The current increase in the population of older adults will not be paralleled by an increase in the number of geriatricians to care for them. Nonetheless, older patients have unique problems that require the internal medicine providers who do care for them have specific competencies. Therefore, it is crucial that geriatrics internal medicine rotations constantly strive to instill these competencies in their learners. To ensure that this task is done to the best of the educators’ abilities, an evaluation plan should be an integral ongoing part of the rotation’s curriculum as should be the case in any educational product. Consequently the evaluation results should be constantly incorporated into the active planning used for the improvement of the rotation.
The data were collected on the last day of their rotations, and there was a 100% response rate from 2 groups of learners during 2 consecutive rotations. Data obtained were analyzed quantitatively and qualitatively and the findings were the following:
Outcome 1: Self-perception of knowledge in geriatrics improved in all domains of the rotation objectives with the greatest improvement seen in "performing functional status evaluation" where the mean increased from 2.7 to 4.7 on a retrospective pre/post 5-point scale. The two areas that learners’ perceived as least improved were "delirium" and "incontinence".
Outcome 2: Caring for older adults was viewed as crucial and complex. Challenges that stem from dealing with multiple intermingled medical and social problems were appreciated. The unique aspects of geriatrics that need to be implemented across the board in treating older adults were identified. The main attractions in caring for older adults were the fact that the care is very personalized, the atmosphere around people who specialize in caring for older adults is generally "happy" and that the stories that the patients have are great.
Outcome 3: Most of the experiences were either "somewhat helpful" or "very helpful" on a 4-point scale. Effective aspects included their "unrushed" experiences in outpatient clinics where they learned comprehensive geriatric assessments, material present on the website, and the effective teaching of faculty and fellows. Less effective areas were lack of lectures on all core topics, logistics in organization of the "transitions of care" experience, multiplicity of sites and difficulty in making it on time, and challenges in browsing through the website.
Recommended rotation changes based on the evaluation results:
Make available, either live or by podcast, a series of lectures on core geriatrics topics.
More clinical experiences in areas of urinary incontinence and delirium.
Assign a patient in the transitions of care experience at the beginning of the rotation.
Make the website more user-friendly.
Frequent updating of assigned reading material.
Change the design of the experiences to minimize having to travel from one site to another that is further away during a given day.