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The COVID-19 AAGP Online Trainee Curriculum: Development and Method of Initial Evaluation

      Highlights

      • With the disruption of in-person geriatric psychiatry residency education by the COVID-19 pandemic, the AAGP Teaching and Training Committee sought to rapidly implement a web-based geriatric psychiatry curriculum.
      • The COVID-19 AAGP Online Trainee Curriculum (aagponline.org/covidcurriculum) consists of approximately 30 video-recorded lectures provided by AAGP members and experts in the field. We developed plans to obtain self-report demographic characteristics of learners and pre-/postsurvey questions assessing perceived changes in knowledge, skills, and attitudes for each module.
      • The AAGP has acted rapidly to implement an online resource that can supplement geriatric psychiatry education during the pandemic, potentially raise the profile of AAGP, and hopefully inspire more interest in our field.

      ABSTRACT

      Objective

      One effect of the COVID-19 pandemic is the disruption of in-person clinical experiences within geriatric psychiatry residency education. Online resources for trainees are needed to fill resultant gaps.

      Methods

      The American Association of Geriatric Psychiatry (AAGP) Teaching and Training Committee leadership collaborated with geriatric psychiatry experts to develop a web-based geriatric psychiatry curriculum for psychiatry residents and other learners. In addition, we planned to obtain initial self-report outcomes of the curricular modules.

      Results

      The COVID-19 AAGP Online Trainee Curriculum (aagponline.org/covidcurriculum) consists of approximately 30 video-recorded lectures provided by AAGP member experts. A demographic survey and pre-/postsurvey attached to each module allow us to obtain learner characteristics and feedback on each module.

      Conclusions

      The Curriculum has the potential to supplement psychiatry residency education during the pandemic and potentially raise the profile of AAGP, with the goal of inspiring interest within geriatric psychiatry. Results of the initial self-report evaluation should be available in 1 year

      Key Words

      INTRODUCTION

      The COVID-19 pandemic disproportionately impacts older adults
      • Applegate WB
      • Ouslander JG
      COVID-19 presents high risk to older persons.
      and may adversely impact their mental health and healthcare.
      • Vahia IV
      • Blazer DG
      • Smith GS
      • et al.
      COVID-19, mental health and aging: a need for new knowledge to bridge science and service.
      The editors of the American Journal of Geriatric Psychiatry have called for new knowledge on the relationship between COVID-19, mental health, and aging.
      • Vahia IV
      • Blazer DG
      • Smith GS
      • et al.
      COVID-19, mental health and aging: a need for new knowledge to bridge science and service.
      The compromise of the geriatric psychiatry training experience is one of the innumerable unforeseen effects of the COVID-19 pandemic where new knowledge is needed. The Accreditation Council for Graduate Medical Education (ACGME) requires all general psychiatry residents complete 4 weeks caring for elderly populations.

      Accreditation Council for Graduate Medical Education (ACGME): ACGME program requirements for Graduate Medical Education in Psychiatry [ACGME Web Site]. July 1, 2019. Available at:https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/400_Psychiatry_2019_TCC.pdf?ver=2019-03-27-090422-550. Accessed April 26, 2020

      This experience is often the only exposure to geriatric psychiatry residents receive in their training. In response to COVID-19, in-person clinical experiences have been streamlined to prevent unnecessary exposure to the virus for our vulnerable older adults. And, in many cases, didactic curricula are significantly truncated due to reassignment of trainees and faculty to perform other hospital care needs.
      Changes in geriatric psychiatry residency education due to the COVID-19 pandemic may compound the critical shortage of providers with adequate training to care for the nation's rapidly aging population. Prior to the crisis, it was estimated that by the year 2030, 1 in every 5 Americans will be over the age of 65, and in the same year, there will be only one geriatric psychiatrist per 5,682 older adults with a psychiatric disorder.
      • Colby SL
      • Ortman JM
      Projections of the size and composition of the US population: 2014 to 2060: Population estimates and projections [U.S. Census Bureau Web Site].
      ,

      American Association for Geriatric Psychiatry (AAGP): IOM study on mental health workforce of older adults fact sheet [AAGP Web Site]. March 2012. Available at:https://www.aagponline.org/index.php?src=gendocs&ref=FactSheetIOMStudyonMentalHealthWorkforceofOlderAdults&category=Advocac. Accessed April 26, 2020

      Novel educational programs are needed to supplement COVID-related training deficits in geriatric psychiatry to equip residents with basic knowledge needed to care for older adults, and, potentially, foster interest in pursuing subspecialty training. In response, members of the American Association of Geriatric Psychiatry (AAGP) collaborated to create a comprehensive geriatric psychiatry curriculum consisting of online video modules: The COVID-19 AAGP Online Trainee Curriculum. This paper describes the development of the Curriculum and our plan to obtain initial self-report metrics.

      Development of the Curriculum

      The idea to develop an online curriculum for trainees unable to join in-person geriatric psychiatry rotations was conceived by the AAGP Teaching & Training (T&T) Committee Vice Chair. A team to plan and organize the curriculum was developed with input from the AAGP Board and T&T Committee leadership. COVID Curriculum team members included the Chair (S.W.L.) and Vice Chair (M.L.C.) of the T&T Committee, Chair of the Scholars Program (B.C.Y.), and Chair of the T&T Subcommittee on Resident Education (E.C.G.). Since the goal was to provide an educational resource for trainees, a PGY-3 psychiatry resident stakeholder (H.A.) was added to the team.
      The list of potential lecture topics for the curriculum was created by the team and then modified iteratively based on suggestions from T&T Committee members with a goal of 20 lectures total. Topics were mapped to several ACGME requirements for psychiatry residents, including the diagnosis and management of the cognitive component of degenerative disorders and the management of drug interactions in older adults.

      Accreditation Council for Graduate Medical Education (ACGME): ACGME program requirements for Graduate Medical Education in Psychiatry [ACGME Web Site]. July 1, 2019. Available at:https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/400_Psychiatry_2019_TCC.pdf?ver=2019-03-27-090422-550. Accessed April 26, 2020

      Topics were also selected based on consensus by those actively engaged in resident learning (M.L.C., E.C.G., and members of the T&T Committee) to target key content areas foundational to resident education in geriatric psychiatry. The goal was for presenters to provide already prepared, online, video-recorded versions of lectures in an area of expertise so that the preparation time would be minimal.
      Presenters were selected by email invitations to AAGP members with expertise in topics of interest and then an email to all participants on the T&T Committee listserv. Initially, we planned to livestream 20 lectures, then make lectures available for later viewing by additional trainees on a secure platform. However, logistical considerations required modifications to enable presenters to record lectures at their convenience. Presenters submitted recordings via Google Drive (Alphabet, Menlo Park, CA) to the team; recorded lectures were posted by AAGP staff to a password-protected database on the AAGP website (www.aagponline.org/covidcurriculum).
      In addition, because of the enthusiastic response from T&T Committee members, the number of lecture topics was increased from the planned 20 lectures to approximately 30. Lecture topics include a comprehensive range of subjects related to the assessment, diagnosis, and treatment of the older adult patients, along with special topics, such as cultural psychiatry and a Psychiatry Resident-In-Training Examination (PRITE) review. The list of lecture topics to date is shown in the Figure 1. Other topics will be added based on feedback obtained from learners.
      FIGURE 1
      FIGURE 1AAGP COVID geriatric psychiatry curriculum modules to date.

      Plans for Initial Evaluation of the Curriculum

      Along with providing online module learning, we sought to obtain demographic data and pre-/postsurvey data from trainee participants who access the educational modules. The initial proposal was presented in writing and approved by AAGP Co-Presidents. Human subjects research exemption was obtained from the Yale University Institutional Review Board.
      Data collection will include the number of unique users of the Curriculum, the number of viewers for each module, viewer demographics, and the perceived benefits of the modules. Trainees will provide informed consent for survey participation by reading an explanation of the survey procedures and then clicking a link on the AAGP COVID Curriculum webpage. Trainees will be assured their participation in the survey research is voluntary, and they may opt out of the research component at any time by not completing or submitting responses to survey items. Trainees will be able to view each lecture and receive a certificate of completion regardless of their decision to complete the survey questions.
      The team developed a self-report demographic questionnaire (including age, marital status, gender, year in training, and geographical region of training) based on previous similar educational research.
      • Rej S
      • Laliberte V
      • Rapoport MJ
      • et al.
      What makes residents interested in geriatric psychiatry? A pan-Canadian online survey of psychiatry residents.
      Additionally, 3 pre- and 3 post-module self-report questions for each lecture were developed based upon an established framework to guide teaching and assessment in medical education.
      • Bloom BS
      • Krathwohl DR
      Taxonomy of educational objectives: the classification of educational goals.
      Questions assessed change in perceived knowledge about the topic, confidence in skills related to the topic, and enthusiasm about the topic. Pre- and post-module questions were pilot tested in psychiatry residents (n = 2), medical students (n = 1), geriatric psychiatry (n = 4) and medicine (n = 2) fellows, geriatric psychiatrists (n = 2), and a nurse practitioner in response to one of the Curriculum modules (Substance Use Disorders) at Yale University. Questions were revised based on verbal feedback during this process.

      Next Steps for Implementation of the Curriculum

      The Curriculum will be launched in May 2020. Recruitment is planned via email outreach to professional organizations involved in psychiatry and medical education, including the AAGP T&T Committee, the American Association of Directors of Psychiatric Residency Training (AADPRT), the Association of Directors of Medical Student Education in Psychiatry (ADMSEP), and others.
      We anticipate completion of the initial wave of feedback analysis in approximately 1 year.

      SUMMARY

      The COVID-19 pandemic has impacted the healthcare system in a myriad of ways. One immediate effect is the disruption of geriatric psychiatry residency. This transition has removed the opportunity for “bedside” learning and, in many cases, didactic learning.
      The AAGP COVID Curriculum is a module-based geriatric psychiatry didactic learning experience developed to address the educational gap caused by the COVID-19 pandemic. The Curriculum consists of approximately 30 online video modules, each delivered by an expert in the field. While the Curriculum is primarily intended to supplement psychiatry residency training, the modules may also benefit medical students, physician assistant students, and advanced practice nursing students, many of whom were also removed from clinical learning sites due to COVID-19. Additionally, these modules may be utilized by geriatric psychiatry fellows, general psychiatrists, or others who wish to access more in-depth learning related to psychiatric illness in older adults.
      The AAGP COVID Curriculum is also a response to the recent call to develop new knowledge about COVID-19, mental health, and aging.
      • Vahia IV
      • Blazer DG
      • Smith GS
      • et al.
      COVID-19, mental health and aging: a need for new knowledge to bridge science and service.
      Feedback obtained from learners will assist in determining whether an online educational curriculum is viewed positively by trainees during a time when usual clinical training experiences are curtailed. Since we will assess each module separately, the data will allow for Curriculum optimization in the future based on the success of various modules.
      In addition, the AAGP COVID Curriculum may enhance geriatric psychiatry residency experiences beyond the pandemic. Given worsening shortages in geriatric mental healthcare, new educational tools are one possible way to promote interest in the field. If successful, the AAGP COVID Curriculum could be transitioned to a permanent offering to enhance recruitment for or be combined with AAGP's other trainee recruitment activities, including the AAGP Scholars Program.
      • Wilkins KM
      • Forester B
      • Conroy M
      • et al.
      The American Association for Geriatric Psychiatry's Scholars Program: a model program for recruitment into psychiatric subspecialties.
      ,
      • Wilkins KM
      • Conroy ML
      • Yarns BC
      • et al.
      The American Association for Geriatric Psychiatry's Trainee Programs: participant characteristics and perceived benefits.
      Since the Curriculum is accessed through the AAGP website, it may increase traffic to the website, increasing exposure to AAGP as an organization committed to the mental health and well-being of older adults, and to AAGP's resources for clinicians, educators, and researchers.
      Limitations include lack of objective evaluation of changes in learners’ knowledge and skills. In addition, due to the accelerated implementation of this project prior, peer review or standardization of the content was not performed. These areas may provide opportunities for future studies and program improvement based on results of the initial evaluation.
      One silver lining of this pandemic is the potential expansion of learning opportunities for medical students, psychiatry residents, and physician assistant and advanced practice nursing students who do not have access to adequate geriatric psychiatry education in their home programs. Indeed, other programs, such as the American Psychiatric Association and the National Neuroscience Curriculum Institute, have shifted toward more web-based educational opportunities. The AAGP COVID Curriculum demonstrates the potential for professional collaboration among AAGP experts to rapidly improve access to high-quality educational materials. As such, it has many potential benefits, including the delivery of high-quality content with the potential to expand interest in the field of geriatric psychiatry and prepare the workforce of mental health providers equipped to care for older adults.

      AUTHOR CONTRIBUTIONS

      Michelle L. Conroy conceived of the project. Michelle L. Conroy, Erica C. Garcia-Pittman, Hana Ali, Susan W. Lehmann, and Brandon C. Yarns each made substantial contributions to the design and implementation of the project, drafting and revising the work for important intellectual content, have approved the final version to be published, and agree to be accountable for all aspects of the work and its accuracy and integrity.
      Dr. Yarns was supported by the US Department of Veterans Affairs (grant number CX001884 ).

      DISCLOSURE

      The authors would like to acknowledge the AAGP Co-Presidents Brent Forester, MD, and Rajesh R. Tampi, MD, and AAGP Executive Office staff Christopher Wood and Victoria Cooper for their contributions to the implementation of this project. In addition, thank you to the 27 AAGP Teaching and Training Committee Members who contributed their expertise to our Curriculum to date.
      Disclosure/Conflict of Interest: The authors report no conflicts with any product mentioned or concept discussed in this article.

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        COVID-19, mental health and aging: a need for new knowledge to bridge science and service.
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