Background We hypothesized that an intervention which improves nursing home (NH) staff connections, communication, and problem solving (CONNECT) would improve implementation of a falls reduction education program (FALLS). Design Cluster randomized trial. Setting Community (n=4) and VA NHs (n=4) Participants Staff in any role with resident contact (n=497). Intervention NHs received FALLS alone (control) or CONNECT followed by FALLS (intervention), each delivered over 3-months. CONNECT used story-telling, relationship mapping, mentoring, self-monitoring and feedback to help staff identify communication gaps and practice interaction strategies. FALLS included group training, modules, teleconferences, academic detailing, and audit/feedback. Measurements NH staff completed surveys about interactions at baseline, 3 months (immediately following CONNECT or control period), and 6 months (immediately following FALLS). A random sample of resident charts was abstracted for fall risk reduction documentation (n=651). Change in facility fall rates was an exploratory outcome. Focus groups were conducted to explore changes in organizational learning. Results Significant improvements in staff perceptions of communication quality, participation in decision making, safety climate, care giving quality, and use of local interaction strategies were observed in intervention community NHs (treatment by time effect p=.01), but not in VA NHs where a ceiling effect was observed. Fall risk reduction documentation did not change significantly, and the direction of change in individual facilities did not relate to observed direction of change in fall rates. Fall rates did not change in control facilities (2.61 and 2.64 falls/bed/yr), but decreased by 12% in intervention facilities (2.34 to 2.06 falls/bed/yr); the effect of treatment on rate of change was 0.81 (0.55, 1.20). Conclusion CONNECT has the potential to improve care delivery in NHs, but the trend toward improving fall rates requires confirmation in a larger ongoing study.

CONNECT appears to enhance the use of social constructivist learning processes among nursing home staff. The impact of CONNECT on clinical outcomes requires further study.

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Mentoring is an important instructional strategy that should be maximally used to develop the next generation of physicians who will care for a growing population of frail older adults. Mentoring can fulfill three specific purposes: (1) help learners choose an area of specialty, (2) help fellows and new faculty navigate advancement in the academic environment, and (3) help new physicians enter a local medical community and develop a high-quality, professionally rewarding, financially viable practice that meets the needs of older adults. The components and process of mentoring are reviewed. Current and potential mechanisms to promote mentoring for the specific purpose of increasing the quality and quantity of physicians available to care for the older adult population are discussed.

This article provides a framework by which leaders in medical education can begin to prepare current trainees interested in careers as clinician-educators.

The difference between the role of advisor and that of mentor is of critical importance and allowed for the evolution of faculty participants' role as resident advisors, including the formulation of expectations for advisors, and the creation of an advisor toolkit. Our modifiable toolkit can enhance the advising process for residents in many disciplines. We saw an improvement in resident satisfaction from 2006 to 2009.

This article describes the development of a learner-centered, needs-based geriatrics curriculum for medical trainees, specifically, a geriatric block rotation for family medicine and internal medicine residents with the incorporation of a new group of learners: medical students. The objectives were to develop a curriculum that meets the needs of learners with diverse levels of geriatric experience and learning needs. The process used to accomplish these objectives is outlined. In an effort to design a learner-centered, competence-based curriculum, two instruments were developed. These instruments served to identify the learning needs of the varied levels of learners and to develop the specific goals and objectives of this 4-week geriatric rotation. The Geriatric Self-Competency Checklist (GSCC) and a Geriatric Knowledge Test were administered before and after the rotation. On average, learners identified eight priority learning needs using the GSCC. Evaluation and feedback from faculty and preceptors was also important in the identification of learning needs and during the learning process. Faculty development was initiated, focusing on the identification of competence in specific curricular areas. Examples of application of adult learning principles in curriculum design and implementation are also shared. No additional costs or faculty were required for this project, which is important if scarce academic geriatrics resources are to be used to reach the many more medical students and residents. This is essential for quality care needs of the rapidly aging population.

The authors developed a Transitions of Care (TOC) curriculum to teach and measure learner competence in performing TOC tasks for older adults. Internal medicine interns at an academic residency program received the curriculum, which consisted of experiential learning, self-study, and small group discussion. Interns completed retrospective pre/post surveys rating their confidence in performing five TOC tasks, qualitative open-ended survey questions, and a self-reflection essay. A subset of interns also completed follow-up assessments. For all five TOC tasks, the interns' confidence improved following completion of the TOC curriculum. Self-confidence persisted for up to 3 months later for some but not all tasks. According to the qualitative responses, the TOC curriculum provided interns with learning experiences and skills integral to performing safe care transitions. The TOC curriculum and a mixed-method assessment approach effectively teaches and measures learner competency in TOC across all six Accreditation Council for Graduate Medical Education competency domains.