To accomplish the above objectives, several important components have been identified for this ongoing joint venture. The following provides a brief description of each of these components along with the progress that has been made thus far.
“Train the Trainers” Program at Johns Hopkins
The Division is responsible for leading the “train the trainers” program. The goal is to create a cadre of PUMC internists and other healthcare providers with geriatric skills who will serve as the backbone of the international geriatric program at PUMC and become the future leaders (or “trainers”) of geriatric medicine and gerontology in China. JHU and PUMC faculty leaders of this joint venture jointly interview candidates. Selection of PUMC trainees is based on their commitment to caring for older patients, clinical skills, English-language skills, leadership potential, interest in aging research, and willingness to come to JHU for an extended period of time and then return to China. For the development of a multidisciplinary geriatric care team, PUMC trainees include internists, nurses, and physicians from other specialties, including neurology, neuropsychiatry, neuropsychology, physical and occupational therapy and rehabilitation, and nutrition. The duration of geriatric training varies depending on the job descriptions of the trainees: 3 months for nurses and physicians in other specialties, 6 months for internists, and 1 year for the person who will lead the program at PUMC.
Didactic sessions and bedside training are the main components of this “train the trainers” program. The didactic sessions include geriatric health services orientation lectures during the summer14 and weekly geriatric medicine grand rounds (clinical, social, and scientific foundations of geriatric medicine, Thursday afternoons between 3:30 and 5:00 p.m.).15 PUMC trainees attend Current Topics in Geriatrics, the annual JHU geriatric medicine continuing medical education course. They also participate in all of the teaching sessions for geriatric medicine fellows (e.g., fellows' morning report, Monday and Wednesday noon conference). In addition, they attend medical grand rounds at Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center.
Bedside training, limited to mentored observership, includes rotations through the continuum of geriatric care services described earlier. These rotations are typically 2 to 6 weeks.
The didactic and bedside training plan can be modified to individual trainee's interests and focus areas. In addition, special arrangements have been made to provide significant training in aging research, introduction of other special geriatric care models such as that at local Continuing Care Retirement Communities (CCRC), and leadership training for the individual designated as the geriatric medicine program leader, whose training occurred over a 1-year period. A special geriatric nursing training program has been developed and implemented for the training of PUMC hospital nurses that includes didactic teaching of the theory and practice of geriatric nursing (in collaboration with the JHU School of Nursing) and clinical rotations through inpatient geriatric units for bedside training of nursing protocols.
To address the challenge of competing Division faculty teaching time (see Challenges and Concerns below), only two PUMC trainees are invited at a time. In addition, they are provided with ample reading materials, including the latest edition of American Geriatrics Society (AGS) Geriatrics Review Syllabus, Geriatrics at Your Fingertips, and other geriatric medicine and gerontology textbooks. Other pertinent printed and online materials are also provided, and trainees are asked to review them before and after each lecture and rotation so that they make the best use of these training opportunities.
As an integral part of this program, the quality of training is evaluated regularly. While clinical skills assessment is limited because trainees are not able to perform hands-on patient care for regulatory reasons (see Challenges and Concerns below), the focus is on assessing trainees' knowledge and attitudes. Assessment is based on a set of geriatric core values developed by the AGS16 with the following major components:
After each clinical rotation, trainees submit a written report describing what they have learned and how it can be modified and applied to geriatrics development in China.
Trainees have debriefing meetings with the program director (SXL) every other week or more frequently if necessary. These regular evaluation sessions provide ongoing assessment of the training progress. Trainees also provide feedback about the training program.
Formal and informal reports of each trainee are provided from supervising Division faculty of the clinical rotation.
A midterm examination with a set of board-type questions adapted from the materials published by the AGS for the preparation of Geriatric Medicine Board for PUMC physician trainees with a training period of 6 months or longer to further assess their geriatrics knowledge base.
Based on the assessment outlined above and feedback from the trainees, clinical rotations and didactic teaching are adjusted accordingly to further strengthen their training. The findings from these evaluations are also reported back to the PUMC leadership.
By October 2009, the fourth month of the final year of this 4-year joint venture, 12 PUMC trainees (4 registered nurses, 4 senior resident physicians, 2 instructors/assistant professors, 1 associate professor, and 1 full professor) had finished or were in training at JHU. In addition to the qualitative evaluation for their geriatric competency described above, scores from the midterm examination provide a preliminary quantitative measurement of learning for some trainees. Because they had had no prior geriatrics training, scores of 55% to 95% obtained from this board-type examination demonstrate a variable but significant grasp of geriatric knowledge base by the trainees. No final examination is administered because of the short duration of the training. As this article focuses on the JHU experience, the learning experiences of the PUMC trainees will be described elsewhere.
Geriatrics Demonstration Ward at the PUMC Hospital
With the infrastructure, facility, and staff support committed from PUMC Hospital, a 30-bed geriatric inpatient demonstration ward was officially opened in May 2007. A multidisciplinary geriatric care team is being constituted from among PUMC trainees who have finished their training at JHU and have returned to PUMC Hospital. Clinical care pathways for specific geriatric syndromes are gradually being developed in the geriatric demonstration ward. In addition, nursing protocols for fall prevention, skin care, and maintenance and support for instrumental activities of daily living (IADLs) and activities of daily living (ADLs) are being implemented.
Faculty Exchange Between JHU and PUMC and On-Site Consultation by JHU Geriatrics Faculty and Leaders from Other U.S. Academic Medical Institutions
Shortly after the initiation of this joint venture in 2006, faculty exchanges between JHU and PUMC have provided opportunities for initial needs assessment and planning. Subsequently, six JHU faculty members including the chairman of the Department of Medicine have visited PUMC and provided on-site consultation. They conducted morning rounds and clinical case discussions in the geriatric demonstration ward at PUMC Hospital, during which they provided consultative expert opinion for the evaluation and management of complex elderly Chinese patients. These faculty and faculty from other leading academic geriatrics programs in the United States have also given lectures and workshops on important topics in geriatric medicine and gerontology including development of a successful academic geriatric program, aging of the cardiovascular system, chronic disease management in older adults, evaluation and treatment of osteoporosis, and other important topics in clinical geriatrics and aging research.