Wake Forest Baptist to extend innovation in geriatrics education with new GPS program

Wake Forest Baptist Medical Center will maintain its position as a leader in geriatric medicine and medical training with continued grant funding from the Donald W. Reynolds Foundation.

Wake Forest Baptist has been awarded $999,979 over four years, a continuation of an almost $2 million grant awarded in 2008 from the foundation to strengthen geriatrics education at all levels of training. Wake Forest Baptist is one of 10 academic health centers in the country to receive new funding from the foundation to extend programs that train medical students, residents and faculty in geriatrics.

"This new funding allows us to take the best elements of our medical training program and expand our efforts to target more doctors and include more sub-specialties of internal medicine," said Hal Atkinson, M.D., M.S., director of the Wake Forest Internal Medicine Residency Program and associate professor at Wake Forest Baptist's J. Paul Sticht Center on Aging. "This will enable faculty, chief residents and fellows to work together to improve education and quality of care for their older patients in their respective specialties."

The continued funding allows Wake Forest Baptist to extend its 25-year track record of innovation in geriatrics education with a new Geriatrics Principles for Specialists (GPS) program. GPS will feature a curriculum of adaptable and sustainable short courses designed to train specialty faculty, fellows and chief residents first in basic geriatrics skills and then in advanced team leadership and transitional care management for older adult patients.

This train-the-trainer approach will build upon previously developed faculty development programs to further enhance geriatrics care provided by specialist physicians at Wake Forest Baptist. Thirteen specialty disciplines will be targeted for GPS training, including internal medicine subspecialties that are highly relevant to geriatric care and hospitalist co-management teams within surgical specialties serving high volumes of geriatric patients.

The capstone assignment for participating specialty teams will be to design and implement quality improvement projects to advance geriatric education and quality of care for their respective departments. By 2017, the GPS program will involve 33 non-geriatrician faculty and 41 chief residents and fellows who will impact more than 526 residents and 480 medical students annually.

Atkinson said the GPS program will build upon the comprehensive geriatrics education program funded by the initial grant that targeted students, residents and faculty physicians. He said it is designed to reflect the medical center's goals of improving transitions in care for older patients, improving engagement of palliative medicine for patients, and improving quality and safety for older patients. "This program is synergistic with the institution's mission," Atkinson said.

Teaching Students
Through the support of the Reynolds Foundation, all Wake Forest medical students in first and second year now are exposed to geriatrics content in class work. By second year, all students are also interviewing active older adults in the community about healthy aging and their experiences in the health care system. In third year, all students spend a week working with geriatricians, including time on the Acute Care for the Elderly (ACE) hospital unit, in geriatrics clinics, and in long-term care facilities. In fourth year, students can take an elective in advanced inpatient management of geriatric patients or an ambulatory geriatrics elective.

Teaching Residents
All internal medicine interns complete a month-long ambulatory geriatrics rotation. Then all second-year IM residents complete a month on the ACE Unit and conduct chart audits and surveys of quality measures on their older primary care patients. A quality improvement project utilizing the data is completed in the third year of residency. Similarly, second-year Family Medicine residents complete a geriatrics rotation, including ACE Unit, clinic and nursing home experience. Family Medicine residents also collect data on their older continuity-clinic patients for a quality improvement project planned and executed in third year. Finally, the support and momentum of the first Reynolds grant was leveraged to obtain funding for a Chief Resident Immersion Training program in geriatrics in 2009 through the Hartford Foundation, which was subsequently continued by a generous gift from a donor foundation in 2011 to support innovations in education in geriatrics throughout multiple specialties.

Teaching Faculty
To build teaching collaborations in geriatrics throughout the medical center, geriatrics works with faculty in other specialties and subspecialties to teach about issues affecting older hospitalized patients. Issues such as delirium, polypharmacy, pain management, cognitive and functional assessment, outcomes-based quality improvement, transitions of care, and palliative care are important not just to geriatricians but to all practitioners of adult medicine. Through the Reynolds program to date, Wake Forest faculty in general medicine, hospital medicine, oncology, nephrology, pulmonary/critical care, cardiology and emergency medicine have attended interactive training sessions in geriatric patient care and have committed to teach geriatrics content to their students and residents.