Better Together: Promoting Geriatrics Education across Residency Specialties with a Pilot Peer Teaching Exchange

Trainees from to a range of specialties must learn to care for a growing cohort of older adults. Although the Accreditation Council for Graduate Medical Education requires internal and family medicine residencies to include formal training in geriatrics, many other residencies have no required geriatrics education. Moreover, geriatricians, whose patients frequently require coordinated teams of specialists, must collaborate and communicate with colleagues from many specialties. To address these needs at the trainee level, we created an innovative peer teaching collaboration.

Peer teaching, defined as “an educational arrangement in which one student teaches one or more fellow students,”¹ was shown to be noninferior to expert teaching,² with the added advantage of preparing trainees to step into the educator role.³ The cognitive congruence between teacher and learner may help facilitate learning because teachers with a similar knowledge base may more easily identify points of confusion for learners. Moreover, social congruence between teacher and learner promotes a collaborative environment, an advantage that fit our goal of promoting cross-specialty collaboration.⁴

We describe the design, implementation, and evaluation of a pilot peer teaching exchange in an urban academic center.

METHODS

We organized a peer teaching exchange between a geriatrics fellowship and four collaborating residencies. Our geriatrics fellowship assigned one to two fellows to teach sessions for participating residencies about geriatric medicine. In exchange, participating residencies assigned one to two senior trainees to teach geriatrics fellows about their specialties.

Recruitment

We invited specialties that care for a significant older adult population yet lack required geriatrics rotations to participate. One program declined for logistical reasons; dermatology, physical medicine and rehabilitation (PMR), anesthesiology, and interventional radiology (IR) joined the exchange.

Didactics Led by Geriatric Fellows for Specialty Residents

We created a needs assessment consisting of core geriatrics topics such as cognitive impairment, polypharmacy, advance care planning, and frailty to identify topics that specialty trainees felt were of interest and relevance to their specialty. Peer teachers individualized sessions for each participating residency based on survey results.

Didactics Led by Specialty Residents for Geriatric Fellows

Two of the authors reached out to the geriatrics fellows by e-mail to identify high-priority topics within each participating specialty. We communicated with the peer teachers from each program to share this information and help focus sessions on geriatric issues. A suggested session outline was provided to the peer teachers in advance.

The VA Boston Research and Development committee determined our project to be exempt from review by the institutional review board because it did not constitute human subjects research.

RESULTS

We organized four peer-led sessions taught by geriatrics fellows and four taught by specialty residents. A total of 40 trainees from dermatology, PMR, anesthesiology, and IR, collectively, and seven geriatrics fellows attended the sessions. An additional 23 trainees from a variety of programs (nurse residents, pharmacy residents, and internal medicine residents) who attend the geriatric fellowship didactics also participated. We collected preand postsurvey data on learner satisfaction and self-efficacy from trainees at the geriatrics didactics and open-ended written feedback on learner reactions from specialty residents.

Overall, 39 of 40 trainees who attended the sessions taught by the geriatrics fellows indicated that the talks were helpful. We collected qualitative feedback immediately after the session, asking participants to provide open-ended comments on the sessions and to identify new areas of learning. A total of 95% of participants provided written feedback, generating a total of 86 comments, summarized in Table 1. Of the new areas of learning identified (55 comments), frailty was most commonly mentioned (31 comments), followed by medication optimization (9 comments) and cognitive assessment (8 comments).

Table 1.

Qualitative Open-Ended Written Feedback from Specialty Residents Following Sessions Taught by Geriatrics Fellows

Themes	No. of comments	Examples
Reflections on healthcare needs of older adults
Sites of care	2	“Learned about description of different types of care facilities and what they can/cannot do.”
End-of-life care	5	“Described helpful ways to approach goals of care conversations.”
Multidisciplinary nature of geriatrics	5	“We need to continue working with multidisciplinary teams to improve our care of geriatric patients.”
Reflections on peer-led teaching modality
Comments on session quality and format	5	“I liked the two-speaker approach; it kept things interesting without derailing the topic.” “Good discussion. Next time, need a longer session.”
Expressions of gratitude	14	“Fantastic talk on very interesting topic. Love the interdisciplinary aspect of it.” “Thank you for coming to speak to us!”
Response to prompt, “What was one new thing you learned from this talk?”
Optimizing medications for older adults	9	“Concrete recommendations relevant to anesthesia practice (eg, meds that should be continued or avoided in peri-op period).” “Recommendations to simplify topical medication regimens in patients with cognitive impairment.”
Frailty	31	“Considering frailty prior to large procedures.” “Learning about how to quantify frailty was very helpful.” “The Frailty Index is a really useful idea.”
Assessing cognition	8	“Can use the Mini-Cog to identify patients at risk for cognitive impairment.”
Resources available to support older adults in the community	7	“Really appreciate resources we can use on our own to help evaluation/manage patients.” “Keep on giving helpful links and resources like Agency on Aging.”

Overall, 34 trainees attended the PMR, anesthesiology, and IR peer-taught sessions at the geriatrics didactics; 29 (85%) completed the preand postsurveys. We were unable to obtain survey data following the dermatology session. Interest in learning about participating specialties was high before and after the sessions. Learner self-efficacy in knowing when and how to consult with the participating specialties increased significantly following the sessions, with 23 of 29 (79%) of trainees indicating agreement or strong agreement that they understood when to consult with the participating specialties after the sessions, compared with 9 of 29 (31%) prior, and 25 of 29 (86%) indicating agreement or strong agreement that they understood how to communicate with the participating specialties after the sessions, compared with 10 of 29 (34%) prior.

DISCUSSION

We created a pilot peer teaching exchange to promote knowledge and collaboration between specialties at the trainee level by capitalizing on the social and cognitive congruence between teacher and learner inherent in peer teaching. To our knowledge, this project represents the first educational innovation of its kind in geriatric medical education. Although we piloted our peer teaching exchange in a large academic center, we believe it may be a useful teaching modality for community programs with smaller pool of faculty teachers, for whom trainee expertise represents a valuable and often underutilized resource.

Trainees expressed a high degree of satisfaction with the peer-taught sessions. Qualitative feedback from trainees following sessions taught by geriatrics fellows identified frailty as a topic of interest for learners. Similarly, geriatrics fellows demonstrated enthusiasm for learning about other specialties and improved self-efficacy in their ability to communicate effectively with these specialties following the sessions.

Our project has several limitations. It is a pilot innovation, currently in its first year, and it remains to be seen whether it will be sustainable, although we believe it will because of the strong interest in both medical education and interdisciplinary collaboration we encountered. In the pilot stages of this innovation, we collected data on learner attitudes and self-efficacy; next steps will involve assessing learner knowledge outcomes and commitment to effective and collaborative teamwork with specialty colleagues. Furthermore, our project was a short-term intervention, implemented at a single institution, involving a relatively small number of trainees; we therefore have limited data on whether this intervention will have a long-term impact on trainee attitudes and knowledge.

In conclusion, despite the limitations just described, we believe the peer teaching modality shows promise for improving the care of older adults by facilitating the exchange of knowledge between specialties and promoting collaboration and communication among trainees.