Interviews were conducted with junior residents (JR; n = 5), senior residents (SR; n = 7), charge nurses (CN; n = 6), orthopaedic surgeons (OS; n = 5), and geriatricians (G; n = 6). The emerging themes are outlined below:
Awareness and comfort in geriatric competencies
Junior residents felt comfortable in their geriatric medicine competencies, particularly in the initial management of the geriatric giants. They were also able to extrapolate their knowledge to work through issues during a patient's hospital stay.
“I am comfortable in taking the first steps in getting them (older adults) optimized.” (JR4)
“It really makes you feel more confident moving forward in terms of how to deal with these ward issues.” (JR3)
In contrast, senior residents had mixed comfort in geriatric medicine competencies. Some felt their knowledge and skills were “probably a little limited” (SR5) and “would not be sufficient to provide a standard of care.” (SR6) Nursing staff also commented that senior residents were sometimes “not sure how to proceed because of all the medical complications.” (CN1)
Geriatric competencies strengthened by the curriculum
Among the geriatric competencies, three sub-competencies appeared to be positively affected by the Orthogeriatrics curriculum.
1. Sensitization to Holistic Care & Medical Complexity: Junior residents recognized the importance of comprehensive care, given the medical complexity of older surgical patients. As residents “learned to assess older adults more holistically”, they began to see beyond the “mechanical” and “surgical” aspects of orthopaedic care (JR6). They also spoke of transferring their knowledge acquired from the geriatrics rotation to their surgical training:
“It’s not just the surgery, it’s the patient as a natural person that has […] dementia or social problems. And now, when you get back into more surgical training, it’s actually in your mind.” (JR5)
2. Communicating with Older Adults: Junior residents also appeared to interact with older adults with improved bedside manner. Role-modelling appeared to play a significant role in developing these communications skills.
“Seeing how much time the internists and geriatricians spend really validates the fact that I might spend an extra bit of my time on the overnight call talking with them.” (JR2)
Since the Orthogeriatrics curriculum, charge nurses observed “more conversation” (CN5) and “one-to-one patient time spent from the MDs.” (CN6)
3. Collaborative Relationships: Understanding the role of the geriatrician and allied health professionals involved in patient care appeared to strengthen interprofessional appreciation among junior residents.
“It (Orthogeriatrics rotation) gives you more tools to know when to refer … it gave me the potential to appreciate how important it is, and what to expect in a referral, and how to better prepare a patient before the geriatric team sees a patient.” (JR5)
Improving the Orthogeriatric curriculum
The Orthogeriatrics rotation focused on managing older adults with emergent hip fractures. One suggestion was to teach about “perioperative assessments” (G2) for patients undergoing elective procedures.
“There should be an emphasis more on the pre-op assessment. So pre-ops for [...] all the elective cases - the elective knee replacements, hip replacements - they probably need more teaching and experience around that.” (G3)
In addition, disposition planning within complex psychosocial situations “to help deal with caregivers and family” (OS4) could be integrated more into the curriculum.
“... whatever setting orthopaedic residents are going to end up practicing in, that they have collaborative relationships […] and make sure that their communication is open with the families and caregivers.” (OS1)