1. CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs Supported by the Hearst Foundations, Donald W. Reynolds Foundation, & The John A. Hartford Foundation Donald W. Reynolds Foundation

2. Increasing Need for Geriatrics Expertise CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs. Supported by the Hearst Foundations, Donald W. Reynolds Foundation, & The John A. Hartford Foundation Source: census.gov

3. Proportion of Work Within Surgical Specialty by Age Group,% Specialty< 65 yrs> 65 yrs Orthopedics4951 General Surgery4060 Urology3565 Cardiothoracic3070 Ophthalmology1288 Source: National Hospital Discharge Survey, National Survey of Ambulatory Surgery, 1996 CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs. Supported by the Hearst Foundations, Donald W. Reynolds Foundation, & The John A. Hartford Foundation

4. What is CRIT? Weekend session to enhance chief residents’ knowledge in the care of older patients. “Training the trainer” Case-based discussions Interactive approach with many small group “breakout” sessions Informal and relaxed atmosphere of learning. CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs. Supported by the Hearst Foundations, Donald W. Reynolds Foundation, & The John A. Hartford Foundation

5. Chief Resident Skills Very high proportion of their patients are older adults Approach to special problems of older patients Each chief resident will choose an area of geriatric focus for his/her chief residency year. Chief resident mentored by geriatrics faculty members throughout the year. Focus on enhancing skills of chief resident as leader and mentor to junior residents. CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs. Supported by the Hearst Foundations, Donald W. Reynolds Foundation, & The John A. Hartford Foundation

6. CRIT Background Focus on inter-specialty coordination of care for older patients. Since its inception at BUMC in 2003, the CRIT program has been disseminated over 30 times at 16 institutions nationwide. Funded by the Hearst Foundations and Donald W. Reynolds Foundation; no participant expenses for chief residents, program directors, and families. CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs. Supported by the Hearst Foundations, Donald W. Reynolds Foundation, & The John A. Hartford Foundation

7. CRIT History 2003: BUMC develops CRIT with support from the Reynolds Foundation 2005: First BUMC CRIT Program held 2007: BUMC/ADGAP receives Hartford grant for CRIT national demonstration 2008: BUMC partners with two Reynolds-funded institutions to replicate CRIT 2010: Univ. of Arizona Center on Aging puts on institutionally funded version of CRIT 2011: Four institutions continue CRIT in the most recent round of Reynolds geriatrics training grants 2011: BUMC/ADGAP receives Hearst and Reynolds funding for continued national dissemination CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs. Supported by the Hearst Foundations, Donald W. Reynolds Foundation, & The John A. Hartford Foundation

8. National CRIT Dissemination Since 2005, 16 institutions have implemented CRIT programs a total of 30 times Baystate Medical Center Cooper University Hospital Marshall University/Joan C. Edwards School of Medicine Medical College of Wisconsin Northeast Ohio Medical University Stony Brook School of Medicine University of Arizona University of Cincinnati University of Colorado University of Kansas University of Nebraska University of Rochester University of South Carolina/Palmetto Health Wake Forest University School of Medicine Warren Alpert School of Medicine of Brown University Yale University CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs Supported by the Hearst Foundations and Donald W. Reynolds Foundation

9. CRIT Schedule Insert Your Program Schedule HERE CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs. Supported by the Hearst Foundations, Donald W. Reynolds Foundation, & The John A. Hartford Foundation

10. CRIT Schedule (cont’d) Insert Your Program Schedule HERE CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs Supported by the Hearst Foundations and Donald W. Reynolds Foundation

11. Sample Chief Resident Action Projects Algorithm for Management of Epistaxis in the Older Patient and Implementation of Geriatric Topics in Otolaryngology Grand Rounds Implementing Focused Geriatrics Teaching for Family Medicine Residents Physical Activity Plan for Older Adults (PM&R) Functional Assessment of the Older Adult in the ED: Alerting the PCP CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs. Supported by the Hearst Foundations, Donald W. Reynolds Foundation, & The John A. Hartford Foundation

12. Sample Chief Resident Action Projects (Cont’d) Incorporating Geriatric Principles into Gynecologic Care: Teaching Modules & Tools and Addressing Goals of Care and Code Status on Gyn Oncology Eye Medication Application and Resources Restoring Your Smile at Any Age: Geriatric Dentistry CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs. Supported by the Hearst Foundations, Donald W. Reynolds Foundation, & The John A. Hartford Foundation

13. Outcomes Six-month follow-up surveys with chief residents who have participated in CRIT showed that they: Were more confident in their application of clinical skills related to the care of older adults Were more likely to teach geriatrics principles to residents and medical students Had an increased recognition of the importance of interdisciplinary approaches to the care of older adults Had more confidence to coordinate care across disciplines and specialties, facilitate small groups, give feedback, connect with reluctant learners, and resolve conflicts in their roles as chief residents. CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs. Supported by the Hearst Foundations, Donald W. Reynolds Foundation, & The John A. Hartford Foundation

14. Testimonials Great materials provided that I have already gone back to for reference. It was a great experience learning from peers and passing on the information to the house-staff. It feels like I achieved something. The CRIT experience helped me develop a more robust set of leadership skills that I was able to utilize throughout the year. Having the geriatrics training at the CRIT was a fantastic review of geriatric clinical pearls. This was highly valuable. This was a great experience to have a focused education session on a topic that we deal with frequently in surgery but do not have much formal training in. There was a good mix of leadership education topics as well. CHIEF RESIDENT IMMERSION TRAINING (CRIT) Co-Sponsored By Boston Medical Center & The Association of Directors of Geriatric Academic Programs. Supported by the Hearst Foundations, Donald W. Reynolds Foundation, & The John A. Hartford Foundation

15. Donald W. Reynolds Foundation