Sharon Levine, MD, Adam Burrows, MD, Lisa Caruso, MD, MPH,
Serena Chao, MD, MSc, Heidi Auerbach, Angela Jackson, MD
At Boston University Medical Center, the Geriatrics curriculum in the Internal Medicine residency program was already well developed. We wanted to build on this base to focus attention on training programs that currently have little or no Geriatrics. The most innovative and far-reaching of our residency training initiatives is Chief Resident Immersion Training
(CRIT) in the Care of Older Adults, which recruits a corps of Chief Residents from departments throughout the hospital.
Chief Residents and Program Directors participate in didactic lectures on leadership and teaching skills.
Chief Residents play a crucial part in the training of residents and students. While CRs have had ample opportunities and guidance in the development of specialty-specific skills, their understanding of geriatrics issues may be limited. They may not recognize the importance of physical and cognitive function in the care of frail older patients or be familiar with geriatric syndromes that pose risks in hospital settings. Furthermore, they may not have had opportunities to develop positive attitudes about the rewards of caring for this diverse, complex, and growing population. In addition, CRs may receive little formal training in teaching techniques and leadership. Through CRIT, we aimed to help Chief Residents become more knowledgeable about Geriatrics, and we have taken the innovative step of enlisting them to attack pervasive deficiencies in the teaching and dissemination of Geriatrics knowledge within their departments.
Our primary objective is to foster collaboration among disciplines in the management of complex older patients. Our secondary goals are:
• To incorporate geriatrics principles into teaching and
administrative roles as Chief Residents
• To develop leadership/teaching skills around the care
of complex older patients
• To enhance leadership/teaching skills required in the
Chief Residents and Program Directors meet in small groups to discuss cases focusing on geriatric patient concerns, such as decision making capacity and functional assessment.
Chief Resident role
• To develop an achievable project related to resident
education in Geriatrics to be carried out during the
Chief Residency year
• To have fun and foster collegiality
This work was supported by a grant from the Donald W. Reynolds Foundation.
Copyright 2008, Trustees of Boston University

A focus group of Chief Residents (CR) and Program Faculty met to assess the needs of the Chief Residents. The results of this discussion and information compiled from a structured questionnaire were used to develop learning objectives that focused on the content areas identified by the Chief Residents at Boston Medical Center. Crossdisciplinary themes emerged regarding teaching skills and conflict management.
A multidisciplinary team, including key faculty from the departments of Family and Internal Medicine and the Geriatrics Section, met regularly to develop curriculum to address the goals outlined above and the areas identified by the CRs. Faculty developed a surgical case that unfolded in three modules over the course of the weekend. The case included various aspects of geriatric care. Didactic and small group content around the case was developed. Planning focused on creating an opportunity to learn in an interactive environment and leave the event with a plan for personal and institutional improvement.
Chief Residents receive mentoring from Geriatrics faculty on developing achievable projects.
Over the past four years, 66 trainees and 20 faculty mentors have participated in CRIT programs representing 14 medical and surgical disciplines. Participating specialties have included Internal Medicine, Otolaryngology, Anesthesiology, Rehabilitation Medicine,
Family Medicine, Neurology, Ophthalmology, Psychiatry, Cardiothoracic Surgery,
Urology, Emergency Medicine, General Surgery, Orthopedic Surgery, and Obstetrics and
Gynecology. Facilitators included key faculty from Geriatrics, Family Medicine and
Internal Medicine.
The retreat program includes an unfolding interactive surgical case divided into 3 modules following a geriatric patient from
Chief Residents increased their network of resources, including other Chief Residents and Program
Directors. presentation to the emergency department to hospital discharge. Each module includes evidence-based mini-lectures on topics in geriatrics, small group interactive exercises, and seminars designed to enhance teaching and leadership skills.
Each Chief Resident and Program Director also attended two or three consultation sessions to develop an action plan for a project.
Social events were planned to foster relationships across specialties. An opening cocktail hour, meals together, and a constant changing of the participants in workgroups allowed
Chief Residents and Program Directors to get to know each
This work was supported by a grant from the Donald W. Reynolds Foundation.
Copyright 2008, Trustees of Boston University

other by name and connect in ways other than by only brief moments of professional collaboration in the hospital.
A few sample Chief Resident projects include:

Dysphagia: Cross-disciplinary Diagnosis and Practical Management

Understanding the Complexities of Managing the Elderly Patient in the
Perioperative Setting

Prevention, Diagnosis and Management of Post-operative Delirium in ENT
Patients

Gait Assessment and Fall Risk in Elderly Patients with Neurological Disease

To incorporate evidence-based geriatrics bibliography to web-based references for
IM trainees
 To increase intern competence in the diagnosis and management of patients with dementia and delirium
CRIT provided an effective forum for increasing CR knowledge and confidence to teach about specific geriatric syndromes and practices, enhancing leadership and teaching skills, building confidence for work as a CR, and reinforcing the importance of multidisciplinary approaches to the care of older patients. In addition, Program Directors and faculty mentors indicated that:

Working together on an action plan relating to geriatrics with their CR(s) was a worthwhile experience

The projects that CRs selected were a good use of their time

Having PDs/faculty mentors and CRs together in small group case work was a good idea

CRIT enhanced PDs/faculty mentors knowledge of issues in geriatrics

Overall, CRIT was a worthwhile experience
Over the past three years, CRIT has provided an effective immediate forum for raising Chief Resident awareness of and interest in geriatrics issues, increasing knowledge about specific syndromes and practices related to geriatrics medicine, enhancing leadership and teaching skills while building confidence for work as a Chief Resident, and reinforcing the importance of multidisciplinary approaches in the care of older patients. It has also provided the opportunity for Chief
Residents, Program Directors, and geriatrics faculty to network with each other and lay the groundwork for multi- and interdisciplinary connections.
2008 Participants (pictured above) included 19 Chief
Residents, 4 Program Directors and 10 Program Faculty
This work was supported by a grant from the Donald W. Reynolds Foundation.
Copyright 2008, Trustees of Boston University