An Educational Intervention to Improve Internal Medicine Interns' Awareness of Hazards of Hospitalization in Acutely Ill Older Adults

Abstract

Hospitalized older adults are susceptible to complications termed "hazards of hospitalization" (HOH), which collectively result in poor patient outcomes. Previous research has shown that residents are not aware of their patients' risk factors for HOH. This study investigated the effect of an educational intervention to increase internal medicine interns' knowledge and self-efficacy of HOH and to improve their care of hospitalized older adults as measured by their documentation of HOH. Targeted learners were internal medicine interns on their geriatrics rotation at a large academic hospital in 2011 to 2012. The intervention covered 10 specific HOH: delirium, pressure ulcers, urinary incontinence and retention, functional decline, falls, suboptimal prescribing, dehydration and malnutrition, infection, depression, and inappropriate interventions. Knowledge and self-efficacy were measured before and after training. HOH documentation rates of interns who did and did not complete the training were compared over a preset 8-week period. Forty-two of 43 eligible interns completed the curriculum. After training, knowledge was significantly greater (approximately 1 more correct question out of 3, P < .001). Self-reported confidence in managing each hazard also significantly increased (13 questions on two 5-point Likert scales, P < .001). Trained interns had significantly more-frequent documentation of patients' activities of daily living, gait, and plan for functional decline prevention than interns who were not trained (P < .05). Conversely, documentation of instrumental activities of daily living was more frequent among interns who were not trained (P < .01). Implementation of an educational intervention was successful in improving educational and behavior change outcomes regarding HOH.

Geriatrics Curricula for Internal and Family Medicine Residents: Assessing Study Quality and Learning Outcomes

“…[25][26][27][28][29][30][31][32][33][34][35][36][37][38] The 14 studies are summarized in 27,29,[31][32][33][34]36 ; didactics 25,28,29 ; web-based 30 or electronic medical record modules 26 ; cues to action 38 ; decision support 27,37 or simulation combined with video and case discssion 38 ; grand rounds 29 ; interdisciplinary team meetings or rounding 29,32 ; geriatrics patient rounds 25,29,32 ; nursing home rounds 31 ; morning case report 28,29 ; independent study projects 29 ; formative feedback 35,38 ; and direct observation. 25 Learning outcomes were matched to Kirkpatrick levels 1 to 4. 19 As shown in TABLE 25,28,32,…”

“…[25][26][27][28][29][30][31][32][33][35][36][37][38] Of these, 10 reported statistically significant changes in knowledge and/or skills. 25,[29][30][31][32][33][35][36][37][38] Five studies reported behavioral changes in learners (Kirkpatrick Level 3), [25][26][27][28]30 and 3 of these changes were statistically significant. 25,26,30 No study reported changes in professional practice or benefits to patients (Kirkpatrick levels 4a and 4b).…”

“…36 Eleven studies reported changes in attitudes (Kirkpatrick Level 2a). [25][26][27][28][29]31,33,34,[36][37][38] Among these, 7 studies showed statistically significant changes in learners' attitudes before and after the described curricula. 25,28,31,34,[36][37][38] Thirteen studies reported changes in knowledge and/or skills (Kirkpatrick Level 2b).…”

“…[25][26][27][28][29]31,33,34,[36][37][38] Among these, 7 studies showed statistically significant changes in learners' attitudes before and after the described curricula. 25,28,31,34,[36][37][38] Thirteen studies reported changes in knowledge and/or skills (Kirkpatrick Level 2b). [25][26][27][28][29][30][31][32][33][35][36][37][38] Of these, 10 reported statistically significant changes in knowledge and/or skills.…”

“…25 Learning outcomes were matched to Kirkpatrick levels 1 to 4. 19 As shown in TABLE 25,28,32,34,36,38 One study covered 14 of the 26 MGCs and 6 of the 7 competency domains. 31 Median coverage of MGCs from 14 selected geriatrics curricula was 4.…”