Staying in the game: the 10-step approach to sustaining geriatrics education in hospitalists and subspecialty providers.

Geriatrics as a field has been fortunate to have the support of several philanthropic organizations to advance geriatrics education and training in the past two decades. Awardees of such grants were presented with unparalleled opportunities to develop new and innovative educational initiatives affecting learners at multiple levels and in multiple disciplines and specialties. The lessons learned from the Donald W. Reynolds Foundation initiatives about effect and sustainability are invaluable to the ongoing strategic development of geriatrics nationally. This article highlights successful educational initiatives developed at four institutions with past and current Donald W. Reynolds Foundation funding. Following an ice hockey playbook, this article identifies 10 strategies and initiatives to "stay in the geriatrics game" by training hospitalists and subspecialty providers. The authors' collective experience suggests that geriatrics educational initiatives can not only influence provider education, but also improve the care of older adults in multiple settings.

The unknown profession: a geriatrician.

The term "plastic surgeon" is oddly uninformative, although it seems likely that most people know what plastic surgeons do. How well can a sample of individuals encountered on the street describe what geriatricians do? To answer this question, we strolled through downtown Baltimore's Inner Harbor, armed with a video camera and picture identification cards to ask the following question: "What is a geriatrician?" Two of us (PA, JY), from the Johns Hopkins Division of Geriatric Medicine and Gerontology, surveyed a convenience sample of people aged 18-80. To further enhance this survey, a video of the interviews was produced (available in online version of article). We entered this exercise having recently joined the ranks of geriatricians-prepared to improve the health and quality of care of our elderly patients. Our naive excitement at entering this noble specialty was trampled by the reality that virtually no one we interviewed knew what a geriatrician was. Answers like, "somebody who works for Ben and Jerry's ice cream" were amusing but at the same time typical and sobering. This simple survey reveals a distressing gap in the public's knowledge of the field of geriatrics and the need for better understanding of its importance to public health and individual health. After all, if people do not know what a geriatrician is, how can they support the growth of geriatrics or seek care from us?

A qualitative and quantitative needs assessment of pain management for hospitalized orthopedic patients.

Despite advances in pain management, little formal teaching is given to practitioners and nurses in its use for postoperative orthopedic patients. The goal of our study was to determine the educational needs for orthopedic pain management of our residents, nurses, and physical therapists using a quantitative and qualitative assessment. The needs analysis was conducted in a 10-bed orthopedic unit at a teaching hospital and included a survey given to 20 orthopedic residents, 9 nurses, and 6 physical therapists, followed by focus groups addressing barriers to pain control and knowledge of pain management. Key challenges for nurses included not always having breakthrough pain medication orders and the gap in pain management between cessation of patient-controlled analgesia and ordering and administering oral medications. Key challenges for orthopedic residents included treating pain in patients with a history of substance abuse, assessing pain, and determining when to use long-acting vs short-acting opioids. Focus group assessments revealed a lack of training in pain management and the need for better coordination of care between nurses and practitioners and improved education about special needs groups (the elderly and those with substance abuse issues). This needs assessment showed that orthopedic residents and nurses receive little formal education on pain management, despite having to address pain on a daily basis. This information will be used to develop an educational program to improve pain management for postoperative orthopedic patients. An integrated educational program with orthopedic residents, nurses, and physical therapists would promote understanding of issues for each discipline.