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1.  Medicine in the 21st Century: Recommended Essential Geriatrics Competencies for Internal Medicine and Family Medicine Residents 
Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation.
Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project.
The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies.
Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory Commission report to Congress. Work is underway through stakeholder organizations to disseminate and assess the competencies among internal medicine and family medicine residency programs.
PMCID: PMC2951777  PMID: 21976086
3.  Mental Health in ACOs: Missed Opportunities and Low Hanging Fruit 
Accountable Care Organizations (ACOs) have potential to improve care for chronic conditions through incentives for better performance and bundled payments that promote care coordination. The Chronic Care Model (CCM) is a framework for providing health services for chronic conditions in primary care settings consistent with the organizational and financial goals of ACOs. Integrated mental health care – collaborative care by mental health and primary care providers for selected patients – improves care and is consistent with the Chronic Care Model. However, under the Medicare Shared Savings Program ACOs currently do not specify financial or organizational incentives for providing integrated mental health care through the CCM, leaving a missed opportunity to realize the full potential of ACOs to improve patient outcomes. We describe the rationale for incorporating mental health care into ACOs; how it can benefit consumers, providers, and ACOs; and what health care organizations can do to implement integrated mental health care.
PMCID: PMC3616514  PMID: 23544760
Mental health; integrated care; chronic care model; patient centered medical home; accountable care organization
4.  Teaching Tips—A new series in JGIM 
PMCID: PMC2173913  PMID: 17882500
5.  Teaching Tips—A new series in JGIM 
PMCID: PMC2173913  PMID: 17882500
6.  Clinical Updates: A New Feature in JGIM 
PMCID: PMC1924734
7.  Are We Making Progress in Medical Education? 
PMCID: PMC1484806  PMID: 16704407
8.  BRIEF REPORT: Brief Instrument to Assess Geriatrics Knowledge of Surgical and Medical Subspecialty House Officers 
Initiatives are underway to increase geriatrics training in nonprimary care disciplines. However, no validated instrument exists to measure geriatrics knowledge of house officers in surgical specialties and medical subspecialties.
A 23-item multiple-choice test emphasizing inpatient care and common geriatric syndromes was developed through expert panels and pilot testing, and administered to 305 residents and fellows at 4 institutions in surgical disciplines (25% of respondents), emergency medicine (29%), medicine subspecialties (19%), internal medicine (12%), and other disciplines (15%).
Three items decreased internal reliability. The remaining 20 items covered 17 topic areas. Residents averaged 62% correct on the test. Internal consistency was appropriate (Cronbach's α coefficient = 0.60). Validity was supported by the use of expert panels to develop content, and by overall differences in scores by level of training (P<.0001) and graded improvement in test performance, with 58%, 63%, 62%, and 69% correct responses among HO1, HO2, HO3, and HO4s, respectively.
This reliable, valid measure of clinical geriatrics knowledge can be used by a wide variety of surgical and medical graduate medical education programs to guide curriculum reform or evaluate program performance to meet certification requirements. The instrument is now available on the web.
PMCID: PMC1484789  PMID: 16704394
measurement; internship and residency; education; surgery; specialists
9.  Evaluation of Evidence for Interprofessional Education 
Based on recommendations from numerous organizations, educators in healthcare disciplines are implementing interprofessional training programs. Our objective was to summarize relevant literature in a way that would be most useful to clinican educators. Studies involving educational interventions in health professions to enhance learner-based outcomes relevant to the provision of interprofessional care were identified. We sought prospective, controlled trials in which at least 2 health care disciplines were represented, and 1 of which was medicine. Thirteen reports met the criteria for inclusion. Interventions varied widely in design and intensity, but generally included both didactic and clinical components and lasted several weeks or longer. Most studies used pretest/posttest controls and observed positive effects on learners' attitudes and knowledge. Combined clinical and didactic experiences may produce short-term improvements in learners' knowledge and attitudes about interprofessional care. Future research should employ control groups and validated, behaviorally oriented outcome measures whenever possible.
PMCID: PMC1636959  PMID: 17136186
interprofessional education; pharmacy education; clinical training
10.  Medical Education and JGIM 
PMCID: PMC1490124  PMID: 15963171
11.  Activities of Daily Living and Costs in Nursing Homes 
Health Care Financing Review  1994;15(4):117-135.
Functionality, as measured by activities of daily living (ADL), is the most important predictor of the cost of nursing home care. Data from a field-test version of the federally mandated Minimum Data Set (MDS) were examined using analysis of variance (ANOVA) and recursive partitioning methods to determine the relationships between ADL limitations and nursing cost (wage-weighted nursing time) among nursing home residents (n = 6,663). From this analysis, an index based on limitations in four ADLs was created. The developed ADL index is a readily determined measure of functional status useful in allocating nursing staff within nursing homes and in comparing the functional status of groups of residents, explaining 30 percent of variance in nursing costs among nursing home residents.
PMCID: PMC4193443  PMID: 10138481

Results 1-11 (11)