Internal medicine residency programs must teach and evaluate geriatric medicine skills, given the significant proportion of older adults cared for by internists. The general evaluation form for our Acute Care for the Elderly unit proved inadequate, both because it failed to capture specific geriatrics skills and the numerical rating scale had poor construct alignment. In keeping with competency-based medical education, we developed an instrument that consists of a series of developmental milestones in four geriatrics competencies. Each milestone is represented with a detailed iconic narrative description of resident performance. The terminal milestone reflects our expectations for a graduating resident. The competencies, which reflect the learning objectives of the rotation, include:
1) Perform geriatric assessment, including assessment of function, mobility, cognition, fall risk, nutrition, and polypharmacy,
2) Negotiate and implement goals of care with older adults and their families,
3) Work effectively with interdisciplinary teams, including physician assistants, therapists, pharmacists, and nurses and
4) Safely oversee transitions of care for hospital to non-hospital settings.
Faculty supervisors are instructed to synthesize all their evaluation observations over the course of the month in determining the residents’ progression along the series of developmental milestones. They also write specific examples of performance to “justify” their rating.