Mandi Sehgal, MD, assistant professor and board certified geriatrician in UC’s division of family and community medicine, says it simply when it comes to the importance of geriatric care: "Think about your grandma."
She says there is a compelling need for physicians in training, regardless of specialty, to learn the fundamentals of caring for older adults, especially as the number of elderly individuals in the United States increases and physicians seeking specialty training in geriatrics decreases.
The Residency Review Committee, an arm of the Accreditation Council for Graduate Medical Education, agrees, which is why a requirement for all family medicine, internal medicine and internal medicine-pediatrics residents to have a "meaningful" geriatrics educational experience was put into place.
Sehgal created a program called the Geriatric Resident Interdisciplinary Elective (GeRIE), a month-long block rotation for primary care residents, and has successfully been running the rotation for about six years.
Now, because of the new requirements, she's changing the meaning of "E" from "elective" to "experience" and is expanding her reach to include all residents in the internal medicine and medicine- pediatrics programs at UC Health University Hospital and all family medicine residents from the UC family medicine residency program housed at Christ Hospital.
Growth and Changes Within GeRIE
The GeRIE rotation, which formerly occurred three months out of the year, will now occur eight months beginning this year and will teach not only primary care residents but also pharmacy students on their geriatrics rotation.
"Having an interprofessional approach to learning is great because residents from different specialties and their pharmacy and nursing colleagues all work together and learn from one another’s experiences collectively," she says. "Now, we'll be adding more than 30 med-peds and internal medicine residents to this rotation this year, in addition to six family medicine residents and about15 pharmacy students, which is very exciting."
The GeRIE has a number of interactive and creative activities to engage residents, one of which includes participation in a polypharmacy project where each learner is required to fill a pill container, or medi-set, and take the candies—like M&Ms and Mike and Ikes—the way they would instruct a patient to take their medicines for a week.
"This exercise is challenging,” says Sehgal. "During the week, residents will often forget to take their ‘medicine,’ which really helps them realize how difficult this could be for patients. It’s a very humanizing experience.
"We have the learners reflect about their experiences through blogging, which brings in a discussion component to the exercise.”
During the rotation, residents take a half-day field trip to agencies in the community that serve older adult populations.
"This rotation really helps residents reflect on how what they are learning about different aspects of caring for older adults is meaningful to them in their future careers,” says Sehgal. "These issues become more real to them because they get to see the agencies that are tailored to helping this population, and it helps them realize that regardless of specialty, as a physician, they all must learn to care effectively for older adults."
Sehgal adds that educators conduct didactic sections on core geriatric topics and spend time in clinical settings—outpatient, inpatient and in the home.
"Residents get paired one-on-one with a geriatrics faculty mentor for the duration of the rotation,” she explains. "At the end of the rotation, they present on a geriatrics topic of interest to them.”
And, as mentioned before, Sehgal says the blogosphere plays a huge role in this course.
"In addition to discussing the polypharmacy project, the residents are asked to reflect weekly, via blogging, about a meaningful experience that has changed the way that they think about older adults,” she says. "We wanted a way for the residents to reflect on what they were learning in this course and discovered that Blackboard (a learning management software system) provided the ability to blog.
"Residents can post their thoughts freely, and others can respond to the posts; it really serves as an open discussion for our GeRIE learners. Each week, the blogs are discussed with a faculty member.”
Sehgal says that this exercise has shown to be successful and powerful and that she is working on some qualitative data about how this rotation improves learning for residents and changes their mindset about older populations. She's hoping to have this data published at a later date.
"It's moving to see how these students come into the program thinking that this content is going to be mundane and leave with an appreciation for elder care; some of their stories and experiences are truly incredible,” she says.
In addition, GeRIE residents are asked to think of one thing that can be implemented within their clinical practice that will affect the way they care for older adults.
Sehgal says she has created an evaluation tool to assess how the learner’s skill sets do or do not improve over the course of the month rotation.
"We've begun asking them a series of questions regarding how comfortable they feel in tending to the care of older adults," she says. "We ask them to rate themselves from novice to expert and complete these evaluations at the beginning and end of the rotation to see if there is any shift in their skill set.
"Truly, this is an exciting time for geriatric education. The new ACGME requirement and the expansion of GeRIE are small steps in the right direction to teaching all learners the importance of providing excellent care for older adults."
Internal Medicine Educators See Benefit
Eric Warm, MD, a professor in the department of internal medicine and internal medicine residency director at UC, agrees with Sehgal and is excited about collaborating with the office of geriatric medicine on this.
"Now that the baby boomers are retiring, there will be a greater number of older patients and not enough geriatricians,” he says. "We have to train all residents in geriatric principles because on any given day, we will all be caring for geriatric patients."
Sharice Wood, MD, assistant professor in the department of internal medicine and co-director of the GeRIE, says she’s heard positive things from the residents as well.
"I think from the internal med and medicine-pediatrics perspective and the initial verbal feedback from the few residents who participated in the first month of the elective, one of the most enjoyable parts of the elective was the clinical experiences,” she says. "The residents really enjoyed working with a geriatrician in the community and seeing the role of the geriatrician first- hand.
"In addition to learning geriatric care that can be used in any field, residents now have a clearer picture of geriatrics as a potential career choice, and as Dr. Warm pointed out, with the aging population, we need elder care now more than ever. Hopefully, this elective helps prepare our residents to fill that void.”