Hazards of hospitalization: hospitalists and geriatricians educating medical students about delirium and falls in geriatric inpatients

Educational interventions to improve recognition of delirium: a systematic review

Delirium is a common and serious condition that is underrecognized in older adults in a variety of healthcare settings. It is poorly recognized because of deficiencies in provider knowledge and its atypical presentation. Early recognition of delirium is warranted to better manage the disease and prevent the adverse outcomes associated with it. The purpose of this article is to review the literature concerning educational interventions focusing on recognition of delirium. The Medline and Cumulative Index to Nursing and Allied Health Literature (CINHAL) databases were searched for studies with specific educational focus in the recognition of delirium, and 26 studies with various designs were identified. The types of interventions used were classified according to the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model, and outcomes were sorted according to Kirkpatrick's hierarchy. Educational strategies combining predisposing, enabling, and reinforcing factors achieved better results than strategies that included one or two of these components. Studies using predisposing, enabling, and reinforcing strategies together were more often effective in producing changes in staff behavior and participant outcomes. Based on this review, improvements in knowledge and skill alone seem insufficient to favorably influence recognition of delirium. Educational interventions to recognize delirium are most effective when formal teaching is interactive and is combined with strategies including engaging leadership and using clinical pathways and assessment tools. The goal of the current study was to systematically review the published literature to determine the effect of educational interventions on recognition of delirium.

Collaborative development of teaching scripts: an efficient faculty development approach for a busy clinical teaching unit

BACKGROUND

Exemplary teachers have been shown to use teaching scripts, ways of organizing the content and instructional approach for commonly encountered teachable moments. This study describes a busy hospitalist unit's early experience with the collaborative development of teaching scripts.

METHODS

In 2010, during monthly workshops, 10 faculty members each prepared and presented a teaching script for a different commonly encountered diagnosis. Open-ended surveys assessing the impact on faculty were analyzed using an iterative approach. Changes in faculty self-efficacy, and the frequency and applicability of teaching were measured.

RESULTS

The program required 10 hours of attendance time and a mean of 4.3 hours for each faculty member who prepared a teaching script. No significant differences in quantity or applicability of teaching were detected, but faculty self-efficacy improved significantly. In addition, faculty described beneficial effects in their individual professional development, development of a shared mental model of professional responsibility, and interpersonal relationships. A majority of comments were positive; negative comments focused on the time required to prepare scripts, and apprehension about presenting to peers.

CONCLUSIONS

The program was an efficient approach to improve self-rated teaching skills, enhance professional development, and build collegiality among clinician-teachers.

Advancing geriatrics education: an efficient faculty development program for academic hospitalists increases geriatric teaching

BACKGROUND

Hospitalists care for an increasing number of older patients. As teachers, they are uniquely positioned to teach geriatric skills to residents. Faculty development programs focused on geriatrics teaching skills are often expensive and time-intensive, and may not enhance trainee learning.

OBJECTIVES

To evaluate a train-the-trainer (TTT) model designed to equip hospitalists with knowledge and skills to teach geriatric topics to residents in a time-constrained, resource-limited environment.

DESIGN

Cross-sectional survey.

SETTING

Academic tertiary hospital.

INTERVENTION

A 10-hour geriatric curriculum, the Reynolds Program for Advancing Geriatrics Education (PAGE), cotaught by geriatricians and hospitalists at preexisting noon conferences over 1 year that consisted of exportable teaching modules.

MEASUREMENTS

Session leaders' and faculty participants' satisfaction, hospitalist geriatrics teaching self-efficacy, residents' self-report of frequency of geriatric teaching received, and frequency of geriatric skill use.

RESULTS

The curriculum was highly rated by session leaders and hospitalist faculty. Hospitalists perceived improvement in geriatric teaching skills, indicating (1: "unlikely" to 5: "highly likely") that they are likely to use these teaching tools in the future (M = 4.61, standard deviation [SD] = 0.53). Residents reported both significantly more geriatrics teaching by hospitalists (P < 0.05) and a borderline significant increase in their practice of geriatric clinical skills (P = 0.05).

CONCLUSIONS

A time-efficient geriatric faculty development program for hospitalists suggests improvement in the amount and quality of geriatrics teaching and skill practice among faculty and residents at an academic medical center. Concise faculty development programs within preexisting faculty meetings may be a feasible, successful method to increase geriatric skill development in the hospital setting.