At Yale New Haven Hospital, in Connecticut, a group of chief residents are collaborating on a one-day, case-based training session for residents-in-training on ambulatory care rotations. At Marshall University, in Huntington, West Virginia, internal medicine chief resident William Nitardy is surveying residents’ knowledge and use of advance directives in the hope of helping all residents in training understand more about the goals of care for their patients. All around the nation, these and similar programs are up and running, following a series of innovative two-and-a half day training retreats sponsored by the John A. Hartford Foundation.
Over 194 chief residents participated in the Chief Resident Immersion Training (CRIT) program retreats at nine medical institutions across the country. The gatherings focused on fostering collaboration among disciplines in the management of complex older patients. Hospitalized older patients typically have multiple chronic conditions that need management during their stay, requiring collaboration and consultation across a number of specialties.
As collaboration among disciplines is a major goal of CRIT, representation from multiple specialties is a critical component of the program. This year’s CRIT programs brought together chief resident participants from 18 specialties, including anesthesiology, emergency medicine, family medicine, general surgery, internal medicine, neurology, obstetrics and gynecology, ophthalmology, orthopedic surgery, neurosurgery, otolaryngology, pathology, pediatrics, radiation oncology, rehabilitation medicine, psychiatry, thoracic surgery, and urology. During the retreats, chief residents worked through an unfolding, interactive surgical case, following a geriatric patient from first presentation in the emergency department to hospital discharge. The cases were divided into three modules. Each module included mini-lectures on topics in geriatric medicine, small group interactive exercises, and seminars designed to enhance teaching and leadership skills. The program’s aim was to give new chief residents a greater understanding of geriatrics principles and improved teaching and leadership skills they can use immediately.
All chief residents also attended two or three mentoring sessions throughout the retreat weekend to help them develop a project for implementation in their chief resident year. The projects focused either on resident education, improvement of clinical care, institutional change, administration, or patient education. With a July 1st start date—aligned with the resident education calendar—CRIT program “graduates” are now well underway in their new roles, and action plans developed during their CRIT retreats are in progress.