Roberts Linda, Cornell Charles, Bostrom Mathias, Goldsmith Sandra, Ologhobo Titilayo, Roberts Timothy, Robbins Laura
Education Institute, Hospital for Special Surgery, New York, New York.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York.
J Surg Educ. 2018 Sep-Oct;75(5):1180-1187. doi: 10.1016/j.jsurg.2018.02.005. Epub 2018 Mar 31.
It is vital for physicians and surgeons to communicate successfully with older adults, who will constitute one-fifth of the US population by 2030. Older adults often perceive themselves as stigmatized and powerless in healthcare settings. Effective communication leads to better patient compliance and satisfaction, which is now a component of Medicare hospital reimbursement and physician and surgeon compensation from hospitals and networks.
To increase orthopaedic surgery resident understanding of the unique needs of older adults in order to maintain effective and sensitive communication with this vulnerable population.
A two-part training program (ongoing for 8 years) comprised of: 1) small-group interactive didactic sessions on aging issues; and 2) workshop demonstrations given by the residents to a group of older adults, followed by a Question & Answer session. Residents were assessed using a 22-item pre-post questionnaire covering medical knowledge of aging, attitudes toward older adults, and personal anxiety about aging. Older adult participants were surveyed for perceptions of residents' sensitivity toward them.
Hospital for Special Surgery in New York City, a specialized urban academic center, with a 5-year Orthopedic Surgery Residency program.
70 PGY3 residents, for whom the program is a requirement, and 711 older adult participants recruited from a community convenience sample.
Older adult participants: Of 711 participants, 672 (95%) responded; 96% strongly agreed/agreed that the residents had demonstrated sensitivity toward them. Residents: Of 70 residents, 35 (50%) were assessed. Mean knowledge scores increased significantly (p ≤ 0.001); five of nine attitude items (p ≤ 0.05) and one of four anxiety items improved significantly (p ≤ 0.001).
Significant change was seen in residents' attitudes and anxiety levels toward older adults, attributes that are usually deep seated and hard to change. Residents moved along the Accreditation Council for Graduate Medical Education Milestones continuum for three core competencies.
到2030年，老年人将占美国人口的五分之一，因此医生和外科医生与老年人成功沟通至关重要。老年人在医疗环境中常常觉得自己受到了污名化且无能为力。有效的沟通能带来更好的患者依从性和满意度，而这如今已成为医疗保险医院报销以及医院和医疗网络对医生和外科医生薪酬补偿的一个组成部分。
增强骨科住院医师对老年人独特需求的理解，以便与这一弱势群体保持有效且贴心的沟通。
一个分为两部分的培训项目（持续8年），包括：1）关于衰老问题的小组互动式教学课程；2）住院医师向一组老年人进行工作坊演示，随后进行问答环节。使用一份包含22个条目的前后调查问卷对住院医师进行评估，内容涵盖衰老的医学知识、对老年人的态度以及对衰老的个人焦虑。对老年参与者就其对住院医师对他们的敏感度的看法进行了调查。
纽约市特种外科医院，这是一家专业的城市学术中心，设有一个为期5年的骨科住院医师培训项目。
70名三年级住院医师（该项目是他们的必修课），以及从社区便利样本中招募的711名老年参与者。
老年参与者：在711名参与者中，672名（95%）做出了回应；96%的人强烈同意/同意住院医师对他们表现出了敏感度。住院医师：在70名住院医师中，35名（50%）接受了评估。平均知识得分显著提高（p≤0.001）；九个态度项目中的五个（p≤0.05）以及四个焦虑项目中的一个有显著改善（p≤0.001）。
住院医师对老年人的态度和焦虑水平出现了显著变化，而这些特质通常根深蒂固且难以改变。住院医师在研究生医学教育认证委员会的三个核心能力里程碑连续统一体上取得了进展。
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