Effects of an inpatient geriatrics rotation on internal medicine residents' knowledge and attitudes.

OBJECTIVE

The purpose of this study is to assess the effect of a geriatrics-focused acute medicine inpatient rotation and the presence or absence of a geriatrician as attending physician on knowledge about and attitudes toward older patients and the field of geriatrics.

DESIGN

Randomized trial.

INTERVENTION

A 4-week acute care inpatient internal medicine rotation at a university-affiliated Veterans Affairs Medical Center; experiences included caring for acutely ill, older medical patients, interdisciplinary team meetings, geriatrics-based noon conferences, interaction with geriatrics-trained nurse practitioners, and a syllabus of readings on geriatric medicine.

PARTICIPANTS

Postgraduate year 1, 2, and 3 internal medicine residents were randomly assigned to one of three groups: (1) the intervention with a geriatrics-trained internist attending (n = 44); (2) the intervention with a non-geriatrics-trained internist attending (n = 25); or (3) no exposure to the intervention (n = 24).

INSTRUMENTS

Knowledge was assessed using a 35-item test. Attitudes were evaluated using a 24-item questionnaire.

RESULTS

There were no differences among the three groups of residents in pretest knowledge (p = .971, analysis of variance). There was a significant difference in the changes in scores from the pretest baseline among the three groups (group 1 = .030, group 2 = .051, group 3 = -.009; p = .039). Both groups assigned to the intervention showed significant improvement in knowledge (p = .011); the presence or absence of a geriatrics-trained attending physician did not alter the results. Resident attitude scores were generally positive and did not change after the intervention.

CONCLUSIONS

An intensive integrated acute medicine rotation in geriatrics improved residents' knowledge of geriatric medicine. The presence of a geriatrics-trained attending physician was not necessary for this improvement. Residents' attitudes toward geriatric medicine and their geriatrics education were generally positive and were not influenced by this experience.