Chief Resident Immersion Training in the Care of Older Adults (CRIT)

CRIT Contacts
CRIT Project Director

Sharon A. Levine, MD
Professor of Medicine, Geriatrics Section
Boston Medical Center
88 East Newton St., Robinson 2
Boston, MA 02118
617-638-6677
salevine@bu.edu
CRIT Project Manager
Amy S. Alawad, MSPH, MPA
Boston University, Section of Geriatrics
617-638-6112
aalawad@bu.edu
CRIT Contact/ADGAP
Mary Jordan Samuel
Senior Coordinator, Professional
Education and Special Projects
212-308-1414
mjsamuel@americangeriatrics.org

The CRIT program provides case-based training in geriatrics principles to chief residents, who typically receive minimal exposure to geriatrics during their medical or surgical specialty residency training. Developed at Boston University/Boston Medical Center (BU/BMC),the program is designed to foster institutional collaboration among disciplines to improve care coordination and quality for hospitalized, at-risk older adults, and to develop chief residents’ teaching and leadership skills with an emphasis on medically complex older patients.  To date the CRIT program has been conducted over 30 times at 16 institutions nationwide. 

CRIT program participants include chief residents as well as faculty responsible for residency training in surgical and medical specialties. The program focuses on chief residents because of the key roles they play in the quality of patient care; medical student and resident training; mediating between faculty, nursing staff, and residents; and communicating with patients and families.

The CRIT program fosters collaboration among disciplines in the management of medically complex older patients. Program participants include both Chief Residents and faculty responsible for residency training in surgical and medical specialties. The program brings these individuals together for an intensive two-day program focused on:

  • incorporating geriatrics principles into Chief Resident teaching and administrative roles;
  • developing Chief Resident teaching and leadership skills with a focus on the care of complex older patients;
  • enhancing leadership and teaching skills that are necessary for a successful term as Chief Resident;
  • enhancing Chief Residents’ abilities to collaborate with other disciplines in the management of complex older patients;
  • developing an achievable action project focused on a geriatrics care issue that the Chief Resident will carry out during his/her Chief Residency year.

The CRIT program is administered by the Association of Directors of Geriatric Academic Programs (ADGAP) in partnership with BU/BMC, with grants from the Hearst Foundations and the Donald W. Reynolds Foundation Program for Faculty Development to Advance Geriatrics Education (FD~AGE).

CRIT Success

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.

A toolkit was developed to assist CRIT programs with fundraising, institutional adoption, and sustainability of their local CRIT programs. The toolkit may also be useful for those interested in developing a CRIT program without external funding. To review the toolkit, please click here.

CRIT History

2003: BU/BMC began development of CRIT with support from the Donald W. Reynolds Foundation.
2005: The first BU/BMC CRIT program was held outside of Boston
2007: BU/BMC was awarded funding from the John A. Hartford Foundation in collaboration with ADGAP to support national dissemination of CRIT.
2008: BU/BMC partnered with two Reynolds-funded institutions to support the replication of CRIT using BU/BMC’s model program.
2010: The University of Arizona Center on Aging institutionally funded a modified version of CRIT developed in consultation with BU/BMC.
2011: Four institutions included CRIT in the most recent round of Reynolds Foundation geriatrics training grants

The Hearst Foundations provided a $600K one-year grant to continue CRIT national dissemination, which may be refunded for up to 4 years at a total of $2.2M.  The Reynolds Foundation provided additional CRIT dissemination support through its Program for Faculty Development to Advance Geriatrics Education (FD~AGE) program.

Cohorts – Past and Current Grantees

2008-2010

Funded by the John A. Hartford Foundation

University of Colorado
PI: Robert Schwartz, MD
Co-PI: Thomas Robinson, MD

University of Kansas
PI: Tomas Griebling, MD
Co-PI: Daniel Swagerty, MD, MPH

University of Nebraska
PI: William Lyons, MD
Co-PI: Chad Vokoun, MD

University of Rochester
PI: Annette Medina-Walpole, MD
Co-PI: Paul Katz, MD

University of South Carolina/Palmetto Health
PI: Victor Hirth, MD
Co-PI: Rachelle Gajadhar, MD

2009-2011

Funded by the John A. Hartford Foundation

Marshall University/Joan C. Edwards School of Medicine
PI: Shirley M. Neitch, MD
Co-PI: Larry D. Dial, MD

Medical College of Wisconsin
PI: Karen Brasel, MD, MPH
Co-PI: Kathryn Denson, MD

University of Cincinnati
PI: Gregg Warshaw, MD
Co-PI: Andrew T. Filak, Jr., MD

Yale University
PI: Leo M. Cooney, Jr., MD
Melissa F. Perkal, MD

Funded by the University of Arizona

University of Arizona
PI: Mindy Fain, MD

Funded by the Donald W. Reynolds Foundation

University of Massachusetts Worcester
PI: Jerry Gurwitz, MD

University of Pennsylvania
PI: Jerry Johnson, MD

2010-2012

Funded by the John A. Hartford Foundation

Baystate Medical Center
PI: Maura Brennan, MD
Co-PI: Mihaela Stefan, MD
Co-PI: Gladys Fernandez, MD

Cooper University Hospital
PI: Carolyn Bekes, MD
Co-PI: Elizabeth Siegert, MD
Co-PI: Vijay Rajput, MD
Co-PI: Anuradha Mookerjee, MD

Wake Forest University School of Medicine
PI: Hal H. Atkinson, MD, MS
Co-PI: Kirsten Feiereisel, MD

2011-2013

Funded by the Hearst Foundations

Northeast Ohio Medical University
PI: Anthony J. Costa, MD
Co-PI: Natalie Kayani, MD

Stony Brook School of Medicine
PI: Lisa Strano-Paul, MD
Co-PI: Catherine Nicastri, MD

University of Arizona
PI: Mindy J. Fain, MD
Co-PI: Andreas A. Theodorou, MD
Co-PI: Amy Lynn Waer, MD

Warren Alpert School of Medicine of Brown University
PI: Lynn McNicoll, MD
Co-PI: Staci Fischer, MD

2012-2014

Funded by the Hearst Foundations

Duke University Medical Center
PI: Heidi White, MD
Co-PI: Sandhya A. Lagoo-Deenadayalan, MD, PhD

Emory University
PI: Curtis Lewis, MD
Co-PI: Ugochi Ohuabunwa, MD

Mount Sinai School of Medicine
PI: Brijen J. Shah, MD
Co-PI: Helen Fernandez, MD, MPH

Texas Tech University Health Sciences Center
PI: Monique Williams, MD
Co-PI: Betsy Goebel Jones, Ed.D.

University of Pennsylvania
PI: Jerry Johnson, MD
Co-PI: Lily Arya, MD, MS

University of Texas Southwestern Medical Center
PI: Bradley Marple, MD
Co-PI: Vivyenne Roche, MD, FACP, AGSF

University of Utah
PI: Katherine Anderson, MD
Co-PI: Megan Fix, MD

Funded by the Donald W. Reynolds Foundation

Medstar Washington Hospital Center
PI: Namirah Jamshed, MD
Co-PI: James N. Debritz, MD

University of Texas Health Science Center at San Antonio
PI: Lois Bready, MD
Co-PI: Jeannette Ross, MD

William Beaumont Hospital/Oakland University Beaumont School of Medicine
PI: Khaled Imam, MD
Co-PI: Daniel Richardson, MD

2013-2015

Funded by the Hearst Foundations

University of California Los Angeles
PI: Randall Espinoza, MD, MPH
Co-PI: Nancy Weintraub, MD

University of Hawaii
PI: Aida Wen, MD
Co-PI: Richard Kasuya, MD, MSEd

University of Massachusetts Worcester
PI: Jerry Gurwitz, MD
Co-PI: Michele Pugnaire, MD

University of North Carolina Chapel Hill
PI: Debra Bynum, MD
Co-PI: Kevin Biese, MD

Funded by the Donald W. Reynolds Foundation

Eastern Virginia Medical School
PI: Robert M. Palmer, MD
Co-PI: Linda Archer, PhD

Sinai Hospital of Baltimore/LifeBridge
PI: Mark Katlic, MD
Co-PI: Susan Levy, MD

University of Louisville
PI: Christian D. Furman, MD, MSPH
Co-PI: Monica Ann Shaw, MD