Creating a Learning Community Creating a Learning Community for Academic Clinician-Educatorsfor Academic Clinician-Educators

99thth Annual Reynolds Meeting Annual Reynolds Meeting

Meeting Binder and WiFi CodeMeeting Binder and WiFi Code Meeting Binder can be found here: Meeting Binder can be found here:

http://www.americangeriatrics.org/files/documents/Binder1.pdf

The WiFi code word for the meeting is The WiFi code word for the meeting is ReynoldsReynolds

Reynolds 2011: Creating a Learning Community Reynolds 2011: Creating a Learning Community for Academic Clinician-Educatorsfor Academic Clinician-Educators

See products and learn about projects for See products and learn about projects for teaching and assessing geriatrics teaching and assessing geriatrics

Faculty DevelopmentFaculty Development Start conversations on sustaining and Start conversations on sustaining and

growing the Reynolds’ legacygrowing the Reynolds’ legacy Begin to define the Field’s entrustable Begin to define the Field’s entrustable

professional activities (EPAs)professional activities (EPAs)

Reynolds Meetings: Reynolds Meetings: a Learning Communitya Learning Community

Form collaborations that move the field Form collaborations that move the field forwardforward CompetenciesCompetencies Certification exam reviews Certification exam reviews Learner Assessment reviewsLearner Assessment reviews Web-GEMSWeb-GEMS

POGOePOGOe

Other Collaborations Born at Other Collaborations Born at Reynolds’ MeetingsReynolds’ Meetings

Re-evaluating Geriatric content on national Re-evaluating Geriatric content on national examsexams NBME subject exams (shelf exams)NBME subject exams (shelf exams) USMLE Step examsUSMLE Step exams ABIM IM examABIM IM exam ABFM ITE examABFM ITE exam

% Qs with patients % Qs with patients >> 60 yo 60 yo Best Estimate*Best Estimate*

* Assumes 25% of test questions are not scored

% % >>60 yo Qs that are Geriatric60 yo Qs that are Geriatric

% All Qs that are Geriatric % All Qs that are Geriatric Best Estimate*Best Estimate*

0

5

10

15

20

25

30

35

40

Step 1 Step 2 Step 3

Geri

'True' Geri

* Assumes 25% of test questions are not scored

Geriatric CompetenciesGeriatric Competencies

Geriatric SyndromesGeriatric Syndromes

New OpportunitiesNew Opportunities

Question writers for NBME and USMLEQuestion writers for NBME and USMLE MCQsMCQs Clinical skills scenariosClinical skills scenarios Computer-based case simulationsComputer-based case simulations

Increased geriatrics content on ABIM Increased geriatrics content on ABIM examexam

All Accomplishments of All Accomplishments of Reynolds Learning Reynolds Learning

CommunityCommunity

But We’re a Closed ClubBut We’re a Closed Club

Reynolds Funded Schools and Reynolds Funded Schools and Departments, 2010Departments, 2010

Reynolds Schools Vs. non-ReynoldsReynolds Schools Vs. non-Reynolds

Reynolds (46) Non-Reynolds

(114)

160 Schools (Allopathic & Osteopathic)

Reynolds Schools vs. All Fellowship Reynolds Schools vs. All Fellowship Programs in GeriatricsPrograms in Geriatrics

Reynolds (46)

Non-Reynolds

(109)

155 Fellowship Programs in Geriatrics

Source: Lou Grosso, ABIM & Gary Jackson ABFM. Compiled by AGS/ADGAP Geriatrics Workforce Policy Studies Center. March 2011

Comparison of Number of Certificates Awarded to Number of Active Certificates in Geriatric Medicine

(Family Medicine and Internal Medicine)

2,412

4,089

5,940

8,279

8,8249,263

9,4749,701

9,91510,215

10,53010,858

11,11711,423

11,71912,026

12,28612,575

2,412

4,089

5,940

8,279

8,824

8,1438,354

7,7627,976

7,4207,735

6,8757,084 7,128

7,344 7,3457,029

6,756

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

1988 1990 1992 1994 1996 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Cumulative Certificates awarded Active Certificates

To maintain their certification in geriatric medicine, family medicine physicians must also maintain their primary certification in Family Medicine. Since July 2006 Internal Medicine recognized geriatric medicine as a subspecialty of Internal Medicine.

Enlarging and Supporting Enlarging and Supporting the Learning Communitythe Learning Community

Opening meeting to non-Reynolds Clinician-Opening meeting to non-Reynolds Clinician-Educators Educators

This meeting– a deep diveThis meeting– a deep dive Discuss how to retain and support our existing Discuss how to retain and support our existing

faculty in:faculty in:• Academic PromotionAcademic Promotion• Assuming leadership rolesAssuming leadership roles

A Conversation about Clinician-A Conversation about Clinician-Educators in Academic GeriatricsEducators in Academic Geriatrics

Monday AM sessions:Monday AM sessions: Needs Assessment: Supporting and promoting Needs Assessment: Supporting and promoting

junior and mid-level faculty, regardless of junior and mid-level faculty, regardless of institutioninstitution

Consider how other academic groups are doing Consider how other academic groups are doing this this • See See Environmental ScanEnvironmental Scan in binder for examples in binder for examples

Wednesday:Wednesday: Learning community discussion with AGS and Learning community discussion with AGS and

ADGAP leadership about findings from the faculty ADGAP leadership about findings from the faculty needs assessmentneeds assessment

Defining Geriatric Defining Geriatric MedicineMedicine

Challenges and OpportunitiesChallenges and Opportunities

20082008

IOM reportIOM report Enhance geriatric competence of entire workforceEnhance geriatric competence of entire workforce Increase recruitment and retention of geriatric Increase recruitment and retention of geriatric

specialists and caregiversspecialists and caregivers Improve the way care is delivered (both developing Improve the way care is delivered (both developing

methods AND leading system change) methods AND leading system change) Fried and Hall: JAGS editorialFried and Hall: JAGS editorial

What is a Geriatrician?What is a Geriatrician? Social AdvocacySocial Advocacy

• ‘‘how can the collective geriatrics professional community how can the collective geriatrics professional community most effectively mount the social change necessary to make most effectively mount the social change necessary to make meaningful systems change in the care of older adults?lmeaningful systems change in the care of older adults?l

Geriatricians, 2011Geriatricians, 2011

Identified geriatric competencies forIdentified geriatric competencies for Medical studentsMedical students IM/FM/EM/Surgical residentsIM/FM/EM/Surgical residents

Works in progressWorks in progress Increase recruitment and retention of geriatrician Increase recruitment and retention of geriatrician

facultyfaculty Improving the way care is deliveredImproving the way care is delivered

• Developing care delivery modelsDeveloping care delivery models• Leading system changeLeading system change• Research into Geriatric syndromesResearch into Geriatric syndromes

Social and Political AdvocacySocial and Political Advocacy

What is a Geriatrician?What is a Geriatrician?ExpertiseExpertise

Content KnowledgeContent Knowledge Physiology of agingPhysiology of aging Care of patients with multiple diseasesCare of patients with multiple diseases Management and prevention of geriatric Management and prevention of geriatric

syndromes (frailty, falls, incontinence, syndromes (frailty, falls, incontinence, disability, cognitive decline)disability, cognitive decline)

Evaluating riskEvaluating risk Appropriately caring for older adults with Appropriately caring for older adults with

different levels of health statusdifferent levels of health status

Fried L and Hall W. JAGS 2008; 56 (10):1791-1795

What is a Geriatrician?What is a Geriatrician?ExpertiseExpertise

Optimism/realism about agingOptimism/realism about aging Cognitive skills and strategiesCognitive skills and strategies

expertise in complex problem analysisexpertise in complex problem analysis patient-centeredpatient-centered

Practice models Practice models interdisciplinary teamsinterdisciplinary teams

Systems of careSystems of care targeted to health status, goalstargeted to health status, goals

Fried L and Hall W. JAGS 2008; 56 (10):1791-1795

Who do Geriatricians Care for?Who do Geriatricians Care for?Priority subsetsPriority subsets

Aged>85Aged>85 Complex biomedical and psychosocialComplex biomedical and psychosocial Geriatric SyndromesGeriatric Syndromes FrailtyFrailty Palliative or end-of-life carePalliative or end-of-life care Posthospital placementPosthospital placement Nursing home careNursing home care

Fried L and Hall W. JAGS 2008; 56 (10):1791-1795

Still no clear articulation…Still no clear articulation…

What makes a fellowship trained geriatrician What makes a fellowship trained geriatrician different than a general internist or family different than a general internist or family practitioner?practitioner?

Entrustable Professional Activities Entrustable Professional Activities (EPA)(EPA)

ACGME competenciesACGME competencies Specialty Milestones (AAIM, AAFP)Specialty Milestones (AAIM, AAFP) Geriatric competenciesGeriatric competencies EPAs EPAs

Represent the routine Represent the routine professionalprofessional-life -life activities of physicians based on their activities of physicians based on their specialty and subspecialtyspecialty and subspecialty

5-7 statements, observable and measureable5-7 statements, observable and measureable Together constitute the CORE of the Together constitute the CORE of the

professionprofession

Reynolds 2011: Creating a Learning Community Reynolds 2011: Creating a Learning Community for Academic Clinician-Educatorsfor Academic Clinician-Educators

See products and learn about projects for See products and learn about projects for teaching and assessing geriatrics teaching and assessing geriatrics

Faculty DevelopmentFaculty Development Start conversations on sustaining and Start conversations on sustaining and

growing the Reynolds’ legacygrowing the Reynolds’ legacy Begin to define the Field’s entrustable Begin to define the Field’s entrustable

professional activities (EPAs)professional activities (EPAs)

EDITORIAL: Leading on Behalf of an Aging SocietyEDITORIAL: Leading on Behalf of an Aging Society

Journal of the American Geriatrics SocietyVolume 56, Issue 10, pages 1791-1795, 1 OCT 2008 DOI: 10.1111/j.1532-5415.2008.01939.xhttp://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.01939.x/full#f2

EDITORIAL: Leading on Behalf of an Aging SocietyEDITORIAL: Leading on Behalf of an Aging Society

Journal of the American Geriatrics SocietyVolume 56, Issue 10, pages 1791-1795, 1 OCT 2008 DOI: 10.1111/j.1532-5415.2008.01939.xhttp://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.01939.x/full#f1

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Geri

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* Assumes 25% of test questions are not scored

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60+ Qs All Qs

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Geri

'True' Geri

* Assumes 25% of test questions are not scored

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60+ Qs All Qs

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Geri

'True' Geri

* Assumes 25% of test questions are not scored

Best Estimate*Best Estimate*

Creating a Learning Creating a Learning Community for Academic Community for Academic

Clinician-EducatorsClinician-Educators

99thth Annual Annual Reynolds Meeting Reynolds Meeting

2011 2011