Gerontology & Geriatrics Education

ISSN: 0270-1960 (Print) 1545-3847 (Online) Journal homepage: http://www.tandfonline.com/loi/wgge20

Advancing Geriatric Education: Development of an Interprofessional Program for Health Care Faculty Channing R. Ford, Cynthia J. Brown, Patricia Sawyer, Angela G. Rothrock & Christine S. Ritchie To cite this article: Channing R. Ford, Cynthia J. Brown, Patricia Sawyer, Angela G. Rothrock & Christine S. Ritchie (2015) Advancing Geriatric Education: Development of an Interprofessional Program for Health Care Faculty, Gerontology & Geriatrics Education, 36:4, 365-383, DOI: 10.1080/02701960.2014.925889 To link to this article: http://dx.doi.org/10.1080/02701960.2014.925889

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Date: 05 November 2015, At: 17:57

Gerontology & Geriatrics Education, 36:365–383, 2015 Copyright © Taylor & Francis Group, LLC ISSN: 0270-1960 print/1545-3847 online DOI: 10.1080/02701960.2014.925889

Advancing Geriatric Education: Development of an Interprofessional Program for Health Care Faculty

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CHANNING R. FORD Department of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA

CYNTHIA J. BROWN Department of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham; and Birmingham Veterans Administration, Birmingham, Alabama, USA

PATRICIA SAWYER and ANGELA G. ROTHROCK Department of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA

CHRISTINE S. RITCHIE Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA

To improve the health care of older adults, a faculty development program was created to enhance geriatric knowledge. The University of Alabama at Birmingham (UAB) Geriatric Education Center leadership instituted a one-year, 36-hour curriculum focusing on older adults with complex health care needs. Content areas were chosen from the Institute of Medicine Transforming Health Care Quality report and a local needs assessment. Potential preceptors were identified and participant recruitment efforts began by contacting UAB department chairs of health care disciplines. This article describes the development of the program and its implementation over three cohorts of faculty scholars ( n = 41) representing 13 disciplines, from nine institutions of higher learning. Formative and summative evaluation showed program success in terms of positive faculty reports of the program, information gained, and expressed intent by each scholar to apply learned content to teaching and/or clinical practice. This article describes Address correspondence to Channing R. Ford, Department of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, CH19-201, 1720 2nd Avenue South, Birmingham, AL 35294-2041, USA. E-mail: [email protected] 365

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the initial framework and strategies guiding the development of a thriving interprofessional geriatric education program.

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KEYWORDS faculty development models, geriatric education curriculum, interdisciplinary education

The 2008 Institute of Medicine report, Retooling for an Aging America: Building the Health Care Workforce (Committee on the Future of Health Care Workforce for Older Americans [CoFHCWOA], 2008), called for more practitioners across the health care field to care for the older adult population. This call speaks to the increasing number of older adults with complex care needs who routinely access health care (Hooyman & Kayak, 2011). Moreover, it is anticipated that health care providers will soon be spending at least 50% of their time caring for older adults (Hooyman & Kayak, 2011). The general lack of geriatric training across multiple health care disciplines and the urgent need for a team approach to provide high quality care for the unique health care needs of older adults is essential to meet this demand (Mezey, Mitty, Burger, & McCallion, 2008). The health status of older adults results from biological, psychological, and social determinants best addressed by an interprofessional model of care. Older adults often have multiple and complex chronic conditions which require “attentive care” in addition to “cure.” Indeed, the central goal of geriatric medicine is to optimize function and quality of life in the presence of chronic disease and disabling conditions. An interprofessional approach is needed to expand the focus from biomedical care (Hooyman & Kayak, 2011) to all aspects of life and wellbeing. Geriatric training needs to incorporate gerontological (social and behavioral aspects) and geriatric (health care) aspects of aging to establish that aging is not a disease, but that older adults have unique health care needs (Halter et al., 2009). The need for a skilled workforce to care for our aging population (CoFHCWOA, 2008) requires routine geriatrics education for trainees and practicing providers in all health care professions. The deficit in geriatric training for physicians has been acknowledged for some time (O’Neill & Barry, 2003), though there has been less focus on the need for training and retraining of other health care professionals. It is projected that by 2030 not only would the proportion of geriatricians to older adults decrease, but also that all health professions would have an inadequate number of providers trained to care for an increasing older adult population (from 12% in 2005 to 20% in 2030; CoFHCWOA, 2008). At a time when the number of older adults accessing health care is steadily increasing, there has been minimal exposure to the subject matter of geriatrics and/or gerontology among faculty teaching nursing, social work, pharmacy, and other health-related professions (Mezey et al., 2008). Moreover, optimal geriatric care should have an interprofessional perspective (CoFHCWOA, 2008).

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Adequate training in geriatric issues, however, is not enough. The increasing number of older adults using the health care system is diverse, and many prefer to be treated by professionals of their own ethnic background (CoFHCWOA, 2008). Although the ideal health care setting would allow minority patients to be paired with health care providers of similar backgrounds, this is typically not possible. It is critical to sensitize faculty preceptors to issues of cultural competency that should be incorporated into geriatric health care in preparing the future health care workforce. Thus, an interprofessional faculty development program providing geriatric education that emphasizes the importance of cultural competency, health literacy, and related resources for integration into the classroom can, at the same time, lead to increased appreciation of the contributions of all participating health care professionals. This content, integrated into teaching curricula and/or the clinical practice of the faculty participants, will improve the geriatrics care provided by future health care professionals. It is not enough to train new faculty; faculty currently engaged in the education process need to immediately integrate appropriate geriatrics content into their existing curricula. This article describes the development of an interprofessional faculty development program designed to teach basic geriatrics principles as well as providing participant’s materials and resources that can be used in their own teaching endeavors.

PROGRAM OVERVIEW The Faculty Scholars Program sponsored by the University of Alabama at Birmingham Geriatric Education Center (UAB GEC) was initially designed as a 36-hour interprofessional faculty development program targeted at faculty with an interest in integrating aging into their teaching and clinical practice. The goals of the program were to provide Faculty Scholars with geriatrics knowledge, resources, and skills to enhance the training of future health care professionals. A required collaborative project with other Faculty Scholars representing multiple disciplines was designed to increase understanding of the inherently interprofessional approach to care of the older adult.

Development In 2007, GECs, funded by the Health Resources and Services Administration (HRSA), were encouraged to develop a 36-hour interprofessional faculty development program. The UAB GEC grant proposal laid the framework for such a program based on content areas identified in the Institute of Medicine Transforming Health Care Quality report (Adams & Corrigan, 2003). The content covered in the program included: advanced illness (e.g., organ failure, advanced cancer), frailty (e.g., falls, weight loss, mobility decline),

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care coordination (e.g., case management, institutional and communitybased long-term-care), symptom management, medication management, ethnogeriatrics, and health literacy/self-management (Adams & Corrigan, 2003). A GEC Leadership Team was established in the initial grant proposal and comprised the grant’s program director (a board-certified geriatrician), an associate director for program management (a psychologist with a certificate in aging studies), an associate director for evaluation (a sociologist with training in gerontology and evaluation), a program manager who was responsible for managing the day-to-day aspects of the grant, and an administrator who was responsible for financial and grants management aspects. After funding was awarded, the GEC Leadership team worked to implement the proposed program. This included reviewing the previously determined topics outlined above to ensure that appropriate instructors were identified, selecting appropriate evaluation strategies, and convening a steering committee. The steering committee comprised faculty from multiple health care disciplines (dentistry, medicine, nursing, nutrition, occupational therapy, physical therapy and social work) on the UAB campus was tasked with reviewing the proposed program and insuring that the curriculum would be interprofessional. Members of the steering committee identified and nominated a faculty member within their respective departments to participate in the inaugural cohort. After initial recruitment, faculty from the Department of Occupational Therapy asked to be included in the first cohort of scholars. A faculty representative from Occupational Therapy was invited to be on the UAB GEC Steering Committee. A single member of the GEC Leadership team was designated as program director and assigned to serve as the contact for all Faculty Scholars. The program director reported to the GEC Leadership on a regular basis to discuss any issues related to the program. Additionally, evaluation strategies and results were reviewed on an ongoing schedule. A checklist (and suggested timeframe) to implement the program is shown in Figure 1. Following the success of the first 2 years of the Faculty Scholars Program within UAB, the GEC Leadership invited faculty at other 4-year institutions of higher education in Alabama to participate. Contact information was obtained for appropriate departments from a review of community and 4-year college and university websites. Each department or division chair received a personalized e-mail describing the program and requesting nominations of potential Faculty Scholar candidates. To ensure that Faculty Scholars would have the time needed to participate in the program, department/division chair signatures were required on the application.

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FIGURE 1 Checklist for Faculty Scholars workshop (deadline in time prior to event).

METHOD Curriculum The program was designed to improve the knowledge, skills, and abilities related to geriatric health care, while teaching appreciation for the contributions an interprofessional health care team can provide to older adults with complex health care needs. All topic areas were presented using an interprofessional approach as well as consideration of health literacy and cultural competency.

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To ensure the Faculty Scholars Program met a level of proficiency, a competency-based curriculum was used as an organizing framework. This framework guided the selection of curriculum elements to ensure consistency, outcomes, and that the program’s responsiveness to societal demands (Frank et al., 2010). Five competencies were identified to prepare participating health care professionals to be able to (1) recognize and manage geriatric syndromes associated with advanced illness or frailty, (2) utilize behavioral interventions and pharmacological treatments to minimize disabling symptoms, (3) provide culturally and linguistically appropriate geriatric care, (4) arrange care so that older adults facing advanced illness can participate in treatment preferences and experience optimal quality of life, and (5) develop a patient-centered plan of care that is characterized by an integrated clinical environment and proactive delivery of evidence-based care. Competencies 1, 2, 4 and 5 were derived from A National Agenda for Geriatric Education: White Papers (U.S. Department of Health and Human Services, 1998), and Healthy People 2010 (U.S. Department of Health and Human Services, 2000), documents that were available during the development phase of the faculty development program and that were recommended as guiding documents by the granting agency. Competency 3 was a required component of the request for proposals for potential GEC programs. Rather than a diseasebased curriculum, it was decided to approach geriatric health care from a patient and family perspective, specifically targeting Institute of Medicine priority areas (Adams & Corrigan, 2003) as well as health care issues and experiences that patients and caregivers typically encounter. Thus, the topic selection included advanced illness, including multiple chronic conditions, frailty, symptom management, and medication management. The importance of health care teams and care coordination also were designated topics (see Table 1). Following participation in the program, Faculty Scholars were expected to identify approaches to integrate culturally and linguistically informed geriatric principles into their coursework and clinical programs. The curriculum was offered through in-person sessions and web-based selfstudy. All curriculum components were available to participants to use or adapt in the development of teaching lectures, modules, and courses. This included slide presentations, written materials, and copies of teaching games. To graduate from the program, participants (all cohorts) had to attend 75% of the in-person sessions and complete 80% of other curriculum elements. This included web-based self-study modules and contributing to conference presentations. Faculty Scholars unable to attend sessions were allowed to submit relevant attendance at seminars, conferences, or lectures to fulfill the program hour requirement. Because the first two cohorts were smaller (all faculty were from UAB), interactions with teaching presenters during the face-to-face teaching sessions were done as a single group or the group was ad hoc divided into two teams within each teaching session.

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Interprofessional Geriatric Education TABLE 1 Enrollment by Institution and Discipline

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Cohort

Institution

Completers Number (retention rate)

2008–2009

UAB

a

11

9 (82%)

2009–2010

UABa

8

6 (75%)

21

15 (71%)

2010–2011

Alabama A&Mb , Miles Collegec , Samford University, UAd , UABa , UAHe , USAf , UNAg

Discipline(s) Dentistry, family medicine, internal medicine, nursing, occupational therapy, physical therapy, psychology, social work Dentistry, family medicine, internal medicine, nursing, occupational therapy, physical therapy Cell biology, communication studies, emergency medicine, family medicine, nursing, nutrition, pharmacy, physical therapy, psychology, social work

Note: a University of Alabama at Birmingham. b Alabama Agricultural and Mechanical University. c Designated as an Historically Black College and University (HBCU). d University of Alabama, Tuscaloosa. e University of Alabama, Huntsville. f University of South Alabama. g University of North Alabama.

Voluntary teams were established for the production of class projects. Because the third cohort included more participants, faculty team assignments were made by the program director prior to the first session with the goal of having each team include faculty from multiple professions. The predetermined teams allowed even representation of the participating health care disciplines to create an interprofessional team for classroom assignments, development of class projects, and to establish relationships outside of the scholars’ institutions and disciplines. These teams were maintained throughout the year and established a team for scholars to rely on throughout their experience. Unlike prior years, the predetermined teams also allowed for consistency and an even distribution of work for the class projects, which had previously been a problem. Cohort 1 (2008–2009): Curriculum for the inaugural Faculty Scholars Program consisted of a minimum of 36 hours, taught over a one-year period. Five in-person 4-hour sessions were scheduled throughout the academic year for a total of 20 hours; eight additional 2-hour sessions were provided online as narrated PowerPoint presentations. Scholars were required to collaborate to develop and give two presentations at the Alabama Gerontological

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Society Annual Conference, cohosted that year by the UAB GEC. Although the availability of continuing education credit was not indicated in recruiting materials, all course content was submitted for discipline-specific accreditation. Due to accreditation restrictions, some scholars were unable to receive continuing education credit; the lack of continuing education credit did not affect faculty participation or enthusiasm. Cohort 2 (2009–2010): Feedback from Cohort 1 indicated that more frequent face-to-face interactions would enhance the experience. Therefore the quarterly half-day sessions were changed to monthly 2-hour workshops (22 hours). Additional program hours came from 10 self-study modules (12 hours), and the development of a conference presentation (2 hours). Attendance at the first annual UAB GEC Interprofessional Geriatric Education Conference (a 2-day seminar series focusing on educating health care professionals regarding how to care for older adults with complex health care needs) was encouraged as part of the course curriculum. Although the initial content areas were identified from the Institute of Medicine report (Adams & Corrigan, 2003), changes in topic and/or presentation format over the 3 years of the program were based on ongoing program participant feedback. Content for the 2nd year was modified based on the previous years’ evaluations. Although most of the geriatric-specific content was retained, there was a deemphasis on learning to use the online Blackboard platform (initially a larger part of the curriculum), and an inperson session was added on principles of adult learning and presentation methods. Additionally based on feedback regarding Personal Action Plans from Cohort 1, a teaching session on the purpose and implementation of Personal Action Plans was integrated into the orientation for the Cohort 2 program year. Another session presented group qualitative data collection techniques, nominal group theory, and focus groups. Narration for the online presentations was discontinued in response from feedback that the narrated component of the web-based modules did not provide additional value. Cohort 3 (2010–2011): In response to the state-wide expansion of participant recruitment, the in-person sessions were redesigned. In response to the comprehensive feedback from prior attendees, the revised curriculum offered maximum face-to-face exposure in fewer sessions. The new format also facilitated attendance by faculty members located throughout the state (up to 5 hours driving time) to minimize travel and the financial burden related to participation (hotel accommodations and expenses were the responsibility of the scholar). The third cohort met for three fullday sessions (21 hours), completed nine one-hour self-study modules, and attended the UAB GEC Interprofessional Geriatric Education Conference (minimum of 6 hours). All elements of the curriculum developed for Cohort 2 were retained. At the initial orientation session, scholars were assigned to one of three teams with the goal of diversity based on discipline and

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institution. These teams had the assignment of organizing team-focused classroom activities; additionally, each team was responsible for the development of a web-based peer-reviewed module for interprofessional continuing education. After identification of a geriatrics-focused topic, team members communicated outside of the in-person sessions to develop the content. Each team was tasked with developing an educational module that would reflect the multiple professions represented within each team and incorporate content presented related to cultural competency and health literacy. Modules were reviewed by an interprofessional editorial committee, finalized, and submitted for continuing education accreditation before being published online. These modules were made available through the Deep South Network sponsored by the UAB Office of Continuing Medical Education and the UAB GEC (average completion time of designed module is one hour).

Instructor Recruitment Prior to the inaugural cohort and again before the start date of subsequent cohorts, the GEC Leadership met to identify faculty with expertise in each content area of the curriculum. Each potential presenter met with members of the GEC Leadership individually before developing his or her curriculum to discuss topics that would be included and the presentation format. The day-long in-person sessions were to include multiple topic areas with each topic lasting between 1 and 1 1/2 hours, taught in an interactive, workshop format that would provide scholars the opportunity to work in interdisciplinary teams. Prior to presentation, the self-study modules were submitted to an interdisciplinary review committee comprising members from the UAB GEC Steering Committee. Reviewers assessed the modules to assure that the content was applicable to all participating disciplines and that principles of cultural competency and health literacy were integrated into the topic areas. Except for the GEC Leadership, all preceptors and reviewers volunteered their time as part of the service and educational commitment associated with their faculty appointments.

Scholar Recruitment Following the success of the program for the first two cohorts, the GEC Leadership decided to accept applications from scholars who represented from nontargeted disciplines such as cell biology and communication studies. We found that including these scholars enhanced the learning experience for all Faculty Scholars. As positive word of mouth increased, knowledge of the program expanded, and the GEC Leadership received requests from teaching and clinical faculty to extend the program to accept faculty at other Alabama institutions.

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To ensure that scholars received the support of their individual departments, the call for nominations was initially sent to each partnering division or department. As with the first two cohorts, department or division chairs received personalized e-mail invitations, which included recruitment materials outlining the program and requesting applicants from relevant health care disciplines. The program application clearly outlined the requirements of the experience and included in-person session dates, submission deadlines for the online curriculum, and reporting requirements during and following the experience. The first cohort of Faculty Scholars was recruited solely from UAB based on specific Steering Committee recommendations. Eleven applications were received and accepted (see Table 1). For the second cohort, the Steering Committee recommended specific faculty from UAB resulting in eight applications. All applications for Cohorts 1 and 2 were accepted and represented medicine, dentistry, nursing, occupational therapy, and physical therapy. With the extension of the program to 2- and 4-year institutions throughout the state for Cohort 3, 41 e-mails were sent to 11 colleges or universities, targeting nine health care disciplines (dentistry, medicine, nursing, nutrition, occupational therapy, pharmacy, physical therapy, psychology, and social work). Twenty-seven applications were received from eight institutions. A total of 21 Faculty Scholars were accepted; five from the hosting institution.

Evaluation Methods Evaluation targeted attitudes toward the training, knowledge gained, and intent to use materials in teaching and/or practice. Formative evaluation was used to assess program development with the goal of identifying effective instructors and preferred content. This was accomplished through quantitative analyses of instructor evaluations completed at the end of each teaching session. Qualitative data was also collected. Data were tabulated and a deidentified summary was provided to the instructors. All of these evaluations were reviewed by the UAB GEC Leadership and used to guide program changes for successive cohorts. Each topic evaluation was modeled after Kirkpatrick (Kirkpatrick & Kirkpatrick, 2006) to assess level 2—knowledge gained and level 3—behavioral change. Each individual in-person and selfstudy module included topical pre- and posttests developed by the faculty presenter as relevant to their component of the curriculum. Scholars evaluated the amount of new material presented and how likely they were to integrate the material into teaching and/or practice. At the start of each year, Faculty Scholars were asked to develop a Personal Action Plan to identify individualized goals and desired outcomes from program participation. Action plans were reviewed on a quarterly basis during the year. For Cohort 1, focus groups were held midway through the year and after program completion to ask Scholars to evaluate strengths

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and limitations of the program and offer suggestions for changes for successive scholar groups. Focus group participants indicated that they desired additional information about the program at orientation and that they had particular difficulty setting goals and tracking outcomes for their Personal Action Plans. The final in-person session for Cohorts 2 and 3 included a presentation explaining the way to conduct a nominal group session and instructions on conducting focus groups. During this session, the Faculty Scholars themselves participated in an informal focus group to discuss positive and negative aspects of their experience as Faculty Scholars. Evaluation for the third cohort included the measures collected above as well as an additional outcome measure of participation on the modules of interprofessional continuing education. The evaluation form was revised so that Faculty Scholars could indicate separately application of material to teaching and practice because individual Faculty Scholars may not have participated in both activities. The UAB Institutional Review Board approved the study protocol.

RESULTS Table 1 shows enrollment for each of the 3 years of the program. Table 2 provides an overview of classroom content areas presented each year, and the number of attendees for each session. Participants were asked to indicate how much of the material presented was new to them, and Table 2 shows the percent that indicated that 50% or more material was new.

Participation and Retention Participation during the first year of the program was regular, with one participant withdrawing as a result of leaving the university. Based on feedback from the focus group held at the end of Cohort 1, the in-person session’s format was changed to monthly, shorter sessions for Cohort 2. However this resulted in intermittent attendance with participants often arriving late. Program retention is indicated in Table 1. Following notification of selection as a Faculty Scholar, the program director maintained e-mail contact with all participants and tracked attendance and completion of modules. All scholars were encouraged to communicate directly with the program director in regard to any aspect of the program. The program director supervised the administrative tasks associated with the program including tracking curriculum development and delivery, continuing education accreditation, evaluation, and mentoring.

Focus Group Feedback Many of the changes below are a result of the feedback from the focus group. Faculty Scholars expressed concerns regarding the Personal Action

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TABLE 2 Classroom Courses: Competency Addressed and % New Material (N = 38 scholars over 3 cohorts)

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Topic Advanced illness Advanced illness/symptom management Care coordination I Care coordination II Cultural competency I Cultural competency II Ethical issues Frailty Health literacy I Health literacy II Learning/teaching tools Medication management Online teaching Patient safety Presentation innovations Symptom management Using blackboard

Years offered

Total attendees

Competency addresseda

2 1

18 9

1, 3 1, 2, 3

2 2 3 2 1 3 3 2 2 3 1 2 1 1 1

19 21 31 22 12 23 31 18 19 22 10 7 10 5 10

2, 3, 2, 3, 3 3 3, 4 1, 2, 3, 5 3, 5 N/A 1, 2, N/A 2, 3, 1, 2, 1, 2, N/A

4, 5 4, 5

4

3, 4 5 3, 4, 5 3

50% + new materialb combined cohorts 1, 2, 3 89% 89% 79% 71% 71% 69% 67% 65% 96% 67% 100% 59% 60% 86% 80% 60% 90%

Note: a Competencies: (1) recognize and manage geriatric syndromes associated with advanced illness or frailty, (2) utilize behavioral interventions and pharmacological treatments to minimize disabling symptoms, (3) provide culturally and linguistically appropriate geriatric care, (4) arrange care so that older adults facing advanced illness can participate in treatment preferences and experience optimal quality of life, and (5) develop a patient-centered plan of care that is characterized by an integrated clinical environment and proactive delivery of evidence-based care b The percent represents the number of participants who indicated that 50%, 75%, or 100% of the material presented was new content.

Plans but they felt the exercise was valuable. They suggested that one-onone meetings with the program director would be helpful for communicating expectations and welcoming scholars into the GEC community. Overall, each cohort of Faculty Scholars reported enthusiasm about the opportunity to work with other disciplines and emphasized their enjoyment of the casebased classroom exercises.

Curriculum Changes Table 2 shows the courses offered, the competency addressed by each, and reflects changes in the curriculum over 3 years. In addition to content changes, specific instructions for developing Personal Action Plans were provided. The revised Personal Action Plan asked scholars to outline three program objectives as well as methods they would use to implement course content into teaching and/or clinical practice. Faculty Scholars were asked to identify barriers to goal implementation.

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Table 2 also shows how participants rated the novelty of the material presented during classroom sessions. A majority of Faculty Scholars indicated that at least one half of the content was new material (range 59% – 100% of participants). Table 2 also indicates the linking between competencies and topics. The sessions focusing on teaching methods, incorporated examples from topical areas previously presented, but were not specifically linked to the five core competencies. The intent to integrate material into teaching or practice is shown in Table 3. Due to the diversity of the Faculty Scholar cohorts, we determined that teaching and clinical application needed to be assessed separately. Members of Cohort 3 with clinical responsibilities indicated that 72% to 100% would apply the material presented to clinical practice; of participants with teaching roles, 82% to 100% indicated the intent to use in a teaching setting. Table 4 indicates the impact of the program through spring 2013 in terms of certificates awarded, Faculty Scholars who reported developing or enhancing curricula, new professional roles, presentations, and new programs that resulted from the program. Not on the table is the continued collaboration of three alumnae from the first cohort (dentistry, internal medicine, and occupational therapy) who established a new clinical training site for their students TABLE 3 Classroom Courses: Intent to Apply to Teaching or Practice Utilization intention

Topic Advanced illness Advanced Illness/symptom Management Care coordination I Care coordination II Cultural competency I Cultural competency II Ethical issues Frailty Health literacy I Health literacy II Learning/teaching tools Medication management On-line teaching Patient safety Presentation innovations Symptom management Using blackboard

Teaching or clinical applicability likely or very likelya Cohort 1 & 2

Clinical applicability likely or very likelya Cohort 3

Teaching applicability likely or very likelya Cohort 3

5/6 7/9

11/11

1/1

− 7/10 12/15 − − 4/7 5/5 3/6 8/8 6/10 9/10 3/7 10/10 2/5 10/10

11/11 9/10 11/11 9/9 8/11 13/13 13/13 10/10 10/11 11/11 − − − − −

14/14 10/12 2/2 11/11 10/12 4/4 16/16 12/12 9/11 12/12 − − − − −

Note: a The denominator indicates the number of Faculty Scholars responding to the question and the numerator those who indicated that they were likely or very likely to integrate the materials.

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TABLE 4 Outcomes of the Faculty Development Program

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Activity Certificates awarded Curricula development New or enhanced academic curriculum New or enhanced professional curriculum New professional geriatric roles Editorial board members GEC steering committee members Instructors for Faculty Scholars Program Resident rotation preceptors Presentations Community provider learning experiences Presentations at Interprofessional Geriatric Education Conference New programs developed Interprofessional clinical experience Interprofessional Geriatric Education Modules (online) Interdisciplinary team training

Number of scholars (N = 41)a

Estimated units

Persons affected

30





29 11

Not available Not available

725b 275b

6 7 6 5

20 − 17 6

3,720 − 74 40

10

18

405

12

23

1,127

6 10

69 3

470 935

9

6

1301

a

Note: The 41 includes all participants including those that did not graduate from the program. b Estimate is based on average class size of 25 students and one course per scholar.

at a local long-term care facility. The collaboration also resulted in the establishment of an oral health clinic (one of two in the country) at the long-term care facility. Former Faculty Scholars Program participants formed an alumni group and have remained involved in GEC activities. Previous Faculty Scholars have also been instrumental in the recruitment of future scholar cohorts and with the expansion of the offered curriculum.

DISCUSSION It has long been understood that one of the chief barriers to geriatric education is the limited number of faculty trained to educate future health care professionals (CoFHCWOA, 2008). Therefore training current health care professionals has immediate and long-term impacts. Although demographers have consistently described the impact of the aging baby boomers on U.S. health care, there have been a limited number of training opportunities to prepare the workforce who will provide their care. The Robert Wood Johnson Foundation (RWJF), the John A. Hartford Foundation, the Health Resources and Services Administration (HRSA), and the Donald W. Reynolds Foundation have provided select opportunities for

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additional training in geriatrics. The RWJF has funded several grants to persons working with the older adult population. However, at the inception of the Faculty Scholars Program, these grants typically focused on improving health care systems and not on preparing faculty educators to educate future health care professionals (Robert Wood Johnson Foundation, n.d.). The Hartford Foundation sponsors several training programs including the Hartford Centers of Excellence, the Hartford Geriatric Social Work Faculty Scholars Program, and the Hartford Center of Gerontological Nursing Excellence. These programs focus on developing leaders through training faculty from geriatric medicine, psychiatry, nursing, and social work; however many of the programs are unidisciplinary. The goal of these programs is primarily to educate faculty about how to conduct research and provide mentoring opportunities in conjunction with additional education in geriatric medicine (CoFHCWOA, 2008). Hartford Centers of Excellence training programs focus on preparing academicians in geriatric medicine, psychiatry, nursing and social work to conduct research and improve clinical teaching (CoFHCWOA, 2008), whereas the Hartford Geriatric Social Work Faculty Scholars Program provides support for potential leaders in geriatric social work (CoFHCWOA, 2008). The Hartford Foundation has also provided significant funding for Centers of Gerontological Nursing Excellence to support the preparation of nursing faculty to train future nurses about caring for older adults (The John A. Hartford Foundation, n.d.). The Hartford Foundation also initiated the Geriatric Interdisciplinary Team Training (GITT) program in 1995, which continues to provide resources to encourage the implementation of geriatric team training into clinical settings (The John A. Hartford Foundation, n.d.). HRSA has provided a number of opportunities for faculty wanting to better prepare themselves for educating the future workforce. Through their Geriatric Academic Career Awards (GACAs), junior faculty received support to enhance teaching skills. The Geriatric Training for Physicians, Dentists and Behavioral/Mental Health Professions Program provides resources for postgraduate training to prepare faculty to teach geriatrics curriculum (CoFHCWOA, 2008). Geriatric Education Centers are funded to support the training of faculty, health professions trainees and practicing health care professionals. This includes the development of geriatric curriculum to enhance training of current and future health care providers working with the older adult population. These training opportunities are interprofessional, represent multiple health care disciplines, and encourage collaborations among schools of health professions and health care facilities (CoFHCWOA, 2008). Lastly, the Donald W. Reynolds Foundation has provided a number of grants to academic health care centers to further the training of physicians in geriatric medicine (CoFHCWOA, 2008). These opportunities provided training for faculty educators; however, they were limited to specific disciplines and did not emphasize

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interprofessional education or learning in interprofessional teams. A costefficient way to prepare the future workforce is to train or retrain the teaching faculty in the principles of interprofessional geriatric health care. The interprofessional health care team approach leads to a stronger “continuity and quality of care, improved health outcomes, and lower costs” (Partnership for Health in Aging, 2011, p. 2). An interprofessional program, bringing together faculty representing all aspects of health care provision, has the potential to increase understanding of the multifaceted nature of health care of older adults, particularly those with multiple chronic conditions. The interaction between these disciplines shows the complex and integrative nature in maintaining function for older adults at risk for adverse health outcomes. The team approach to care, including the adaptive and compensatory behaviors to maintain independence, is fostered by the shared learning experience. Although an initial needs assessment was integral in designing the program, feedback and suggestions from scholars have improved the program. We have found that in-person interaction over a full day bonds faculty and enhances the interprofessional sharing that can then be maintained between sessions. Our instructors have found it rewarding to work with faculty dedicated to improving the health care provided to older adults. The importance of a designated program director cannot be understated. The program director serves as the link between the participants (current and past Faculty Scholars), GEC Leadership, and the day-to-day activities of the program. We estimate that adaptation and integration of curriculum elements resulted in Faculty Scholars teaching geriatrics content to more than 1,000 students at universities across the state (see Table 4). This estimate does not take into account the impact the Faculty Scholars’ increased knowledge has had on practicing professionals they interact with on a daily basis. It has been rewarding to have Faculty Scholars as partners with the GEC Leadership to continue their personal training and to develop new educational opportunities for the students they teach.

Limitations Recruiting for Cohort 2 of the Faculty Scholars Program proved to be problematic, primarily due to use of the same procedure utilized for the initial cohort, which was limited to nominees identified by members of the GEC Steering Committee. When recruiting for Cohort 2, members of the GEC Steering Committee struggled to identify nominees from their various departments and divisions, which resulted in a smaller cohort. As a result, the GEC Leadership determined that expansion outside the host university was essential to recruiting an adequate number of diverse participants for Cohort 3.

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Other challenges included participant retention. As discussed in the participant retention section of this article, we had sporadic attendance at the monthly sessions for Cohort 2. We determined that though Cohort 1 would have preferred more opportunities to meet over the course of the year this was not feasible for scholars’ calendars. Going from five sessions to 11 sessions proved to be an obstacle. Therefore the curriculum was revised to three all-day sessions for Cohort 3. This change in delivery worked effectively for the third cohort. However there were challenges for Cohort 3 in completing the off-site requirements, possibly due to the number of scholars from other universities. This may have resulted in a sense of isolation and reduced urgency to complete the self-study elements. Lastly, a minor limitation was our decision to not digitally record the focus group sessions. We feel that the feedback was more freely given because sessions were not recorded. Although we utilized note-takers for these sessions, a recording of the session would have allowed us to rereview the feedback.

Lessons Learned The GEC Leadership found that program elements had to be continually revisited throughout the program year. By the end of Cohort 1, we had revised the curriculum to remove some of the elements that had been suggested by GEC Steering Committee members as helpful resources for their faculty (i.e., Using Blackboard, Online Teaching). These topics were replaced with content that previous scholars indicated they would have preferred (i.e., Ethical Issues). We also determined that instructors should be provided a variety of dates to give their presentation prior to the start of the program year. This was essential for instructor retention, especially as they were donating their time to the program. Following the initial year, we found that the program director needed to dedicate more time for interaction with individual Faculty Scholars. Providing reminders regarding deadlines, upcoming sessions, and so on, was not sufficient to encourage program completion. The Program Director was needed to serve as a conduit for off-line feedback, resource suggestions, and as a sounding board for ideas, potential partnering opportunities and scholarship development.

CONCLUSION In conclusion, the first three cohorts of the Faculty Scholars Program have helped us create a sustainable program for faculty development. We have found that a faculty development program in geriatrics can be an effective tool for curricular change to introduce the care of the complex older adult

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into existing classes, and the impact of the program extends well beyond the scholar participants. The strategies outlined in this article demonstrate the initial framework to develop a thriving and cost-effective program. Yet we have learned that following the initial needs assessment and curricular plan, ongoing evaluation is needed to implement timely content and optimize the learning experience.

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FUNDING The authors, Ms. Ford, Drs. Brown, Sawyer and Rothrock received support from the Health Resources and Services Administration (HRSA) funded Geriatric Education Center grant (UB4HP19045). Dr. Ritchie was previously supported by the HRSA-funded Geriatric Education Center grant while at the University of Alabama at Birmingham. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the funding agency.

REFERENCES Adams, K., & Corrigan J. M., with the Committee on Identifying Priority Areas for Quality Improvement. (Eds.). (2003). Priority areas for national action: Transforming health care quality. Washington, DC: National Academies Press. Committee on the Future Health Care Workforce for Older Americans (CoFHCWOA). (2008). Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: Institute of Medicine, National Academies Press. Frank, J. R., Mungroo, R., Ahmad, Y., Wang, M., De Rossi, S., & Horsley, T. (2010). Toward a definition of competency-based education in medicine: A systematic review of published definitions. Medical Teacher, 32, 631–637. Halter, J., Ouslander, J., Tinetti, M., Studenski, S., High, K., Asthana, S., & Hazzard, W. (2009). Hazzard’s geriatric medicine and geronology (6th ed.). New York, NY: McGraw-Hill. Hooyman, N. R., & Kayak, H. A. (2011). Social gerontology: A multidisciplinary perspective (9th ed.). Boston, MA: Allyn and Bacon. The John A. Hartford Foundation. (n.d.). Working to improve the health of older Americans. Retrieved from http://www.jhartfound.org. Kirkpatrick, D. L., & Kirkpatrick, J. D. (2006). Evaluating training programs (3rd ed.). San Francisco, CA: Berrett-Koehler Publishers. Mezey, M., Mitty, E., Burger, S. G., & McCallion, P. (2008). Healthcare professional training: A comparison of geriatric competencies. Journal of the American Geriatrics Society, 56(9), 1724–1729. O’Neill, G. O., & Barry, P. P. (2003). Training physicians in geriatric care: Responding to critical need. National Academy on Aging Society Public Policy and Aging Report, 13(2), 17–21.

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Partnership for Health in Aging. (2011). Position statement on interdisciplinary team training in geriatrics: An essential component of quality healthcare for older adults. Retrieved from www.americangeriatrics.org/pha. Robert Wood Johnson Foundation. (n.d.). Grants: Programs & initiatives. Retrieved from http://www.rwjf.org/en/about-rwjf.html. U.S. Department of Health and Human Services. (1998). A national agenda for geriatric education: White papers (3rd printing). Rockville, Maryland: U.S. Government Printing Office. U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and improving health (2nd ed.). Washington, DC: U.S. Government Printing Office.

Advancing geriatric education: development of an interprofessional program for health care faculty.

To improve the health care of older adults, a faculty development program was created to enhance geriatric knowledge. The University of Alabama at Bir...
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