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Medicine in the 21st century: recommended essential geriatrics competencies for internal medicine and family medicine residents.

ABSTRACT: BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

SUBMITTER: Williams BC

PROVIDER: S-EPMC2951777 | biostudies-other | 2010 Sep

REPOSITORIES: biostudies-other

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Project description:There is no good science in bad models. Cell culture is especially prone to artifacts. A number of novel cell culture technologies have become more broadly available in the 21st century, which allow overcoming limitations of traditional culture and are more physiologically relevant. These include the use of stem-cell derived human cells, cocultures of different cell types, scaffolds and extracellular matrices, perfusion platforms (such as microfluidics), 3D culture, organ-on-chip technologies, tissue architecture, and organ functionality. The physiological relevance of such models is further enhanced by the measurement of biomarkers (e.g., key events of pathways), organ specific functionality, and more comprehensive assessment cell responses by high-content methods. These approaches are still rarely combined to create microphysiological systems. The complexity of the combination of these technologies can generate results closer to the in vivo situation but increases the number of parameters to control, bringing some new challenges. In fact, we do not argue that all cell culture needs to be that sophisticated. The efforts taken are determined by the purpose of our experiments and tests. If only a very specific molecular target to cell response is of interest, a very simple model, which reflects this, might be much more suited to allow standardization and high-throughput. However, the less defined the end point of interest and cellular response are, the better we should approximate organ- or tissue-like culture conditions to make physiological responses more probable. Besides these technologic advances, important progress in the quality assurance and reporting on cell cultures as well as the validation of cellular test systems brings the utility of cell cultures to a new level. The advancement and broader implementation of Good Cell Culture Practice (GCCP) is key here. In toxicology, this is a major prerequisite for meaningful and reliable results, ultimately supporting risk assessment and product development decisions.

Project description:BACKGROUND: Few studies have examined residents' retained knowledge and confidence regarding essential evidence-based medicine (EBM) topics. OBJECTIVE: To compare postgraduate year-3 (PGY-3) residents' confidence with EBM topics taught during internship with that of PGY-1 residents before and after exposure to an EBM curriculum. METHODS: All residents participated in an EBM curriculum during their intern year. We surveyed residents in 2009. PGY-1 residents completed a Likert-scale type survey (which included questions from the validated Berlin questionnaire and others, developed based on input from local EBM experts). We administered the Berlin questionnaire to a subset of PGY-3 residents. RESULTS: Forty-five PGY-3 (88%; n = 51) and 42 PGY-1 (91%; n = 46) residents completed the survey. Compared with PGY-1 residents pre-curriculum, PGY-3 residents were significantly more confident in their knowledge of pre- and posttest probability (mean difference, 1.14; P = .002), number needed to harm (mean difference, 1.09; P = .002), likelihood ratio (mean difference, 1.01; P = .003), formulation of a focused clinical question (mean difference, 0.98; P = .001), and critical appraisal of therapy articles (mean difference, 0.91; P = .002). Perceived confidence was significantly lower for PGY-3 than post-curriculum PGY-1 residents on relative risk (mean difference, -0.86; P = .002), study design for prognosis questions (mean difference, -0.75; P = .004), number needed to harm (mean difference, -0.67; P = .01), ability to critically appraise systematic reviews (mean difference, -0.65, P = .009), and retrieval of evidence (mean difference, -0.56; P = .008), among others. There was no relationship between confidence with and actual knowledge of EBM topics. CONCLUSIONS: Our findings demonstrate lower confidence among PGY-3 than among PGY-1 internal medicine residents for several EBM topics. PGY-3 residents demonstrated poor knowledge of several core topics taught during internship. Longitudinal EBM curricula throughout residency 5 help reinforce residents' EBM knowledge and their confidence.

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Medicine in the 21st century: recommended essential geriatrics competencies for internal medicine and family medicine residents.

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