Today, Medicare patients account for approximately 50% of hospital days. Hospitalists are a key strategy for providing care to hospitalized older adults, however, most of these hospitalists have not received geriatric training. Faculty development is an important component to the success of a hospitalist program. We developed a geriatric-focused lecture series to improve the skills of our hospitalists in geriatric medicine as one of our faculty development projects.
The aim of this initiative was to develop a geriatric-focused lecture series in order to improve care of hospitalized older adults and to assess its efficacy as a venue of faculty development.
In a collaborative effort between the Divisions of Hospital Medicine and Geriatrics and Palliative Care Medicine, we created a lecture series in selected areas focused on the care of hospitalized older adults. Topics included the management of dementia and delirium, poly-pharmacy, falls and malnutrition as well as advanced care planning and community resources. Hospitalists across two academic tertiary care hospitals received 6 lectures over a 7 month period. Each lecture, given by a Geriatrics and Palliative Care expert was conducted twice (once at each hospital). Anonymous surveys of comfort levels (expressed as a Likert scales 1-5) in each of the selected areas were conducted before and after the lecture series.
Of the daytime hospitalists across the two centers, 47 hospitalists attended at least 1 lecture and 29 hospitalists attended 4 or more lectures. Pre-lecture surveys revealed that 51% of hospitalists had 5 or less years of experience and 86% had no formal training in Geriatrics. Most (66%) hospitalists expressed a need for additional training in Geriatrics.
Of the 47 hospitalists that attended at least 1 lecture, 35 completed a pre-intervention survey and 26 completed a post-intervention survey. In regards to comfort level of managing hospitalized older adults, the data demonstrated an increase in the level of physician comfort in 4 of the 6 areas, including the management of: dementia and delirium (from 36.5% to 73.1%), polypharmacy (from 44.4% to 84.6%), malnutrition (from 25.0% to 69.2%) and falls (41.7% to 83.3%). Comfort levels in advanced care planning (80.6% to 84.6%) and community resources (16.7% to 26.9%), showed less of an improvement.
While most hospitalists do not receive geriatric training, they are increasingly tasked with caring for an increasing population of frail older adults. Geriatric-focused faculty development initiatives could be an important strategy to improve hospitalists’ comfort levels in caring for common geriatric syndromes.