Medicine in the 21st century: recommended essential geriatrics competencies for internal medicine and family medicine residents.
Medicine in the 21st century: recommended essential geriatrics competencies for internal medicine and family medicine residents.
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DOI：
10.4300/jgme-d-10-00065.1
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发表时间：
2010-09-01
影响因子：
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通讯作者：
Leipzig, Rosanne M
中科院分区：
文献类型：
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作者：
Williams, Brent C;Warshaw, Gregg;Leipzig, Rosanne M
背景：医学研究所对医生队伍的预测要求加强对所有初级保健和专科医生的老年病学培训。确定内科和家庭医学住院医师的老年病学基本能力将改善对初级保健和专科医生的培训。这项研究的目标是(1)定义内科和家庭医学住院医师共同的基本老年医学能力，这些能力建立在为医学生建立的国家老年医学能力的基础上，在当前的住院医师计划中是可行的，是可评估的，并向研究生医学教育能力认证委员会提出建议；以及(2)让关键利益相关者组织参与其开发和实施。方法：通过小组会议和对100多名专家的调查确定初始候选能力，然后由来自关键专业组织的26名项目主任和住院医师临床教育人员进行详细的项目审查。在整个过程中，一个由8名成员组成的工作组进行了修订，以保持各能力之间的一致性和兼容性。结果：该过程确定了7个领域的26项能力：药物管理；认知、情感和行为健康；老年人的复杂或慢性疾病；姑息和临终关怀；医院患者安全；过渡护理；和动态护理。这些能力直接映射到医学生老年病学能力和6个医学研究生教育能力认证委员会。结论：通过包括领导层和关键利益相关组织成员在内的共识建立过程，已经制定了一套简明的内科和家庭医学住院医师的老年病学基本能力。这些能力与医疗保险支付咨询委员会最近提交给国会的一份报告中提出的对住院医师培训的关注很好地结合在一起。正在通过利益相关者组织开展工作，以传播和评估内科医学和家庭医学住院医师计划的能力。
BACKGROUND: Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation.METHODS: Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project.RESULTS: The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies.CONCLUSIONS: Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory Commission report to Congress. Work is underway through stakeholder organizations to disseminate and assess the competencies among internal medicine and family medicine residency programs.