Caring for a hospitalized older adult requires the coordinated efforts of various specialists and geriatricians throughout the patient’s hospital stay. At Brigham and Women’s Hospital, an attending physician in the Division of Aging is facilitating such collaboration by developing a co-management service that embeds geriatrics within the hospital’s internal medicine floors.

Shoshana Streiter, MD, who joined the Division of Aging in 2019, said the service will provide an extra level of support for older patients with a high need for geriatric care. The goal is to break down the barriers and silos that can exist between disciplines by getting specialists from different professional backgrounds in one space, working together as a team.

“As a geriatrician, I provide the most effective patient care when I’m on the floor and accessible at all times instead of being viewed as an ‘outside consultant’ who is available by phone and only steps in when requested,” Dr. Streiter said. “I get to know the patients better and can form real relationships with them and the entire care team.”

Meeting the Needs of a Heterogenous Patient Population

One of Dr. Streiter’s main objectives for the co-management service is to align older patients’ multidisciplinary care teams with each individual patient’s goals for their hospital stay.

“Patients enter the hospital with an idea of what they want to get out of their experience here,” she said. “Care teams need clarity around those expectations and must work together to tailor care that makes the most sense for that individual case.”

According to Dr. Streiter, delivery of that tailored care doesn’t always adhere to the same formulaic approach. “The older patient population is heterogeneous,” she explained. “Care teams need to think beyond checklists, algorithms and evidence-based practices to provide out-of-the-box care.”

Peer Teaching Making for Rich Learning Experiences

Dr. Streiter’s interest in multidisciplinary collaboration coalesced during her multi-campus fellowship at the Brigham and its sister institutions. She spent the second year of her fellowship focusing on medical education and created a pilot peer-teaching exchange—a program detailed in The Journal of the American Geriatrics Society.

Peer teaching can be defined as “an educational arrangement in which one student teaches one or more fellow students.” It’s part of the “hidden curricula” in medical education—teaching that goes beyond a written syllabus and learning objectives.

In the pilot program led by Dr. Streiter, she organized a peer-teaching exchange between a geriatrics fellowship and four collaborating residencies in specialties that typically interface less with geriatrics, such as physiatry, dermatology, anesthesiology and interventional radiology.

The geriatrics fellowship assigned one or two fellows to teach sessions about geriatric medicine to the participating residencies. In exchange, participating residencies assigned one or two senior trainees to teach geriatrics fellows about their specialties. Geriatrics topics covered included cognitive impairment, polypharmacy, advanced care planning and frailty.

“The peer didactics were incredibly rich learning experiences,” Dr. Streiter said. “All the trainees expressed a high degree of satisfaction.”

‘Cognitive Congruence’ the Key

According to Dr. Streiter, peer teaching works well because the “cognitive congruence” between teachers with a similar knowledge base can more easily identify points of confusion for learners.

“We can connect with our professional peers on a more personal level while teaching and learning from each other,” she explained. “We’re all at the same stage of life, unlike the traditional professor/student relationship, in which the teachers are on a completely different level than the learners.”

Dr. Streiter added that the camaraderie developed among colleagues during these peer-led learning sessions also promotes an effortless sense of community and a more collaborative environment for effective cross-disciplinary care, as evidenced by her early success in building the new co-management service.

“Not only can peer teaching help improve care for older adults by facilitating the exchange of knowledge and collaboration, but it’s honestly great fun as well,” she concluded.