85. PSYCHIATRIC EMERGENCY IN LATE-LIFE: A STORY DRIVEN CLASS TO CHALLENGE ATTITUDES AND PROVIDE LOCATION SPECIFIC TRAINING TOOLS

Abstract

Introduction

According to the World Health Organization, by 2030 one in six people will be aged 60 and older with approximately 14% of older adults living with a mental health disorder. The Health Resources and Services Administration projects over a 42,000 psychiatrist workforce shortage by 2036 and by 2030 only one geriatric psychiatrist is estimated to be available for every 27,000 older adults. With current behavioral health resource limitations, patients are more likely than ever to be cared for in the emergency setting. The National Center for Health Statistics found that emergency department visits in 2020 for adults aged 60 and older had longer wait times, were more likely to be discharged with unmet needs, required high levels of care coordination, and had an increased likelihood of hospital admission. This shift of care location, increase of older adults with psychiatric needs, and insufficient geriatric psychiatry expertise makes training general psychiatry residents in diagnosis and management of psychiatric emergencies in late life critically important. To address these needs we created a story driven class to build knowledge, shift attitudes, and provide location specific training for PGY-1 and PGY-2 general psychiatry residents working in a psychiatric emergency service.

Methods

A learner needs assessment found that over 60% of PGY-1 and PGY-2 general psychiatry residents surveyed (n=19) reported a high to very high need for learning in identifying, managing, and reflecting on common geriatric psychiatry diagnosis and presentations in emergency care. This 60 minute class on psychiatric emergencies in late-life was created with the affective context learning theory and the push and pull learning design model to target both cognitive and affective learning. In the push and pull model, learning experiences are designed to address learner specific concerns, provide resources for motivated learners, and employ storytelling to create emotionally impactful experiences. The class examines common clinical presentations and challenges of psychiatric emergency care in late-life through an interactive lecture designed to foster discussion and provide relevant tools for clinical service specific training. Group results will be presented descriptively of Likert scale pre-posttest self-assessments.

Results

The class was taught one time at the University of New Mexico to PGY-1 and PGY-2 general psychiatry residents. Of the 20 participants, 13 completed both pre-posttest self-assessments. Confidence with learning objectives was assessed via a 5-point Likert scale. Residents reported increased confidence identifying acute concerns and common diagnosis, discussing management of common presentations, and reflecting on challenging presentations of geriatric psychiatry emergency care with over 50% normalized gain for all learning objectives (Table). Residents also reported increased comfort and confidence in caring for medically and psychiatrically complex patients in the emergency setting with 21% and 40% normalized gain respectively. Residents reported no change in attitudes towards caring for geriatric psychiatry patients in emergency settings as rewarding with a flat 3.2 mean pre and posttest responding they agreed with this statement, indicating an average neutral response. Narrative feedback included favorable response to case-based focus, near-peer discussions, training resources, and time for reflection.

Conclusions

This class to teach general psychiatry residents in diagnosis and management of psychiatric acuity in late-life was successful. Participant’s confidence increased in the psychiatric emergency setting and narrative feedback reinforced the educational methods selected to emphasize storytelling and participant engagement. Study limitations include small participant number and administration, variable participation in pre-posttest self-assessments, and lack of knowledge or behavior evaluation raising concerns for generalizability and durability of impact. Designing classes with the affective context learning theory may increase learner engagement in both the classroom and the clinical setting; however, more research with diverse learner populations and topic areas is required. The impact of providing site-specific training resources was not evaluated and future scholarship could assess resident behavior change and clinical outcomes after training focused educational experiences. Ambivalent attitudes toward caring for older adults were unchanged after this class which likely indicates the complex and powerful influences contributing to these attitudes. More research is required to address these issues that negatively impact patient care and are barriers to resident training. Ultimately designing curricula to tell older patient stories could encourage learner engagement while building skills and knowledge to improve care for geriatric patients now more likely to be cared for in emergency settings.