Department of Emergency Medicine, Resurrection Medical Center, University of Illinois, Chicago, IL, USA.
Acad Emerg Med. 2010 Mar;17(3):316-24. doi: 10.1111/j.1553-2712.2010.00684.x.
The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes.
The objective was to develop a consensus document, "Geriatric Competencies for Emergency Medicine Residents," by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training.
This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project.
In Phase I, participants (n=363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n=24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions.
The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population.
老年患者在急诊科（ED）的就诊率超过除婴儿以外的所有年龄段。随着人口老龄化，老年 ED 患者的就诊量将占所有就诊量的 35%至 60%。老年患者的临床表现可能较为复杂，对资源的需求较高。有证据表明，急诊医师未能为老年 ED 患者提供一致的高质量护理，导致临床结局较差。
通过确定的专家制定一份名为“急诊医学住院医师老年医学能力”的共识文件。这是一组最低限度的基于行为的绩效标准，所有住院医师都应在完成住院医师培训后能够展示这些标准。
本共识过程采用了一种归纳的、定性的、多阶段方法，以确定急诊医学（EM）住院医师所需的最低老年医学能力。在整个项目中使用了对表面有效性和可靠性的评估。
在第 I 阶段，参与者（n=363）确定了 12 个领域和 300 个潜在能力。在第 II 阶段，一个专家小组（n=24）对第 I 阶段的回答进行了聚类，得出了 8 个领域和 72 个能力。在第 III 阶段，专家组将能力减少到 26 个。在第 IV 阶段，对表面有效性和可靠性的分析得出了 8 个领域和 26 个能力的 100%共识。确定的领域包括疾病的非典型表现；创伤，包括跌倒；认知和行为障碍；紧急干预措施的修改；药物管理；医疗保健的转移；疼痛管理和姑息治疗；以及合并症的影响。
《急诊医学住院医师老年医学能力》是一份共识文件，可以为急诊医学住院医师培训和评估提供基础，以满足人口老龄化的需求。
