Systems-based practice assessed with a performance-based examination simulated and scored by standardized participants in the health care system: feasibility and psychometric properties.

Background: Systems-based practice is one of the six general competencies proposed by the Accreditation Council for Graduate Medical Education in their Outcome Project. However, little has been published on its assessment--possibly because the systems-based practice competency has been viewed as difficult to define and measure.

Purpose: The purpose of this study was to determine whether a full performance-based examination of systems-based practice cases simulated and scored by standardized participants in the health care system could feasibly be constructed and implemented that would provide reliable and valid measurements.

Development of the objective structured system-interaction examination.

Study Objective: The purpose of this study was to develop an objective method of evaluating resident competency in systems-based practice.

Study Design: Faculty developed a 12-station examination, the Objective Structured System-Interaction Examination (OSSIE), patterned after the Objective Structured Clinical Examinations (OSCEs), to evaluate residents' ability to effectively work within the complex medical system of care. Scenarios consisted of multiple situations, such as patient hand-offs, consultations, complicated discharges, and family meetings, in which residents interacted with simulated professionals, simulated patients, and simulated family members to demonstrate the systems-based skills.

Aging Couple Across the Curriculum.

Aging Couple Across the Curriculum is a unique program designed around a couple who "age" a decade with each year of medical school. In these half-day sessions, students encounter the aging couple through a standardized patient experience. Interactive breakout sessions conducted by multidisciplinary professionals enhance student learning and appreciation of the contributions of the team of professionals.

The physician's role in assessing and counseling aging drivers: a training session for undergraduate medical students.

The critical need for physicians to become entrenched in the issues of older drivers and public safety is the focus of a training initiative developed as a component of an innovative geriatrics curriculum, Aging (Couple) Across the Curriculum. As the number of aging drivers in the United States rises, physicians can play an important role in helping older patients continue safe driving practices and in counseling those who need to cease driving. This article describes an inventive course designed to sensitize medical students to the many complex issues entangled in driving and aging and to prepare them to competently and compassionately assess and counsel older drivers.

Infection in the elderly.

Many functional, demographic, and immunologic changes associated with aging are responsible for increasing the incidence and severity of infectious diseases in the elderly. Management is complicated by age-related organ system changes. Because many of the elderly are on multiple medications for underlying illnesses, antimicrobial therapy needs to be chosen keeping drug interactions and adverse events in mind.

Tangling with the barriers to culture change: creating a resident-centered nursing home environment.

Prior to beginning culture change, nursing homes should analyze potential barriers, such as staff turnover, and develop plans to deal with these barriers. Infusion of culture change is dependent on inversion of the organizational structure, placing decision-making in the hands of the older adults. Although data from this study indicated decreased depression in older adults and increased family satisfaction with culture change, there were many confounding variables.

A simulated couple aging across the four years of medical school.

Background: The medical students of today will deliver health care to an ever-increasing aging population. Regardless of specialties, physicians must view older patients holistically with attention to medical, psychosocial, and family issues and functional status.

Description: This program was designed around a couple who ages from 60 to 90 over the 4 years of medical school.

Impact of the Eden Alternative on family satisfaction.

Objectives: The purpose of the study was to determine the impact of the Eden Alternative on family satisfaction.

Design: The study was a one-group pre-post design. Families were surveyed prior to the beginning of implementation of the Eden Alternative and again 2 years later.

Can a beverage cart help improve hydration?

The purpose of this study was to determine the effectiveness of a hydration program to improve hydration and prevent conditions associated with dehydration (delirium, urinary tract infections, respiratory infections, falls, skin breakdown, and constipation). Data showed a significant increase in fluid in each body compartment, significant decrease in the number of laxatives, increase in the number of bowel movements, decline in the number of falls, and decrease in cost during the hydration period.