CHAMP (CURRICULUM FOR THE HOSPITALIZED AGING MEDICAL PATIENT)—
THE FACULTY DEVELOPMENT PROGRAM MATERIALS/METHODS OVERVIEW/USER’S
GUIDE
UNIVERSITY OF CHICAGO, SECTION OF GERIATRICS
Paula Podrazik MD
The CHAMP core working group:
Paula M. Podrazik, MD (CHAMP program director, Teaching on Today’s Wards); Aliza Baron,
MA (CHAMP project manager); Core working group—Stacie Levine MD(Program evaluation),
Don Scott, MD (Observed Standardized Teaching Experience (OSTE)/Medical Students &
CHAMP), Catherine DuBeau MD, Sandy Cook, PhD(Program evaluation), Sandy Smith, PhD
(Program evaluation), Julie Mohr, PhD (Teaching on Today’s Wards), Chad Whelan, MD
(Teaching on Today’s Wards), Vineet Arora, MD (Assessing care of vulnerable elders
(ACOVE)/Outcomes), David Meltzer, MD, PhD (ACOVE/ Outcomes), and Greg A. Sachs MD
(Principle Investigator)
SUPPORTED BY THE DONALD W. REYNOLDS FOUNDATION
CHAMP—An overview:
1. Teaching in the inpatient setting—Challenges and Importance:
The inpatient setting is the main training site for residents and medical students. The hospital, with
potential iatrogenic events, challenging transitions, mortality risk, is likewise a crucial setting for older
patients. Changes in residency work rules and new Accreditation Council for Graduate Medical Education
(ACGME) core competencies have added to the challenge of teaching in this busy setting. Addressing
these challenges and demands, the CHAMP faculty development program (FDP) merges the educational
needs of faculty teachers, residents, and medical students around the goal of improving the care of
hospitalized older adults.
2. CHAMP—How to Use the Materials:
The CHAMP FDP has the potential for widespread portability to all teaching faculty who care for the aging
hospitalized patient. These materials can be used in their entirety to recreate a similar FDP at your
institution for General Internists, Hospitalists, Geriatricians, Family Practitioners and fellows who attend
and teach adult medicine in the inpatient setting. Or, they can be used in modular pieces as well, e.g.,
specific geriatric topic areas lecture /bedside teaching materials/tools. The Teaching on Today’s Wards can
also be used in its entirety or in modular pieces, e.g., a workshop on teaching Practice Based Learning and
Improvement (PBLI) or Systems Based Practice (SBP) competencies or just using the census audit tool to
teach.
3. CHAMP Faculty Development Program: Methods and Materials
CHAMP (Curriculum for the Hospitalized Aging Medical Patient) is a multi-tiered educational project with
a faculty development program at its core. Hospitalists, general internists and family practitioners who
teach residents and students are the targeted audience.
The CHAMP FDP is a 12-week course consisting of 12 four-hour sessions. Two hours of each session
cover inpatient geriatric content and two hours address improving clinical teaching. Geriatric content is
organized around four themes, as outlined below. General clinical teaching skills are addressed using the
Stanford “Improving Clinical Teaching Skills” course, and challenges specific to the inpatient wards are
CHAMP (Curriculum for the Hospitalized Aging Medical Patient)
University of Chicago
Supported by a Donald W. Reynolds Foundation grant
covered using a newly developed mini-course entitled: “Teaching on Today’s Wards.” The aims of content
areas in “Teaching on Today’s Wards” are also outlined below.
Bedside teaching skills are practiced in a four-hour Observed Standardized Teaching Experience (OSTE)
Session. Similar to an observed structured clinical evaluation (OSCE), the OSTE is a performance-based
assessment method for teaching skills which uses “standardized” students in a simulated teaching
environment. The OSTE allows the deliberate practice of teaching new curricular materials and skills and
have been shown to improve teaching skills for both faculty and resident teachers. In the CHAMP
curriculum, OSTE’s allowed the participants to practice teaching new geriatric content. Teaching topics
include: hospital discharge, appropriate indications for foley catheter use, delirium, teaching the mini-cog.
and the gait-timed get up and go assessment at bedside.
CHAMP materials include bedside teaching triggers which identify opportunities to teach geriatrics at
bedside or during the course of ward rounds with the house staff and medical student team. Each “teaching
trigger” consists of a clinical question and summary 5-10 minute teaching points. See Figure #1—sample
teaching trigger and materials.
4. CHAMP FDP Curriculum:
Aging Medicine Themes and Topics
Identify the Frail /Vulnerable Elder
• Identify and assess the frail hospitalized older patient
• Dementia in the Hospitalized Aging Medical patient: Recognizing dementia, Assessing Medical
Decision Making Capacity, implications for the treatment of non-dementia illness, pain assessment,
improving the transition of care post-hospitalization
Avoid Hazards of Hospitalization
• Delirium: Diagnosis, Treatment, Risk stratification and Prevention
• Falls: Assessment and Prevention
• Foley Catheter Use: Appropriate indications
• Deconditioning: Scope of the Problem and Prevention
• Adverse Drug Reactions/Medication Error: Principles of Drug Review
• Pressure Ulcers: Assessment, Treatment and Prevention
Palliate and Address End-of-Life Issues
• Pain Control
• Symptom Management in Advanced Disease: Nausea
• Difficult Conversations and Advanced Directives
• Hospice/Palliative Care and Changing Goals of Care
Improve Transitions of Care
• The Ideal Hospital Discharge
• Destinations of Post-Hospital Care
Teaching on Today’s Wards: Aims and Content Areas
Aims:



Assist the teaching faculty to improve their own individual process of teaching in the specific site
of the inpatient wards.
Advance techniques and materials for teaching across all the ACGME competencies with an
emphasis on teaching aspects of systems based practice (SBP) and practice based learning and
improvement (PBLI) in “real” time during the course of ward rounds.
“Teaching on Today’s Wards” uses geriatric content as the basis for all discussions.
CHAMP (Curriculum for the Hospitalized Aging Medical Patient)
University of Chicago
Supported by a Donald W. Reynolds Foundation grant
Sessions One and Two: Improving the Teaching Process
 Use of process mapping to analyze and improve a faculty learner’s teaching process
 Incorporating professionalism/communication into the bedside teaching agenda
 Setting teaching goals
 Two interactive card games that explores goal setting for the team of residents and medical
students and how to expand a teaching agenda to include more teaching across the ACGME
competencies using geriatric content.
Card Game #1: “I hope I get a good team.” explores the effects of the inpatient team dynamics on
the teaching process. The aim of this card game is to reflect on your teaching process with regard
to how you goal setting for the team and members of the team based on level of learner and
individual strengths and weaknesses.
Card game #2—“Missed teaching opportunities”— explores what you teach on a given call cycle,
How to develop a teaching agenda to include more of the aging related topics and
teach this geriatric content across the ACGME competencies.
Session Three: Systems Based Practice
 Introduction to systems
 Introduction to triggers for teaching about systems problems
 Introduction to quality improvement using the Plan-Do-Study-Act (PDSA) model
Session Four: Practice-Based Learning and Improvement
 Introduction to practice-based learning and improvement
 Use of the case audit and census audit tools. See Figure # 2 – sample census audit
Session Five: Life-Long Learning
 When, what and how to formulate teaching questions
5. CHAMP FDP Evaluation
Evaluation of the CHAMP FDP includes traditional methods of evaluation of both the faculty teachers and
faculty learners. The faculty learner takes a knowledge test 1 2 3 * (given pre and post-course), an attitudes
survey 4 about aging (given pre-course only), and a self-assessment survey measuring self-confidence,
importance and frequency practicing and teaching geriatric skills on the wards. The same measures are
assessed relating to the advanced teaching skills in Teaching on Today’s Wards. The faculty learner also
signs a “commitment to change” contract at the end of the CHAMP course selecting topics of interest to
teach on future inpatient teaching attending months from the geriatric topics section and an aspect of the
ACGME competencies or specific tools developed, e.g., census audit tool. Developing a Quality
Improvement (QI) project is another option on the faculty learner’s commitment to change contract. These
contracts are reviewed during the CHAMP course and reminders via e-mail are sent prior to the faculty
learner’s month on the inpatient service. Contact with the faculty learners is frequent before, during and
after each time the faculty learner attends on the wards. After the faculty leaner’s month on the inpatient
service they receive a follow-up survey contract asking them to rate their success in attaining their teaching
goals.
At the end of the year, all faculty in general internal medicine are surveyed about the frequency of teaching
geriatric clinical skills on the wards, and the frequency with which the team performed the skills. The
residents and medical students are likewise surveyed about the frequency of being taught geriatric clinical
skills on the wards and the geriatric teaching of their inpatient team attending physician (s). In addition, the
residents are surveyed annually, on their self-confidence practicing geriatric clinical skills on the wards, the
importance of geriatric clinical skills and the frequency with which they practice geriatric skills. The
residents will be completing the geriatric knowledge test at of the start of the academic year 2006.
Medical students—second and third years—also complete the geriatrics knowledge test pre and post their
inpatient month, in addition to completing the attitudes survey.
CHAMP (Curriculum for the Hospitalized Aging Medical Patient)
University of Chicago
Supported by a Donald W. Reynolds Foundation grant
*Note the Geriatrics knowledge test is a 23-item exam from the sources referenced. Questions were
selected based on their relevance to the specific goals and modules covered in the inpatient geriatrics
portion of CHAMP. Four additional questions were developed to address content areas not covered in these
sources.
Bibliography
1. Reuben DB, Lee M, Davis JW, et al. Development and evaluation of a geriatrics knowledge test
for primary care residents. J Gen Intern Med 1997;12 (7): 450-452.
2. Storey P, Knight CF. UNIPAC Three: Assessment and treatment of pain in the terminally ill.
Second edition. American Academy of Hospice and Palliative Care. 2003.
3. Lee M, Wilkerson L, Reuben DB, et al. Development and validation of a geriatric knowledge test
for medical students. J Am Geriatr Soc 2004; 52(6):983-8.
4. Reuben DB, Lee M, Davis JW Jr, Eslami MS, et al. Development and validation of a geriatrics
attitudes scale for primary care residents. J Am Geriatr Soc 1998; 46(11):1425-30.
CHAMP (Curriculum for the Hospitalized Aging Medical Patient)
University of Chicago
Supported by a Donald W. Reynolds Foundation grant
Figure #1
Sample CHAMP Bedside Teaching Materials:
Teaching trigger on assessing pain
ASSESSING PAIN
By Stacie Levine MD
Teaching Trigger:
During daily rounds, when obtaining history, ask the patient if he/she is feeling pain. If a patient responds
affirmatively, OR, for patients with advanced cognitive impairments, exhibits a change in behavior, there
may be pathology contributing to pain.
Clinical Question:
How do you assess pain in older adults, regardless of cognitive status?
Teaching Points:
1) Every older adult should be screened for pain when hospitalized (“the Fifth
Vital Sign”)
2) Even patients with moderate, and some with advanced dementia, may be able
to reliably report pain
3) Assume persons with dementia feel pain the same as cognitively intact
persons
4) Find the patient’s Preferred Pain Terminology
 hurting, aching, stabbing, discomfort, soreness
5) Use a Pain Scale that works for the individual
 Numeric Rating Scale
 Verbal Descriptor Scale
 Faces Pain Scale
 Pain thermometer
6) In patients with advanced dementia:
(a) Formal assessment tools may not be useful
(b) Identify Unique Pain Signature
 How does the patient usually act?
 What changes are seen when they are in pain?
 Communication across caregiver settings is key!
(c) Look for Nonverbal Pain Indicators
 Changes in interpersonal interactions
 Changes in mental status
 Changes in usual activity
(d) Perform timely, thorough physical exam
(e) Insure basic comfort needs are being met
(f) Rule out other causative pathologies
(g) Consider empiric analgesic trial
CHAMP (Curriculum for the Hospitalized Aging Medical Patient)
University of Chicago
Supported by a Donald W. Reynolds Foundation grant
FIGURE #2
SAMPLE CENSUS AUDIT
CENSUS AUDIT: FOLEY CATHETER USE*
By Chad Whelan, MD
Foley Catheter:
Yes
No
If Yes then:
Where was it placed? _____________________
When was it placed? _________________
Appropriate indication when placed? Yes
No
Appropriate indication now?
Yes
No
Yes
No
If No, then DC
If Yes, Plan for DC
Patient Safety Issues/Systems Issues?
SUMMARY
Proportion of Patients with Foley Catheter ________
Proportion of Patients with Catheters with indication when placed ____
Proportion of Patients with Catheters with indication now _______
Patient Safety Issues/Systems Issues Themes
_____________________________________________________________________
_____________________________________________________________________
Plan for Change: _______________________________________________________
______________________________________________________________________
Plan to Re-Measure: __________________________________________________
CHAMP (Curriculum for the Hospitalized Aging Medical Patient)
University of Chicago
Supported by a Donald W. Reynolds Foundation grant