The Donald W. Reynolds Foundation Geriatrics Education Program
In 2008, the Section of Geriatrics at the Wake Forest Baptist Medical Center was awarded nearly $2 million by the Donald W. Reynolds Foundation to implement a comprehensive program in geriatrics education for all levels of medical providers offering care to older adult patients. Since the program’s start, special training activities for medical students, residents, fellows, and faculty have been initiated with a goal of “gerontologizing” care provided throughout our institution.
“Our ultimate goal is to use this generous support from the Donald W. Reynolds Foundation to add meaningful geriatrics programs for all medical students and physician trainees,” said Hal Atkinson, Reynolds program director, internal medicine residency director, and associate professor of geriatrics. “Through this comprehensive program, we, along with our growing number of older patients, can be confident that all doctors in adult medicine trained at Wake Forest, regardless of specialty, will be able to put principles of geriatrics care into practice.”
Through the support of the Reynolds Foundation, all Wake Forest medical students in first and second year are exposed to geriatrics content in classwork. By second year, all students are also interviewing active older adults in the community about healthy aging and their experiences in the health care system. In third year, all students spend a week working with geriatricians, including time on the Acute Care for the Elderly (ACE) ward, in geriatrics clinics, and in long-term care facilities. Geriatrics content also is being integrated into other third-year rotations. In fourth year, students can take an elective in advanced inpatient management of geriatric patients or an ambulatory geriatrics elective.
All Internal Medicine (IM) interns complete a month-long ambulatory geriatrics rotation. Then all second-year IM residents complete a month on the ACE Unit and conduct chart audits and surveys of quality measures on their older continuity-clinic patients. A quality improvement project utilizing the data is completed in the third year of residency. Similarly, second-year Family Medicine residents complete a geriatrics rotation, including ACE Unit, clinic and nursing home experience. Family Medicine residents also collect data on their older continuity-clinic patients for a quality improvement project planned and executed in third year. Finally, the support and momentum of the Reynolds grant was leveraged to obtain funding for a Chief Resident Immersion Training program in geriatrics in 2009 through the Hartford Foundation, which was subsequently continued by a generous gift from a donor foundation in 2011 to support innovations in education in geriatrics throughout multiple specialties .
To build teaching collaborations in geriatrics throughout the medical center, Geriatrics works with faculty in other specialties and subspecialties to teach about issues affecting older hospitalized patients. Issues such as delirium, polypharmacy, pain management, cognitive and functional assessment, outcomes-based quality improvement, transitions of care, and palliative care are important not just to geriatricians but to all practitioners of adult medicine. Through the Reynolds program to date, Wake Forest faculty in general medicine, hospital medicine, oncology, nephrology, pulmonary/critical care, and emergency medicine have attended interactive training sessions in geriatric patient care and have committed to teach geriatrics content to their students and residents.
Geriatrics: Honoring Elders through Improved Health Care