4Ms for Early Learners: A Skills-Based Geriatrics Curriculum for Second-Year Medical Students

Abstract

Introduction Given the growing population of older adults, it is of utmost importance for all future physicians to be trained in the core skills of conducting geriatric assessment. Methods We designed an interactive, skills-based session introducing core competencies for geriatric assessment for second-year medical students (MS2s). We organized our curriculum for early learners based on the 4Ms framework: mind/memory, medications, mobility, and matters most. The session consisted of brief didactics with integration of real-time skills-based practice. Students completed pre- and postsession surveys to assess their confidence in their knowledge and skills. All students completed a geriatric assessment during a clinical skills encounter as part of a multistation, end-of-course, summative clinical skills examination (CSE). The session was conducted virtually over 2 academic years, and the CSE was conducted virtually in 2020 and in person in 2021. Results One hundred ninety-nine MS2s participated in the session (100 in 2020, 99 in 2021). All students surveyed (33%) reported improved confidence in geriatric knowledge and skills by the end of the session ( p s < .001). Students were more likely to use a cognitive screening tool, ask about advance care planning, and assess medication adherence on the CSE in 2021 compared to 2020 ( p s < .001). Discussion We provide an interactive curriculum for MS2s to develop geriatric assessment skills. The curriculum and assessment tools are versatile, can be easily integrated into any medical school curriculum, and can be effectively delivered in person or on a virtual platform.

An age‐friendly residency: Geriatrician and internist perspectives on geriatric education in an internal medicine residency

“…Third, geriatrics content covered in IM residency curricula could be mapped to the 4Ms framework, based on the age‐friendly health systems initiative, 15,16,36 to ensure each area is covered and identify curricular gaps. Within geriatric education, the 4Ms framework has already been used to guide development of curricula and other educational initiatives 17,18,37–40 . In the future, more research is needed to explore organizational factors that may impact geriatric education across multiple institutions, especially from the perspective of other stakeholders such as residents, patients and their care partners, and institutional leaders.…”

“…Within geriatric education, the 4Ms framework has already been used to guide development of curricula and other educational initiatives. 17,18,[37][38][39][40] In the future, more research is needed to explore organizational factors that may impact geriatric education across multiple institutions, especially from the perspective of other stakeholders such as residents, patients and their care partners, and institutional leaders. In addition, perceptions of geriatrics should be rigorously assessed across specialties to understand facilitators and barriers to enhancing geriatric education in the institution.…”

“…Though initially designed for use in clinical care and quality improvement, the age-friendly "4Ms" framework can be a useful construct to organize geriatric educational curricula. 17,18 Before designing and implementing curricula, it is critical to explore the current status quo of geriatric education and involve major stakeholders in IM residency education. There is little research into the perceptions of clinician educator faculty regarding the value and incorporation of geriatric medical education into IM residency training.…”

“…The Age‐Friendly Health Systems initiative was developed to guide healthcare systems in becoming more “age‐friendly,” defined as providing high‐quality care across four evidence‐based domains: What Matters, Medication, Mentation, and Mobility 15,16 (Figure 1). Though initially designed for use in clinical care and quality improvement, the age‐friendly “4Ms” framework can be a useful construct to organize geriatric educational curricula 17,18 . Before designing and implementing curricula, it is critical to explore the current status quo of geriatric education and involve major stakeholders in IM residency education.…”

Optimizing Medications with the Geriatrics 5Ms: An Age-Friendly Approach

“…Educational curricula using the 4Ms or 5Ms help provide a common language and structure for health professions trainees early in their training, and provide a framework for deeper dives on polypharmacy and deprescribing [15,28,29]. Recognizing the challenges and opportunities with providing care to an aging population, health profession education programs are developing creative modules guided by these frameworks [30][31][32]. At our own institution, we developed the Geriatrics 5Ms pocket card for medical and dental students as a teaching tool that could be carried on the wards as a resource to guide holistic care for older patients [33], as well as home visits with older adult patients grounded in the concepts of the 5Ms [34].…”