Primary Care Trainees Learn to Support Aging in Place Through a Virtual Area Agency on Aging Practicum

Connecting older adults to community resources is essential to their health, well-being, and ability to age in place. Area Agencies on Aging (AAAs) are key drivers for meeting these needs throughout the United States [1]. However, there are limited training opportunities that expose future primary care providers to the wealth of resources available through AAAs. To address this gap, the Northwest Geriatrics Workforce Enhancement Center partnered with three AAAs in Washington State to develop and implement a practicum for primary care trainees (originally developed as an in-person experience) [2]. While successful, its reach was limited to trainees geographically proximal to an AAA, which may perpetuate unintended learning disparities [3]. To address this important limitation of the original practicum, we developed a virtual version and implemented it in partnership with the three AAAs. Herein, we describe the virtual AAA Practicum and present evaluative findings. The evaluation assessed trainee knowledge of and confidence to invoke community-based resources to help older adults age in place. The virtual practicum was adapted from the original AAA practicum, which utilized in-person visits to the AAA and in-person, “experiential” visits with AAA case managers. For the virtual format, online modules were created by AAAs. These AAAs were located in King County, Southwest Washington, and Southeast Washington. Two AAAs trained Family medicine (FM) resident physicians, while the third trained advanced registered nurse practitioner (ARNP) students and geriatric medicine fellows. Trainees were given protected time by their respective training programs to complete the practicum. AAA staff implemented the virtualized curriculum for trainees (Figure 1). It consisted of seven online modules that introduced trainees to AAAs and their core services. Each module included videos (less than 16 min each) that incorporated client examples [4]. After reviewing the modules, trainees were asked to spend 1–2.5 h in independent learning to familiarize themselves with agency-specific resources via hyperlinks and PDFs. Thereafter, trainees had videoconferences (usually one-on-one) with AAA staff to debrief, reflect on learning, and discuss resources relevant to their own patients. At one AAA, some trainees also had an opportunity to complete a virtual experiential with aging network providers (e.g., attend evidence-based exercise or wellness programs). Later in the evaluation period, two AAAs offered in-person experientials (e.g., case management visits). AAA staff distributed confidential pre–post surveys in SurveyMonkey (SurveyMonkey Inc., San Mateo, CA). Both pre- and post-surveys (Data S1) asked about the trainee's frequency of referring their patients to AAAs, familiarity with age-friendly care, and confidence on seven items related to understanding and utilizing AAA resources. Post-only questions asked trainees to rate the extent to which the practicum (1) met their expectations, (2) prepared them to connect older adults and caregivers to resources that support aging in place (on a 5-point Likert scale of excellent, good, average, fair or poor), and (3) whether they would change their practice as a result of the practicum (yes/no), as well as (4) an open-ended question asking trainees to describe what they would do differently in their practice. We compared pre- and post-practicum responses as well as comparisons between trainees who had modules only (no experiential visit) to those who had any type of experiential visit using Wilcoxon signed-rank tests with an α level of 0.05 in Stata (v13, College Station, Texas). The University of Washington Human Subjects Division guidance indicated this activity was not human subjects research. Between June 2021 and June 2024, 112 trainees completed the virtual practicum, including 83 FM resident physicians (74%), 17 ARNP students (15%), and 12 geriatric medicine fellows (11%). Response rates were 96% for pre-surveys and 75% for post-surveys. Of the 84 trainees who filled out both pre- and post-surveys, 46 trainees completed modules only (no experiential visit) and 38 completed an experiential visit: virtual, in-person, or both. Trainees significantly improved over all pre–post domains (p < 0.01), including how often they would refer, their familiarity with age-friendly care, and their confidence in utilizing AAA services. We found no differences on any measures between trainees who completed an experiential vs. modules only. Nearly all trainees (93%) reported that the program was “good” or “excellent” in meeting their expectations, and 95% indicated it did a “good” or “excellent” job of preparing them to connect older adults and caregivers with resources that promote aging in place. Ninety percent of trainees said the practicum would change the way they practice, with exemplar quotes including, “[I] feel more confident exploring the needs of older patients and then providing prompt referrals or resources for these needs” and “Ask more about social determinants of health now that I have more tools to address them.” A virtual AAA practicum was feasible and led to increased participant confidence in connecting older adults to relevant community-based resources. Although there are certainly benefits to an in-person, experiential practicum, the present analysis demonstrates that a virtual practicum is an effective alternative for enhancing trainee knowledge and confidence to link older adults and their care partners with AAA resources. These resources are an essential component of comprehensive high-quality, person-centered care of older adults that integrates social determinants of health. Strengths of this evaluation include its relatively large sample size, several trainee types across multiple sites, and high survey response rates. Additionally, we were able to compare trainees with and without experientials in their practicum, providing a surrogate for comparison to the original practicum. Limitations include the convenience sample of trainees, lack of ability to ascertain actual behavior, and inability to ascertain other influences (e.g., other geriatrics curricula) on trainee knowledge and confidence vis à vis AAAs and their resources. We demonstrated that a virtual practicum created through a community-academic partnership resulted in an impactful virtual learning experience for primary care trainees. Next steps include disseminating it beyond the original trainee groups to new audiences, including interdisciplinary team members in clinical settings and trainees in other AAA catchment areas across the United States. Broad uptake of the virtual AAA practicum holds substantial potential to increase the number of primary care teams that connect older adults and their care partners with resources that support aging in place, thereby contributing to the realization of this deeply valued personal goal. The author contributions can be categorized as the following: Substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data: Katherine A. Bennett, Breanne M. Wise-Swanson, Felicia Sanchez, Phung K. Nguyen, Mary P. O'Leary, Aimee M. Verrall. Drafting the article or revising it critically for important intellectual content: Katherine A. Bennett, Breanne M. Wise-Swanson, Felicia Sanchez, Phung K. Nguyen, Mary P. O'Leary, Aimee M. Verrall, Barbara B. Cochrane, Michael V. Vitiello, Elizabeth A. Phelan. Final approval of the version to be published: Katherine A. Bennett, Breanne M. Wise-Swanson, Felicia Sanchez, Phung K. Nguyen, Mary P. O'Leary, Aimee M. Verrall. Drafting the article or revising it critically for important intellectual content: Katherine A. Bennett, Breanne M. Wise-Swanson, Felicia Sanchez, Phung K. Nguyen, Mary P. O'Leary, Aimee M. Verrall, Barbara B. Cochrane, Michael V. Vitiello, Elizabeth A. Phela. The authors wish to express their sincerest appreciation to our Area Agencies on Aging partners who made this practicum possible and enriched the learning for trainees. This publication is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award, U1QHP28742, totaling $3,749,999 with zero percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by HRSA, HHS or the US Government. The authors declare no conflicts of interest. Data S1: Pre and post-survey administered before and after the practicum. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.