by Cindy Abole
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
“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
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
“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
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