Presented at the Council of Emergency Medicine Residency Directors Academic Assembly, San Diego, CA, March 2011; the American Geriatrics Society Annual Scientific Meeting, Washington, DC, May 2011; and the Society for Academic Emergency Medicine Annual Meeting, Boston, MA, June 2011.
Emergency Medicine Core Content
Effect of a Geriatric Curriculum on Emergency Medicine Resident Attitudes, Knowledge, and Decision-making
Article first published online: 14 OCT 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Special Issue: CORD/CDEM Educational Advances Supplement
Volume 18, Issue Supplement s2, pages S92–S96, October 2011
How to Cite
Biese, K. J., Roberts, E., LaMantia, M., Zamora, Z., Shofer, F. S., Snyder, G., Patel, A., Hollar, D., Kizer, J. S. and Busby-Whitehead, J. (2011), Effect of a Geriatric Curriculum on Emergency Medicine Resident Attitudes, Knowledge, and Decision-making. Academic Emergency Medicine, 18: S92–S96. doi: 10.1111/j.1553-2712.2011.01170.x
Funded by The American Geriatrics Society and John A. Hartford Foundation Geriatrics for Specialists program.
The authors have no relevant financial information or potential conflicts of interest to disclose.
Supervising Editor: Terry Kowalenko, MD.
- Issue published online: 14 OCT 2011
- Article first published online: 14 OCT 2011
- Received April 19, 2011; revision received June 23, 2011; accepted June 28, 2011.
ACADEMIC EMERGENCY MEDICINE 2011; 18:S92–S96 © 2011 by the Society for Academic Emergency Medicine
Objectives: Despite an increasing number of elderly emergency department (ED) patients, emergency medicine (EM) residency training lacks geriatric-specific curricula. The objective was to determine if a 1-year geriatric curriculum, designed for residents, would affect residents’ attitudes, knowledge, and decision-making for older patients seen in the ED.
Methods: The authors created a geriatric curriculum for EM residents composed of six lectures on the following topics: trauma, abdominal pain, transitions of care, medication management, iatrogenic injuries, and confusional states. A second component of the curriculum included seven high-fidelity simulation skills training sessions on aortic aneurysm, salicylate toxicity, drugs of abuse, infection from a posterior pressure ulcer, medication-induced elevated prothrombin time resulting in gastrointestinal bleeding, mesenteric ischemia, and myocardial infarction. Before and after completion of the curriculum, residents were assessed on attitudes toward caring for geriatric patients using a validated survey and knowledge of geriatric principals of care using a 35-question multiple choice test. To determine differences before and after the new curriculum was implemented, the paired t-test was performed on knowledge and attitude scores. ED records were also reviewed for frequency of chemical sedation and urinary catheter placement in patients aged 65 and over, both before and after the educational intervention, as a measure of appropriate decision-making. Appropriateness of urinary catheter placement was determined by two physician reviewers using criteria adapted from the Centers for Disease Control and Prevention indications for appropriate urinary catheter use. Reviewers met to adjudicate any disagreements about appropriateness. Fisher’s exact test was used to examine differences in frequency of chemical sedation and urinary catheter placement.
Results: Twenty-nine EM residents underwent the training. There was no measured change in attitudes. Knowledge improved from the pre- to posttest with average scores of 58.5 and 68.0%, respectively (p < 0.0001), among the 25 residents who completed both tests. There was no change in the percentage of elderly patients receiving chemical sedation and urinary catheters before and after the curriculum (5.4% vs. 4.5%, p = 0.47; and 7.4% vs. 5.9%, p = 0.3, respectively). The number of inappropriate urinary catheters placed significantly decreased after the curriculum, from 8 of 49 to 1 of 47 (16.3% vs. 2.1%, p = 0.03).
Conclusions: Geriatric educational curricula for EM residents may positively affect knowledge base and appropriate decision-making when working with older adults in the ED. These educational enhancements may place elderly patients at less risk of adverse outcomes.