by Cindy Abole
Public Relations
Preparing today’s physicians with the knowledge and skills needed to care for America’s elderly population is a priority recognized by medical educators. Last fall, MUSC was named among 10 academic health science centers from around the country to receive a four-year, $2 million grant to develop such programs and strengthen training among medical students, residents and physicians.
 
MUSC was awarded grants totaling $20 million from the Donald W. Reynolds Foundation to develop a quality-focused, education based program to improve geriatrics competencies among resident physicians. MUSC joined the University of Alabama at Birmingham, Wake Forest University, University of Pennsylvania and other national institutions to receive these geriatrics training grants. MUSC’s effort is being led by William Moran, M.D., director of the division of general internal medicine & geriatrics and the project’s principal investigator, and Patty J. Iverson, Aging Q3 Project director. The project continues until 2012.
 
“This program is not just about changes in medical education, it’s about a change in the system and performance among medical practitioners,” said Moran, who came to MUSC from Wake Forest University in 2005.
 
MUSC’s effort focuses on training physicians by arming them with the knowledge and skills to provide quality care for the Lowcountry’s elderly population. To address this challenge, Moran and an interdisciplinary team of educators, clinicians and researchers proposed the aging quality education, quality care and quality of life (Aging Q3) project as an educational and practice-based program focused on training residents in geriatric medicine.
 
Borrowing from successful progress made by the University of South Carolina (USC) School of Medicine’s Division of Geriatrics to improve resident and faculty training in geriatrics, Moran and project leaders recruited faculty from several disciplines and organized a geriatrics teaching core who are involved in teaching residents as part of the program’s quality education component. USC School of Medicine was among the first institutions to receive a Reynolds Geriatric Training Grant in 2001. Translating new knowledge into practice changes involving residents and faculty defines the quality of care component. Finally, demonstrating improved care outcomes including end-of-life care is the quality of life component.
 
The program is built around 16 identified Assessing Care of Vulnerable Elders (ACOVE) areas and work groups. Faculty, along with some residents and fellows, are assigned to each of the ACOVE work groups to help plan resident didactic lectures, strategize faculty development, (meetings with faculty members), practice partner documentation, identify practice cues to trigger screening for patients, etc. Each ACOVE theme lasts three months to help sensitize internal medicine residents in adopting these skills and practices within their clinics and offices.  
 
The first ACOVE theme was vision, which enlisted the help of physicians at MUSC’s Storm Eye Institute (SEI) from June to August. Training outcomes included the successful screening of 632 patients; and of those patients screened, 113 patients were referred out to SEI ophthalmologists. Physicians screened older  patients for age-related vision diseases and conditions like macular degeneration, cataracts and glaucoma. Individuals identified as at-risk patients also were provided with educational materials on vision loss and aging.
 
The project’s second ACOVE is falls and mobility, which began Sept. 8 and will continue until December. Falls are considered one of the most life-limiting threats of aging, which oftentimes is exacerbated by physicians prescribing medications to patients, according to Moran. New medications may develop side effects that can cause falls, give rise to fractures and contribute to social isolation among elderly adults. Residents are currently learning how to properly assess patients for falls and who is at–risk, evaluating their medications, assessing for vision impairment, muscular skeletal issues or cardiovascular problems. Information is provided to at-risk patients to reduce their risk for falls. This ACOVE hopes to work with physical therapy in regards to patient referrals. It is led by Kathy Wiley, M.D., a geriatrician and associate professor division of general internal medicine; and includes Cara Litvin, M.D., a fellow in general internal medicine & geriatrics; Cathryn Caton, M.D., assistant professor of medicine; and Amy Thompson, PharmD, assistant professor, College of Pharmacy.
 
“Since the falls and mobility indicator began in September, more than 70 percent of Internal Medicine residents have been ‘detailed’ about evaluation of falls in the elderly,” said Wiley. “They have practiced the skill of performing tests that are fall risks measures. This intervention has been well-received by residents as applicable to their clinical practice.”
 
“This program teaches physicians how to identify and evaluate for falls and know what to do once they identify it,” said Moran. “Ultimately, these actions affect quality of care for patients.”
 
More importantly, this program provides a mechanism to respond to the immediate need for more geriatric expertise in the Palmetto State. South Carolina is 17th in the nation for U.S. growth of senior citizens, yet the state has only a few geriatricians (with almost half located in the Midlands) to provide this level of medical expertise. Unfortunately, geriatric medicine remains an unpopular residency choice among medical students because of reimbursement and patient complexity.
 
“Rather than increase the number of physicians to work in geriatrics, this program focuses on increasing the knowledge base and skills needed by physicians who will be working with the elderly population,” Moran said.
 
Reynolds Geriatric Training Grants have funded 40 institutions nationwide since 2001. The Donald W. Reynolds Foundation is a national philanthropic organization founded in 1954 by the late media entrepreneur for whom it is named. Headquartered in Las Vegas, it has committed more than $200 million to teach physicians to better care for frail elderly people.  
 
“It’s exciting to see the enthusiasm and support of our faculty and residents as MUSC enriches its quality of geriatric education and quality of care for the elderly population in our area through this project,” said Iverson.
 
For information about the Aging Q3 Project, visit http://mcintranet.musc.edu/agingq3.

Friday, Nov. 6, 2009