READINGS IN GERIATRIC PSYCHIATRY: A QUALITATIVE RETROSPECTIVE ANALYSIS OF A STRUCTURED LITERATURE REVIEW COURSE

Introduction At our institution, psychiatric interns rotate for two months on the inpatient geriatric psychiatry unit. During this rotation, they are expected to provide high quality care for geriatric patients with a wide range of diagnoses as well as co-morbid medical and neurologic illnesses and to attend to any accompanying family or psychosocial issues. Internal surveys conducted by resident leadership at our institution discovered that interns and residents often found inpatient rotations to be of relatively low educational yield citing high clinical burden and limited structured time for teaching/didactics as some of the core contributors to this concern. Similarly, residents voiced frustration with not understanding the evidence base for choices made during teaching rounds and did not feel equipped to manage interactions with patients and families that involved communicating the evidence base for the clinical decisions involved in the care of their patients. In an attempt to address this, a structured didactic/reading curriculum was constructed with assistance from the inpatient geriatric psychiatry attendings and the program director. This curriculum included selected readings from the literature on topics determined to be pertinent to the patient population generally admitted to our unit including delirium, diagnosis and management of various neurocognitive disorders, and continuation/maintenance treatment after an index course of electroconvulsive therapy. This reading curriculum was distributed to the interns and an hour per week was dedicated to going through the readings in a critical fashion. Methods To determine the impact of the curriculum, a qualitative survey was constructed and administered to two classes of residents at our institution in a retrospective cohort fashion. These two classes, current PGY2s and PGY3s, did and did not have access to the curriculum respectively during their intern years and the PGY2 class served as the "active" group whereas the PGY3 class served as the "control" group. It was the hypothesis that the curriculum would result in a greater subjective confidence in the active group as opposed to the control group in providing evidence based care to geriatric patients with a range of diagnoses discussed in the readings as well as while discussing treatment options with the family of geriatric patients. The survey questions are as follows: 1. Before the rotation, rate your level of confidence in recognizing and responding to delirium in older adults 2. After the rotation, rate your level of confidence in recognizing and responding to delirium in older adults 3. Before the rotation, rate your level of confidence in recognizing and responding to the neuropsychiatric symptoms of various dementias (e.g. Alzheimer's disease, Lewy body dementia, Parkinson's disease dementia, and rapidly progressive dementias) 4. After the rotation, rate your level of confidence in recognizing and responding to the neuropsychiatric symptoms of various dementias (e.g. Alzheimer's disease, Lewy body dementia, Parkinson's disease dementia, and rapidly progressive dementias) 5. Before the rotation, rate your level of confidence in prescribing continuation and maintenance treatment for patients who have achieved response or remission from a major depressive episode with ECT 6. After the rotation, rate your level of confidence in prescribing continuation and maintenance treatment for patients who have achieved response or remission from a major depressive episode with ECT 7. Before the rotation, rate your level of confidence in providing evidence-based information regarding treatment benefits, risks, and alternatives to geriatric patients and their family members 8. After the rotation, rate your level of confidence in providing evidence-based information regarding treatment benefits, risks, and alternatives to geriatric patients and their family members 9. Before the rotation, rate your overall level of confidence in providing evidence-based inpatient psychiatric care for geriatric patients 10. After the rotation, rate your overall level of confidence in providing evidence-based inpatient psychiatric care for geriatric patients Results The survey was distributed to both classes and 12/15 PGY2 and 6/16 PGY3 residents responded. Of those that responded, the results are as follows: Table 1, 2, and 3 Conclusions Given the results in tables 1, 2, and 3, it appears that this approach to structured didactic/reading content on clinical rotations may be of mild to moderate utility as a supplement to teaching that arises as part of routine patient care. This approach does seem to enhance resident confidence in the care that they provide but it is difficult to disentangle the overall effect of the rotation from that of the didactic curriculum. Further limitations include the retrospective and qualitative approach to the survey, lag time between the geriatric psychiatry rotation for each class and completion of the survey (between four and twenty-eight months depending on individual resident schedules), and the poor capture of the survey (12/15 PGY2 residents and 6/16 PGY3 residents completed the survey). Further studies to elucidate the objective utility of this curriculum would include a prospective, quantitative approach with a pre- and post-test to determine actual impact of the course on a resident's knowledge base in supplement to the organic learning that occurs over the course of the rotation. This research was funded by: UCLA Department of Psychiatry