Williams Brent C, Warshaw Gregg, Fabiny Anne Rebecca, Lundebjerg Mpa Nancy, Medina-Walpole Annette, Sauvigne Karen, Schwartzberg Joanne G, Leipzig Rosanne M
J Grad Med Educ. 2010 Sep;2(3):373-83. doi: 10.4300/JGME-D-10-00065.1.
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.
医学研究所对医师劳动力的预测要求所有初级保健和专科医师都要加强老年医学培训。明确内科和家庭医学住院医师的老年医学核心能力，将有助于改善初级保健和专科医师的培训。本研究的目的是：（1）明确内科和家庭医学住院医师共有的老年医学核心能力，这些能力基于已确立的医学生全国老年医学能力，在当前住院医师培训项目中可行，可评估，并符合毕业后医学教育认证委员会的能力要求；（2）让关键利益相关组织参与这些能力的制定和实施。
通过小组会议和对100多名专家的调查确定了初步的候选能力，随后由来自关键专业组织的26名项目主任和住院医师临床教育工作者进行详细的项目审查。在此过程中，一个由8名成员组成的工作组进行了修订，以保持各项能力之间的一致性和兼容性。在整个项目过程中，确保了关键利益相关组织的支持和参与。
该过程确定了7个领域的26项能力：药物管理；认知、情感和行为健康；老年人的复杂或慢性疾病；姑息治疗和临终关怀；医院患者安全；医疗过渡；以及门诊护理。这些能力直接对应医学生的老年医学能力和毕业后医学教育认证委员会的6项能力要求。
通过一个包括关键利益相关组织的领导人和成员的共识建立过程，已经制定了一套简洁的内科和家庭医学住院医师老年医学核心能力。这些能力与医疗保险支付咨询委员会最近提交给国会的报告中提出的住院医师培训关注点高度一致。利益相关组织正在开展工作，以在内科和家庭医学住院医师培训项目中传播和评估这些能力。
