Top of Form

The University of Chicago
Division of the Biological Sciences and the Pritzker School of Medicine
Care of the Hospitalized Aging Medical Patient (CHAMP)
CHAMP is an educational project aimed at improving the care of older adult patients within the University of Chicago Medical Center. This survey enables us to identify baseline levels of geriatric practice and teaching among residents.
- You can save any work on this survey at any time by using the Save button (at the bottom of each page).
- You can return to your partially completed survey by simply following the link (URL) given in the email invitation.
We appreciate your cooperation.
The CHAMP Project Evaluation Team

We want you to focus on your clinical practice in the hospital. We are interested in how confident you feel performing a range of clinical skills, how important they are to your hospital practice, and how often you perform them.
The Importance of the Practice of Clinical Skills in the Hospital Care of Older Adult Patients

How important is it for you to: / Degree of Importance
Unimportant / Somewhat Important / Moderately Important / Very Important / Extremely Important
Conduct functional status assessments in hospitalized older adult patients? / / / / /
Conduct cognitive assessments in hospitalized older adult patients? / / / / /
Assess risk and prevent delirium in hospitalized older adult patients? / / / / /
Reduce polypharmacy and use of high risk/low benefit drugs in hospitalized older adult patients? / / / / /
Screen for depression in hospitalized older adult patients? / / / / /
Determine appropriateness for urinary (Foley) catheter use, discontinuing when inappropriate in hospitalized older adult patients? / / / / /
Mobilize hospitalized older adult patients early to prevent deconditioning? / / / / /
Routinely perform a complete skin exam in hospitalized older adult patients? / / / / /
Document advance directives and DNR orders with hospitalized older adult patients? / / / / /
Give bad news? / / / / /
Discuss hospice care with hospitalized older adult patients? / / / / /
Routinely assess pain at bedside in persons with dementia? / / / / /
Manage pain using the WHO 3-step ladder and opiate conversion table, and manage side effects of opiates? / / / / /
Identify risk factors of hospital falls, including conventional and unconventional types of restraints? / / / / /
Develop safe and appropriate discharge plans for older adult patients, beginning shortly after admission and involving communication with other members of the multidisciplinary team (e.g. SW and case manager), family members, and primary care physicians? / / / / /

Confidence in Performing Geriatric Clinical Skills in the Hospital

How confident do you feel in your ability to: / Your Level of Confidence
Very Low / Low / Moderate / High / Very High
Conduct functional status assessments in hospitalized older adult patients? / / / / /
Conduct cognitive assessments in hospitalized older adult patients? / / / / /
Assess risk and prevent delirium in hospitalized older adult patients? / / / / /
Reduce polypharmacy and use of high risk/low benefit drugs in hospitalized older adult patients? / / / / /
Screen for depression in hospitalized older adult patients? / / / / /
Determine appropriateness for urinary (Foley) catheter use, discontinuing when inappropriate in hospitalized older adult patients? / / / / /
Mobilize hospitalized older adult patients early to prevent deconditioning? / / / / /
Routinely perform a complete skin exam in hospitalized older adult patients? / / / / /
Document advance directives and DNR orders with hospitalized older adult patients? / / / / /
Give bad news? / / / / /
Discuss hospice care with hospitalized older adult patients? / / / / /
Routinely assess pain at bedside in persons with dementia? / / / / /
Manage pain using the WHO 3-step ladder and opiate conversion table, and manage side effects of opiates? / / / / /
Identify risk factors of hospital falls, including conventional and unconventional types of restraints? / / / / /
Develop safe and appropriate discharge plans for older adult patients, beginning shortly after admission and involving communication with other members of the multidisciplinary team (e.g. SW and case manager), family members, and primary care physicians? / / / / /

The Frequency of your Practice of Geriatric Clinical Skills in the Hospital

How often do you: / Frequency
Never / Some-times / Often / Very Often / Always
Conduct functional status assessments in hospitalized older adult patients? / / / / /
Conduct cognitive assessments in hospitalized older adult patients? / / / / /
Assess risk and prevent delirium in hospitalized older adult patients? / / / / /
Reduce polypharmacy and use of high risk/low benefit drugs in hospitalized older adult patients? / / / / /
Screen for depression in hospitalized older adult patients? / / / / /
Determine appropriateness for urinary (Foley) catheter use, discontinuing when inappropriate in hospitalized older adult patients? / / / / /
Mobilize hospitalized older adult patients early to prevent deconditioning? / / / / /
Routinely perform a complete skin exam in hospitalized older adult patients? / / / / /
Document advance directives and DNR orders with hospitalized older adult patients? / / / / /
Give bad news? / / / / /
Discuss hospice care with hospitalized older adult patients? / / / / /
Routinely assess pain at bedside in persons with dementia? / / / / /
Manage pain using the WHO 3-step ladder and opiate conversion table, and manage side effects of opiates? / / / / /
Identify risk factors of hospital falls, including conventional and unconventional types of restraints? / / / / /
Develop safe and appropriate discharge plans for older adult patients, beginning shortly after admission and involving communication with other members of the multidisciplinary team (e.g. SW and case manager), family members, and primary care physicians? / / / / /

Bottom of Form