Development of Geriatric Competencies for Emergency Medicine Residents Using an Expert Consensus Process

Authors

  • Teresita M. Hogan MD,

    1. From the Department of Emergency Medicine, Resurrection Medical Center (TMH), Chicago, IL; the Department of Emergency Medicine, University of Illinois (TMH), Chicago, IL; The Buehler Center on Aging, Northwestern University Feinberg School of Medicine (TMH, LE), Chicago, IL; the Department of Emergency Medicine, University of Michigan (EDL), Ann Arbor, MI; the Department of Emergency Medicine, Washington University (CRC), St. Louis MO; the Division of Education, Brookdale Department of Geriatric and Palliative Care (KS, RML), Mount Sinai School of Medicine, New York, NY; and the American Medical Association (CI), Chicago, IL.
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  • Eve D. Losman MD,

    1. From the Department of Emergency Medicine, Resurrection Medical Center (TMH), Chicago, IL; the Department of Emergency Medicine, University of Illinois (TMH), Chicago, IL; The Buehler Center on Aging, Northwestern University Feinberg School of Medicine (TMH, LE), Chicago, IL; the Department of Emergency Medicine, University of Michigan (EDL), Ann Arbor, MI; the Department of Emergency Medicine, Washington University (CRC), St. Louis MO; the Division of Education, Brookdale Department of Geriatric and Palliative Care (KS, RML), Mount Sinai School of Medicine, New York, NY; and the American Medical Association (CI), Chicago, IL.
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  • Christopher R. Carpenter MD,

    1. From the Department of Emergency Medicine, Resurrection Medical Center (TMH), Chicago, IL; the Department of Emergency Medicine, University of Illinois (TMH), Chicago, IL; The Buehler Center on Aging, Northwestern University Feinberg School of Medicine (TMH, LE), Chicago, IL; the Department of Emergency Medicine, University of Michigan (EDL), Ann Arbor, MI; the Department of Emergency Medicine, Washington University (CRC), St. Louis MO; the Division of Education, Brookdale Department of Geriatric and Palliative Care (KS, RML), Mount Sinai School of Medicine, New York, NY; and the American Medical Association (CI), Chicago, IL.
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  • Karen Sauvigne MA,

    1. From the Department of Emergency Medicine, Resurrection Medical Center (TMH), Chicago, IL; the Department of Emergency Medicine, University of Illinois (TMH), Chicago, IL; The Buehler Center on Aging, Northwestern University Feinberg School of Medicine (TMH, LE), Chicago, IL; the Department of Emergency Medicine, University of Michigan (EDL), Ann Arbor, MI; the Department of Emergency Medicine, Washington University (CRC), St. Louis MO; the Division of Education, Brookdale Department of Geriatric and Palliative Care (KS, RML), Mount Sinai School of Medicine, New York, NY; and the American Medical Association (CI), Chicago, IL.
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  • Cheryl Irmiter PhD,

    1. From the Department of Emergency Medicine, Resurrection Medical Center (TMH), Chicago, IL; the Department of Emergency Medicine, University of Illinois (TMH), Chicago, IL; The Buehler Center on Aging, Northwestern University Feinberg School of Medicine (TMH, LE), Chicago, IL; the Department of Emergency Medicine, University of Michigan (EDL), Ann Arbor, MI; the Department of Emergency Medicine, Washington University (CRC), St. Louis MO; the Division of Education, Brookdale Department of Geriatric and Palliative Care (KS, RML), Mount Sinai School of Medicine, New York, NY; and the American Medical Association (CI), Chicago, IL.
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  • Linda Emanuel MD, PhD,

    1. From the Department of Emergency Medicine, Resurrection Medical Center (TMH), Chicago, IL; the Department of Emergency Medicine, University of Illinois (TMH), Chicago, IL; The Buehler Center on Aging, Northwestern University Feinberg School of Medicine (TMH, LE), Chicago, IL; the Department of Emergency Medicine, University of Michigan (EDL), Ann Arbor, MI; the Department of Emergency Medicine, Washington University (CRC), St. Louis MO; the Division of Education, Brookdale Department of Geriatric and Palliative Care (KS, RML), Mount Sinai School of Medicine, New York, NY; and the American Medical Association (CI), Chicago, IL.
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  • Rosanne M. Leipzig MD

    1. From the Department of Emergency Medicine, Resurrection Medical Center (TMH), Chicago, IL; the Department of Emergency Medicine, University of Illinois (TMH), Chicago, IL; The Buehler Center on Aging, Northwestern University Feinberg School of Medicine (TMH, LE), Chicago, IL; the Department of Emergency Medicine, University of Michigan (EDL), Ann Arbor, MI; the Department of Emergency Medicine, Washington University (CRC), St. Louis MO; the Division of Education, Brookdale Department of Geriatric and Palliative Care (KS, RML), Mount Sinai School of Medicine, New York, NY; and the American Medical Association (CI), Chicago, IL.
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  • This work was primarily funded by a grant from the Brookdale Foundation, through the Brookdale Leadership in Aging Fellowship. The authors thank them for their generous support and advocacy for geriatric care. Additional support was provided by the American Medical Association through underwriting the conference calls, consensus conference, and support of the Mount Sinai School of Medicine and the Portal of Geriatric Online Education.

Address for correspondence and reprints: Teresita M. Hogan, MD; e-mail: thogan@reshealthcare.org.

Abstract

Background:  The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes.

Objectives:  The objective was to develop a consensus document, “Geriatric Competencies for Emergency Medicine Residents,” by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training.

Methods:  This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project.

Results:  In Phase I, participants (n = 363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n = 24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions.

Conclusions:  The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population.

ACADEMIC EMERGENCY MEDICINE 2010; 17:316–324 © 2010 by the Society for Academic Emergency Medicine

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