Geriatric Cardiology OSCE: The Hidden Curriculum, Identifying End Stage Heart Disease &amp; Clarifying Care Goals

Simpson

J American Geriatrics Society

et al. 2016

Self Cite

Caring for the growing elderly population will require specialty and subspecialty physicians who have not completed geriatric medicine fellowship training to participate actively in patient care. To meet this workforce demand, a sustainable approach to integrating geriatrics into specialty and subspecialty graduate medical education training is needed. This article describes the use of a geriatrics education team (GET) model to develop, implement, and sustain specialty-specific geriatrics curricula using a systematic process of team formation and needs assessment through evaluation, with a unique focus on developing curricular interventions that are meaningful to each specialty and satisfy training, scholarship, and regulatory requirements. The GET model and associated results from 15 specialty residency and fellowship training programs over a 4-year period include 93% curriculum sustainability after initial implementation, more than half of the programs introducing additional geriatrics education, and more than 80% of specialty GETs fulfilling their scholarship requirements through their curriculum dissemination. Win-wins and barriers encountered in using the GET model, along with the model's efficacy in curriculum development, sustainability, and dissemination, are summarized.

Section: Resultsmentioning

confidence: 99%

Geriatrics Education Team Model Results in Sustained Geriatrics Training in 15 Residency and Fellowship Programs and Scholarship

Simpson

J American Geriatrics Society

et al. 2016

Self Cite

“…Several publications in MedEdPORTAL describe communication skills training in GOC, 13 – 15 but none incorporate knowledge acquisition, personal reflection, skills practice in simulation, evaluation of performance during an actual patient encounter, and real-time feedback from patients. This training has been designed to address all levels of the Kirkpatrick model, 16 including reaction, learning, behavior, and results.…”

Section: Introductionmentioning

confidence: 99%

“…Conceptually, we drew from best practices from VitalTalk 10 and the Serious Illness Care Program to create this experience and adapted evaluation tools from the American Academy of Hospice and Palliative Medicine (AAHPM) 11 and the Mini-CEX format of the American Board of Internal Medicine (ABIM). 12 Several publications in MedEdPORTAL describe communication skills training in GOC, [13][14][15] r One member of the simulation center staff to schedule exam rooms and SPs, keep time for the simulation, set up and monitor video recordings of the encounters, and set up computer evaluations after the session.…”

Section: Introductionmentioning

confidence: 99%

Effective Goals-of-Care Conversations: From Skills Training to Bedside

et al. 2021

Introduction Goals-of-care (GOC) conversations are essential to ensure high-quality care for people with serious illness. We developed a simulation experience to train internal medicine residents in GOC conversations near end of life, followed by a real-life GOC conversation as a Mini-Clinical Evaluation Exercise (Mini-CEX) including direct feedback from participating patients. Methods The 3-hour simulation session trained teams of two learners each to interact with standardized patients portraying a patient with end-stage heart failure and an accompanying family member. Residents completed pre- and postsurveys regarding their self-assessed abilities and confidence in conducting these conversations. Piloted in 2016, the Mini-CEX was completed in 2017 with 28 residents 3–9 months after simulation. Patients and participating family members were invited to complete an optional, deidentified survey of their experience. Results From 2015 to 2017, 84 residents completed simulation training. Ninety percent of postsurvey responders felt more prepared to conduct GOC conversations after simulation compared to 42% before training. Eighty percent or more reported confidence in discussing GOC (previously 67%), prognosis (previously 62%), and hospice (previously 49%). Analysis of Mini-CEX scores revealed that the majority of residents' skills were the same or improved compared with their performance in simulation; more than 70% demonstrated improvement in ensuring patients' comfort, displaying empathy, and recognizing/responding to emotion. Almost all patients and families reported feeling heard and satisfied with their conversation with the resident. Discussion This curriculum was well received, and initial data support its effectiveness in enhancing residents' self-perceived confidence and interpersonal skills in real-world patient encounters.

“…Case-based learning resources representing these CV diseases have been published previously, using a number of active learning methods that do not involve SP encounters. Resources involving SP cases for heart failure have been published by a number of authors 22 – 24 ; however, these were not focused on clinical reasoning, and none of these resources included accompanying ECG images or heart sound audio files for interpretation practice. Others have published SP cases involving patients following an MI; however, these cases were not focused on the diagnosis of MI.…”

Section: Introductionmentioning

confidence: 99%

The Simulated Cardiology Clinic: A Standardized Patient Exercise Supporting Medical Students' Biomedical Knowledge and Clinical Skills Integration

et al. 2020

Introduction Development of cardiac disease-related diagnostic skills—including hypothesis-driven data gathering, heart sound interpretation, and ECG interpretation—is an important component of medical student training. Prior studies indicate trainees' performance of these skills is limited. Simulation provides students with opportunities to practice integrating their developing knowledge in a relevant clinical context. We developed a simulated clinic activity for second-year medical students consisting of standardized patient (SP) cases representing cardiovascular (CV) diseases. Methods Student small groups rotated through four SP encounters. For each case, one student performed the history, after which the whole small group listened to audio files of heart sounds, interpreted an ECG, and collaboratively developed a prioritized differential diagnosis. The CV course director met with students for a large-group debrief, highlighting key learning points. We collected learners' evaluations of the event through an online survey. Results Of students, 276 participated in this activity over the course of 2 years. Nearly all students assessed the activity as extremely or quite effective for applying learning content from the CV course (97%, 2018; 93%, 2019), and for practicing how to approach chest pain, shortness of breath, palpitations, and fatigue (100%, 2018; 95%, 2019). The most helpful aspects were reinforcement of CV disease illness scripts, hypothesis-driven data gathering practice, ECG interpretation, and applying knowledge and skills in a realistic context. Discussion SP encounters representing CV conditions can effectively provide opportunities for students to integrate basic science knowledge and clinical skills. Students assessed the activity as helpful and engaging.