Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2023 Jul;71(7):2279-2289. doi: 10.1111/jgs.18315. Epub 2023 Mar 22.
General internists and subspecialists need skills to deliver age-friendly care to older adults, yet a minority of Internal Medicine (IM) residency programs provide robust geriatric-specific clinical instruction. We sought to explore internist and geriatrician perspectives regarding current strengths and weakness of geriatric education, and perceived supports, barriers, and strategies to enhance geriatric education in an IM residency program.
Using social learning theory as a conceptual framework, we conducted a needs assessment using focus groups and semi-structured interviews with IM residency leadership and geriatricians at an academic medical center. Interviews were recorded and transcribed; thematic analysis was performed on deidentified transcripts.
We recruited faculty by e-mail in 2021; eight geriatricians and seven internists participated (60% female, 13% Hispanic/Latino, and 73% White). Six participated in two virtual focus groups and nine participated in virtual one-on-one interviews. All had at least monthly teaching contact with residents and six were associate program directors. We identified five key themes: (1) professional role models, (2) personal attitudes toward aging, (3) the powerful influence of patients, (4) clinical complexity of geriatrics, and (5) branding and prestige of the field. Participants offered multiple suggestions for improvement, especially faculty development for non-geriatrician faculty.
Geriatric education for IM residents is impacted by multiple factors, but uniformly viewed as important. Moving forward, programs could capitalize on opportunities for closer collaboration between residency leadership, internists, and geriatricians to train the next generation of IM residency graduates to deliver age-friendly care.
普通内科医生和亚专业医生需要掌握为老年人提供友好关怀的技能，但只有少数内科住院医师培训计划提供了强大的老年医学特定临床指导。我们试图探讨内科医生和老年病医生对老年医学教育的当前优势和劣势的看法，以及对增强内科住院医师培训计划中老年医学教育的支持、障碍和策略的看法。
我们使用社会学习理论作为概念框架，通过焦点小组和半结构化访谈，对学术医疗中心的内科住院医师培训领导和老年病医生进行了需求评估。访谈进行了录音和转录；对匿名转录本进行了主题分析。
我们于 2021 年通过电子邮件招募了教员；有八名老年病医生和七名内科医生参加（60%为女性，13%为西班牙裔/拉丁裔，73%为白人）。六名参与者参加了两次虚拟焦点小组，九名参与者参加了虚拟一对一访谈。所有人都与住院医师至少每月有一次教学接触，其中六人为副主任医师。我们确定了五个关键主题：（1）职业榜样，（2）个人对老龄化的态度，（3）患者的强大影响力，（4）老年医学的临床复杂性，以及（5）该领域的品牌和声望。参与者提出了多项改进建议，特别是针对非老年病学教员的师资发展。
内科住院医师的老年医学教育受到多种因素的影响，但普遍被认为很重要。展望未来，项目可以利用住院医师培训领导、内科医生和老年病医生之间更紧密合作的机会，为下一代内科住院医师培训毕业生提供友好关怀老年人的培训。
