Assessing Geriatric Competencies in Residents: Validating the 5Ms Dimensions

Area of Science:

• Medical Education
• Geriatric Medicine
• Assessment Methods

Background:

• Existing undergraduate geriatric care training has limitations in evaluating resident medical expertise across geriatric dimensions.
• Current assessment methods inadequately address the complexities of geriatric care during residency.
• A need exists for improved evaluation tools in geriatric medicine training.

Purpose of the Study:

• To develop and present feasibility data and preliminary validity evidence for a case-based assessment using the geriatric 5Ms framework.
• To align geriatric assessment with undergraduate objectives and North American internal medicine milestones.
• To evaluate residents' medical expertise in geriatrics using the 5Ms framework (Mind, Mobility, Medications, Multicomplexity, Matters Most).

Main Methods:

• Sixty-eight internal medicine residents were randomly assigned to complete assessment and management plans for 3 geriatric cases within 1 hour.
• Two blinded educators rated resident performance on 5Ms dimensions and general medical expertise using a 3-level scale.
• Feasibility and validity evidence were collected, including resident feedback via a post-assessment questionnaire.

Main Results:

• The 5Ms framework assessment demonstrated feasibility, with 201 cases completed, integrating all 5Ms dimensions.
• Residents scored significantly lower on 5Ms dimensions (mean=1.1) compared to non-geriatric medical expertise (mean=1.5).
• Interrater reliability was moderate to strong (ICC=0.67-0.85), and most residents found the cases and assessment representative of clinical practice.

Conclusions:

• A case-based assessment utilizing the geriatric 5Ms framework is feasible for evaluating resident geriatric medical expertise.
• The assessment shows preliminary validity, indicating its potential to improve geriatric care training.
• This framework offers a structured approach to assessing core geriatric competencies.