Effect of a Geriatric Curriculum on Emergency Medicine Resident Attitudes, Knowledge, and Decision-making

Authors

  • Kevin J. Biese MD, MAT,

    1. From the Department of Emergency Medicine (KJB, FSS, GS), the Division of Geriatric Medicine/Institute on Aging (ER, ML, ZZ, JSK, JB), and the Department of Medicine (DH), University of North Carolina School of Medicine, Chapel Hill, NC; and the Center for Innovative Learning, WakeMed Health & Hospitals (GS, AP), Raleigh, NC.
    Search for more papers by this author
  • Ellen Roberts PhD, MPH,

    1. From the Department of Emergency Medicine (KJB, FSS, GS), the Division of Geriatric Medicine/Institute on Aging (ER, ML, ZZ, JSK, JB), and the Department of Medicine (DH), University of North Carolina School of Medicine, Chapel Hill, NC; and the Center for Innovative Learning, WakeMed Health & Hospitals (GS, AP), Raleigh, NC.
    Search for more papers by this author
  • Michael LaMantia MD,

    1. From the Department of Emergency Medicine (KJB, FSS, GS), the Division of Geriatric Medicine/Institute on Aging (ER, ML, ZZ, JSK, JB), and the Department of Medicine (DH), University of North Carolina School of Medicine, Chapel Hill, NC; and the Center for Innovative Learning, WakeMed Health & Hospitals (GS, AP), Raleigh, NC.
    Search for more papers by this author
  • Zeke Zamora MD,

    1. From the Department of Emergency Medicine (KJB, FSS, GS), the Division of Geriatric Medicine/Institute on Aging (ER, ML, ZZ, JSK, JB), and the Department of Medicine (DH), University of North Carolina School of Medicine, Chapel Hill, NC; and the Center for Innovative Learning, WakeMed Health & Hospitals (GS, AP), Raleigh, NC.
    Search for more papers by this author
  • Frances S. Shofer PhD,

    1. From the Department of Emergency Medicine (KJB, FSS, GS), the Division of Geriatric Medicine/Institute on Aging (ER, ML, ZZ, JSK, JB), and the Department of Medicine (DH), University of North Carolina School of Medicine, Chapel Hill, NC; and the Center for Innovative Learning, WakeMed Health & Hospitals (GS, AP), Raleigh, NC.
    Search for more papers by this author
  • Graham Snyder MD,

    1. From the Department of Emergency Medicine (KJB, FSS, GS), the Division of Geriatric Medicine/Institute on Aging (ER, ML, ZZ, JSK, JB), and the Department of Medicine (DH), University of North Carolina School of Medicine, Chapel Hill, NC; and the Center for Innovative Learning, WakeMed Health & Hospitals (GS, AP), Raleigh, NC.
    Search for more papers by this author
  • Amar Patel MS,

    1. From the Department of Emergency Medicine (KJB, FSS, GS), the Division of Geriatric Medicine/Institute on Aging (ER, ML, ZZ, JSK, JB), and the Department of Medicine (DH), University of North Carolina School of Medicine, Chapel Hill, NC; and the Center for Innovative Learning, WakeMed Health & Hospitals (GS, AP), Raleigh, NC.
    Search for more papers by this author
  • David Hollar PhD,

    1. From the Department of Emergency Medicine (KJB, FSS, GS), the Division of Geriatric Medicine/Institute on Aging (ER, ML, ZZ, JSK, JB), and the Department of Medicine (DH), University of North Carolina School of Medicine, Chapel Hill, NC; and the Center for Innovative Learning, WakeMed Health & Hospitals (GS, AP), Raleigh, NC.
    Search for more papers by this author
  • John Steve Kizer MD,

    1. From the Department of Emergency Medicine (KJB, FSS, GS), the Division of Geriatric Medicine/Institute on Aging (ER, ML, ZZ, JSK, JB), and the Department of Medicine (DH), University of North Carolina School of Medicine, Chapel Hill, NC; and the Center for Innovative Learning, WakeMed Health & Hospitals (GS, AP), Raleigh, NC.
    Search for more papers by this author
  • Jan Busby-Whitehead MD

    1. From the Department of Emergency Medicine (KJB, FSS, GS), the Division of Geriatric Medicine/Institute on Aging (ER, ML, ZZ, JSK, JB), and the Department of Medicine (DH), University of North Carolina School of Medicine, Chapel Hill, NC; and the Center for Innovative Learning, WakeMed Health & Hospitals (GS, AP), Raleigh, NC.
    Search for more papers by this author

  • 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.

  • 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.

Address for correspondence and reprints: Kevin J. Biese, MD, MAT; e-mail: kbiese@med.unc.edu.

Abstract

ACADEMIC EMERGENCY MEDICINE 2011; 18:S92–S96 © 2011 by the Society for Academic Emergency Medicine

Abstract

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.

Ancillary