Characteristics of patients referred for assessment of decision-making capacity in the acute medical setting of an outer-metropolitan hospital-A retrospective case series.

OBJECTIVE: To identify characteristics of older people referred for assessment of decision-making capacity in the acute hospital setting. METHODS: A retrospective chart audit was undertaken for 98 consecutive medical inpatients referred for capacity assessments between February 2015 and August 2017 in an outer-metropolitan hospital. The data were analysed using descriptive and univariate analysis. RESULTS: In this case series, 56% of patients had a diagnosis of dementia. Social isolation was common; 70% were not presently married, and 63% had no community services. For 90% of patients, the referral was to determine the person's capacity to make their own accommodation decisions-usually to return home on discharge. Of those with impaired capacity, 54% were discharged to residential aged care, whilst most who retained capacity were discharged home (73%). Those with impaired capacity were more likely to have a diagnosis of dementia and a prolonged length of stay (both P < 0.001).

Objective structured clinical examination as a novel tool in inflammatory bowel disease fellowship education.

BACKGROUND: Experiential learning in medical education, as exemplified by objective structured clinical examinations (OSCEs), is a well-validated approach for improving trainee performance. Furthermore, the Accreditation Council for Graduate Medical Education has identified OSCEs as an ideal method for assessing the core competency of interpersonal and communication skills. Here, we describe a novel educational tool, the inflammatory bowel disease OSCE (IBD OSCE), to assess and improve this clinical skill set in Gastroenterology fellows. METHODS: We developed a 4-station IBD OSCE that assessed shared decision making, physician-physician communication, and physician-patient consultative skills specifically related to the care of patients with IBD. Each station was videotaped and observed live by faculty gastroenterologists. Behaviorally anchored checklists were scored independently by a faculty observer and the standardized patient/physician, who both provided feedback to the fellow immediately after each case. Post-OSCE, fellows attended a debriefing session on patient communication and were surveyed to assess their perspective on the examination's educational value. RESULTS: Twelve second-year gastroenterology fellows from 5 fellowship programs participated in the IBD OSCE. Fellows performed well in all measured domains and rated the experience highly for its educational value. Fellows cited IBD as an area of relative deficiency in their education compared with other knowledge areas within gastroenterology. CONCLUSIONS: To our knowledge, this is the first OSCE designed specifically for the evaluation of skills as they relate to IBD management. Using OSCEs for IBD education provides an opportunity to robustly assess core competencies and the role of the physician as an educator.

The Rowland Universal Dementia Assessment Scale (RUDAS) as a reliable screening tool for dementia when administered via videoconferencing in elderly post-acute hospital patients.

The Rowland Universal Dementia Assessment Scale (RUDAS) is a six-domain screening tool for dementia. We measured the practicality and reliability of administering the RUDAS in a telemedicine setting. Inpatients were recruited from a Geriatric and Rehabilitation Unit. Each patient was administered the RUDAS both face-to-face (FTF) and via videoconferencing (VC). The assessment format (FTF or VC) and the allocation of doctor (Doctor 1 or Doctor 2) to format were randomized. Scores from each assessment format were compared. The outcome of no difference was decided based on a difference in mean of no more than ± one point. Percentage agreement (agreement being ±2 points) was calculated on individual test scores. Forty-two patients (average age 75 years) completed the two assessments. Their mean Mini-Mental State Examination (MMSE) score was 24.7 (range 10-30). The mean RUDAS score for both FTF and VC assessment was 24.9 (difference between the means 0.04), i.e. there was no significant difference. The results suggest that the RUDAS can be reliably administered via VC in post acute patients as an alternative to FTF administration.