After the end of World War II in 1945, American soldiers came home and started families. Between the years of 1946-1964, millions of babies were born and they became known as the “baby boomer” generation. Today Americans feel the reverberations of this generation as the group ages into retirement and beyond.

“Today more than 13 percent of the population is over the age of 65 and as a country, we have a shortage of geriatricians,” says Sharon Levine, MD, Geriatrics. “We will never have enough specialists to care for older adults, so there is an overwhelming need to ‘geriatricize’ the other medical specialty areas.”

Older adults typically present complex medical challenges for any care provider as there are usually multiple health issues involved, which can often mean a variety of medications to manage. There also are unique challenges in their personal lives, such as caring for an aging spouse or living alone. This complexity, combined with the shortage of medical specialists who are trained specifically to address these issues, creates a gap and results in a significant number of older people who do not receive adequate care.

To address this gap, Levine spearheaded the Chief Resident Immersion Training (CRIT) in the Care of Older Adults program at BMC. The program brings rising chief residents to an intensive, two-day retreat to discuss common challenges in caring for older adults, enhance their knowledge and create awareness of geriatric issues. The program, held in May, attracted 15 rising chief residents and two fellows as participants.

“An unintended, yet positive effect of the program is the bonds formed between participating residents, who might never have had an opportunity otherwise to meet face to face,” says Levine. “By bringing the residents together from a variety of different specialties through the shared experience of this program, it does wonders to foster collegiality between disciplines, improving care for all patients.”

The program, which has been replicated at 33 institutions nationwide, includes an unfolding interactive case divided into three modules: following a geriatric patient from presentation in clinic, following the patient through his hospital stay, and his discharge. Each module includes evidence-based mini-lectures on topics in geriatrics, group exercises and seminars designed to enhance teaching and leadership skills. Together with their faculty mentor, each chief resident develops an action project related to geriatric care s/he can complete during their chief residency year. These projects, aligned with Graduate Medical Education-mandated quality improvement initiatives, support the hospital in meeting goals around quality improvement, patient safety, transitions of care and other key focus areas.

Jolion McGreevy, MD, MBE, MPH, a chief resident in emergency medicine at BMC and member of the hospital ethics committee, participated in this year’s CRIT program. He worked with his advisor to devise a training program in BMC’s Alan D. Solomont & Susan Lewis Solomont Clinical Simulation and Nursing Education Center that explores end-of-life care for patients in the Emergency Department. While the program is not yet finalized, participants will work in different stations, each presenting different scenarios typical in an ED, such as a patient from a nursing home with unclear advance directives or a patient accompanied by their family receiving a catastrophic diagnosis, complete with mock-patient encounters.

“In the Emergency Department, we get a lot of complex scenarios where it can be difficult to know how to move forward with end-of-life care. The goal is to make the culture in the ED more conducive to end-of-life discussions, similar to how it is in intensive care,” says McGreevy. “By opening these lines of interdisciplinary communication in an educational environment, we will establish best practices that will improve patient care.”

There are many projects descended from the CRIT program, spanning from procedural to educational like McGreevy’s, that have been implemented as a standard in caring for older adult patients at BMC. The award-winning CRIT program, now in its tenth year, was first funded by the Hartford Foundation and is currently funded by the Donald W. Reynolds Foundations and the Hearst Foundations through the spring of 2015. Due to the overwhelmingly positive outcomes resulting from the program, going forward Levine says she will focus on methods to sustain the program indefinitely, citing the importance of being prepared for the prevalence of retirement-aged baby boomers.

“Most doctors, no matter what specialty, will be taking care of older adult patients,” concludes Levine. “It takes a village.”

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Boston Medical Center

Originally Posted: July 1, 2014

Appears on: The BMC Brief, Volume 3, Issue 10

The BMC Brief is a monthly staff e-newsletter that highlights staff and department happenings, research breakthroughs, clinical care, and strategic initiatives. This story highlights an innovative program unique to BMC that has since spread to other institutions across the nation. This demonstrates my ability to write an informative feature story for a general audience.