The majority of studies demonstrated statistically significant effects associated with the advance directive intervention. The most successful interventions incorporated direct patient-healthcare professional interactions over multiple visits. Passive education of patients using written materials (without direct counseling) was a relatively ineffective method for increasing advance directive completion rates in the primary care setting.

Adverse events commonly occur during hospital-to-home transitions and cause substantial morbidity. This study evaluated the effectiveness of Fast Forward Rounds (FFR), a novel educational intervention that aims to foster awareness of the essential elements of transitional care in 3rd-year medical students. FFR consists of two 90-minute sessions using lectures, an interactive video, small-group discussion, and a team-based learning exercise. It emphasizes functional assessment to identify patients at risk for poor discharge outcomes, promotes interdisciplinary collaboration to link vulnerable patients with appropriate services, reviews Medicare and Medicaid reimbursement, and teaches development of comprehensive care plans. Using a pre/posttest design, participants' knowledge, attitudes and behaviors within the domains of transitional care, functional assessment, interdisciplinary team, community resources, and reimbursement were assessed. Of 103 students, 99.0% attended Session 1 and 97.1% attended Session 2 (pretest completion rate 99.0%, posttest 94.1%). Significant improvements were found in all domains, with the largest gains seen in transitional care. After the intervention, 56.0% identified medication errors as the most common source of adverse events after discharge (vs 14.9% before the intervention, P<.001). Significantly more participants reported feeling competent or expert in safely discharging chronically ill patients (66.3% vs 9.8%, P<.001) and in educating patients about discharge medications (75.8% vs 28.4%, P<.001). Participants also reported changes in transitional care behaviors (e.g., 71.6% now review the discharge medication list with patients and caregivers > or =50% of the time (vs 42.3%, P=.002)). A multimodal educational intervention for medical students increased their transitional care knowledge, reported frequency of transitional care behaviors, and perceived competence in managing the discharge process.

Background Residents need to acquire an understanding of the biopsychosocial aspects of caring for older adults with chronic illness, along with effective use of interdisciplinary services inside and outside of the hospital. Objective We expanded the geriatric medicine experience for second-year internal medicine residents and present the results of the first year's experience. Methods We paired a mandatory rotation for postgraduate year–2 internal medicine residents (2 weeks of day and 1 week of night inpatient experience in the Acute Care for Elders Unit), and a 1-week outpatient systems-based practice experience with online modules and readings. Evaluation included a case presentation, an oral examination, a written questionnaire for all residents, and a global assessment of the residents' performance on the geriatrics portion of the 2012 In-Training Examination (ITE). Results All residents passed their oral examination; there was little difference between classes in systems-based practice knowledge. More than 90% (21 of 23) of the residents who took the rotation reported that it left a lasting impression on how they would care for their patients. Mean ITE scores in geriatrics for all residents increased from 53% (versus 61% overall) in 2010 to 87% (versus 81%) in 2012, although they dropped to 69% (versus 82%) in 2013. Conclusions A rotation in geriatrics that is highly rated and covers both acute care and systems-based practice concepts is feasible for internal medicine residents. Residents did not learn detailed knowledge about specific programs for older adults, but clinical geriatrics knowledge improved.