactive breakout sessions conducted by multidisciplinary professionals enhance student learning and appreciation of the contributions of the team of professionals. A panel of elder specialists provides personal insight into how they have overcome and/or adapted to various health-related problems. Evaluation measures have indicated that students are benefiting from the program and that it is affecting their attitudes in a positive way toward caring for older adults.

Elder Specialists: Psychosocial Aspects of Medical Education in Geriatric Care

This paper describes an Elder Specialist Program developed by one school of medicine to sensitize medical students to geriatric psychosocial issues. Elder Specialists participate in panel discussions as part of each geriatric session. As an alternative to traditional senior mentoring programs, the Elder Specialist Program provides all students a consistent experience and enlightens students to the heterogeneity of the older adult population. Cost of the Elder Specialist Program is minimal. Without exception, the Elder Specialist component of each geriatric session has been rated by students as the highest. Measures of attitudes toward older adults are showing a positive trend.

Use of foot veins to monitor hydration in the elderly.

To the Editor: The American Geriatrics Society (AGS) is withdrawing the abstract (A31) of Paper Presentation, ‘‘Fondaparinux is superior to enoxaparin for venous thromboembolism prevention in major orthopedic surgery irrespective of patient characteristics,’’ presented at its 2003 Annual Scientific Meeting by Turpie AG, Bauer KA, Eriksson BI et al. A synopsis of the same abstract was also published in J Am Geriatr Soc 2003; 51(suppl 4):S37. This abstract is being withdrawn after a review by the AGS Research and Executive Committees identified violations of AGS submission guidelines. The results reported in this presentation were not original, previously unpublished, research. In addition, the authors were not directly involved with the conduct of the research that was presented.

The physician's role in assessing and counseling aging drivers: a training session for undergraduate medical students.

ABSTRACT The critical need for physicians to become entrenched in the issues of older drivers and public safety is the focus of a training initiative developed as a component of an innovative geriatrics curriculum, Aging (Couple) Across the Curriculum. As the number of aging drivers in the United States rises, physicians can play an important role in helping older patients continue safe driving practices and in counseling those who need to cease driving. This article describes an inventive course designed to sensitize medical students to the many complex issues entangled in driving and aging and to prepare them to competently and compassionately assess and counsel older drivers. The act of driving connotes more than mobility. It reinforces ones independence, including the ability to go when and where one chooses. There must be a careful balance between an older persons privilege to drive and the publics right to safety. Through this training program, students can experience the complexity of this significant issue. This model has the potential to be utilized in other medical schools and could be adapted for use in interdisciplinary education.