A Novel, Web-based Curriculum on Guardianship

A Novel, Web-based Curriculum on Guardianship

Academic Year:
2021 - 2022 (June 1, 2021 through May 31, 2022)
Funding Requested:
Project Dates:
Overview of the Project:
As part of the Medical Education Scholar’s Program, I am developing a web-based course on the topic of guardianship for internal medicine (IM) and family medicine (FM) residents. Older adults with dementia or other medical conditions that impair rational thinking may ultimately require guardianship for protection. However, the incapacitated patient (ward) who is assigned a guardian loses the ability to make independent decisions, presenting a major threat to personal freedom of choice. Guardianship can pose an ethical dilemma for providers who must weigh the principals of nonmaleficence and autonomy. Although physicians may perform capacity assessments, serve as witnesses in guardianship hearings, and/or care for wards, they receive little, if any, formal education on this topic. Furthermore, guardianship is ultimately pursued in the probate court system, outside of the clinical realm. A curriculum targeted to the need of internists and family medicine physicians is needed to fill these educational gaps and allow physicians to understand the guardianship process, perform therapeutic alliances with guardians, and most importantly, understand alternatives to guardians such that guardianship is only pursued for those who truly require it. This curriculum is being developed with input from geriatricians, hospitalists, primary care providers, social work, and risk management. As a pilot project, it will be deployed to first year IM and FM residents. Their pre- and post-curriculum knowledge will be assessed and we will solicit feedback on the efficacy and clinical relevance of the content.
Final Report Fields
Project Objectives:

1. Develop a curriculum for internal medicine and family medicine residents on the topics of: Capacity Determination, Surrogacy Decision-Making, and Guardianship

2. Collect real-time feedback on the curriculum to allow improvement in an iterative process, to ensure content is meeting the needs of the target audience

3. Collect pre- and post-curricular data regarding knowledge of the above topics

Project Achievements:

The lecture was administered a total of six times during the grant-funding period. A total of 78 participants completed the pre-course survey and 41 completed the post-course survey. The pre-course survey assessed basic demographic data, prior educational experiences with surrogate-decision making and guardianship, and included a knowledge test. The post-course survey solicited course feedback, assessed attitudes and confidence on the included topics, and repeated the knowledge test. Participants included a mix of internal medicine residents, family medicine residents, geriatric medicine fellows, fellows and residents other than the listed categories, faculty, and advanced practice providers. Only 15% reported receiving prior teaching on the topic of guardianship. Knowledge improved significantly after course administration (p < 0.001). Course feedback was universally positive. 

This project will continue, both as ongoing content offered to internal medicine and family medicine residents, as well as expanding to other interprofessional learners, with the goal of similar educational offerings for medical students, physician assistant students, and nurse practitioner students. This work, in part, helped to support my application for a geriatrics-focused career award (GACA), which will continue to support my educational and research efforts around the topic of guardianship.,
We hope to disseminate data at a national conference and plan to submit an abstract to the American Geriatrics Society. We are also in the early stages of preparing a manuscript for publication.
Advice to your Colleagues:
This curriculum was realized and initially developed as part of the Medical Education Scholars Program, which I would highly recommend for any junior faculty interested in medical education, as it gave me both protected time and a strong didactic framework in curricular development, as well as allowing networking that facilitating project dissemination. I am glad that I sought out feedback and reviewed it after each lecture, as it led to meaningful improvement in future versions of the lecture. For instance, the lecture is partially case-based and accompanied by (stock) photos. Early feedback pointed out that the photos featured exclusively Caucasian individuals. Early review of the feedback allowed me to address this and make the content more inclusive. I would highly recommend seeking feedback as early and often as possible!