Goldman Laura N, Wiecha John, Hoffman Miriam, Levine Sharon A
Department of Family Medicine, Boston University Medical School, Boston, MA 02111, USA.
Fam Med. 2008 Nov-Dec;40(10):721-5.
We addressed a lack of geriatric content in our third-year family medicine clerkship. Adding this content posed a challenge in that students are dispersed to clinical sites across New England. Our goal was to promote student skill in functional assessment of elderly patients.
We used multiple formats: a workshop, a small-group case discussion, an online video, and an online discussion of a new geriatric case. Students were directed to use five assessment tools on actual patients in the office and on a home visit.
A total of 155 students participated in the new curriculum. Students completed a required home visit on an older patient and evaluated geriatric patients in an office setting. They performed the Mini-Mental State Exam (MMSE), Activities of Daily Living Scale (ADL), Instrumental Activities of Daily Living Scale (IADL), Geriatric Depression Scale (GDS), and Get-Up-and-Go tests in patients in both settings. There was significant improvement from before to after the clerkship in identification of the appropriate geriatric assessment tool to use (MMSE 86% to 96%; ADL/IADL 32% to 94%; GDS 71% to 94%, and Get-Up-and-Go 4% to 58%). Students evaluated the curriculum positively.
We were able to successfully increase the correct selection of and document high rates of use of geriatric functional assessment tools in our third-year family medicine clerkship using a mixture of teaching methods.
我们发现三年级家庭医学实习中缺乏老年医学相关内容。由于学生分散在新英格兰各地的临床实习点，增加这部分内容面临挑战。我们的目标是提高学生对老年患者进行功能评估的技能。
我们采用了多种形式：举办一次研讨会、进行小组病例讨论、制作在线视频以及开展新老年病例的在线讨论。指导学生在办公室对实际患者以及进行家访时使用五种评估工具。
共有155名学生参与了新课程。学生完成了对一名老年患者的必修家访，并在办公室环境中对老年患者进行评估。他们在两种环境下的患者中进行了简易精神状态检查表（MMSE）、日常生活活动量表（ADL）、工具性日常生活活动量表（IADL）、老年抑郁量表（GDS）以及起立行走测试。实习前后，在确定合适的老年评估工具使用方面有显著改善（MMSE从86%提高到96%；ADL/IADL从32%提高到94%；GDS从71%提高到94%，起立行走测试从4%提高到58%）。学生对该课程评价积极。
我们能够通过多种教学方法成功提高三年级家庭医学实习中对老年功能评估工具的正确选择率和高使用率，并进行记录。
