Advanced Geriatrics Evaluation Skills.

BACKGROUND AND OBJECTIVES: Older adults are the fastest growing subset of the population and residency training in the basic concepts of care to the older adult is limited. We created a 1-day interactive training program, Advanced Geriatric Evaluation Skills (AGES), to upskill first-year primary care residents in the care of older adults. METHODS: An interprofessional faculty team developed and taught the IRB-approved course to a convenience sample of family medicine and internal medicine interns in 2017, 2018, and 2019. Topics addressed common geriatric presentations seen in the outpatient setting. The faculty provided useful tips and hints for successful workup, diagnosis, and treatment. RESULTS: Over the 3 years, 56 of the 135 (41%) first-year primary care residents participated. Residents reported that the course was well organized, relevant, and well taught, and they appreciated the dedicated time to focus on caring for older adults. During 2019, residents completed a pre- and posttest with 25 multiple-choice questions. The average score on the pretest was 76% and the average on the posttest was 88%. Ninety percent of the residents improved their score from the pre- to the posttest. CONCLUSIONS: The development of an AGES program provided a structured geriatric didactic curriculum for primary care residents. The course was well received by the residents, was reported to be relevant and timely, and resulted in increased knowledge in the care of older adults in the outpatient setting.

Content Analysis of Family Medicine Resident Peer Observations.

BACKGROUND AND OBJECTIVES: Direct observation is a critical part of assessing learners' achievement of the Accreditation Council for Graduate Medical Education (ACGME) Milestones and subcompetencies. Little research exists identifying the content of peer feedback among residents; this study explored the content of residents' peer assessments as they relate to ACGME Milestone subcompetencies in a family medicine residency program. METHODS: Using content from a mobile app-based observation tool (M3App), we examined resident peer observations recorded between June 2014 and November 2017, tabulating frequency of observation for each ACGME subcompetency and calculating the proportion of observations categorized under each subcompetency, as well as for each postgraduate year (PGY) class. We also coded each observation on three separate dimensions: "positive," "constructive," and "actionable." We used the χ2 test for independence, and estimated odds ratios and 95% confidence intervals for two-by-two comparisons to compare numbers of observations within each category. RESULTS: Our data include 886 peer observations made by 54 individual residents. The most frequently observed competencies were in patient care, communication, and professionalism (56%, 47%, and 38% of observations, respectively). Practice-based learning and improvement was observed least frequently (16% of observations). On average, 97.25% of the observations were positive, 85% were actionable, and 6% were constructive. CONCLUSIONS: When asked to review their peers, residents provide comments that are primarily positive and actionable. In addition, residents tend to provide more feedback on certain subcompetencies compared to others, suggesting that programs may rely on peer feedback for specific subcompetencies. Peers can provide perspective on the behaviors and skills of fellow residents.