Scholars@Duke
Mitchell Tod Heflin

Mitchell Tod Heflin

Professor of Medicine
Medicine, Geriatrics and Palliative Care
hefli001@mc.duke.edu
Duke Box 3322, Durham, NC 27710
4242 Ipe Building, 311 Trent Dr, Durham, NC 27710

Selected Publications

Increasing interprofessional education experiences and collaboration: Outcomes of a virtually-based continuing education program

Journal Article Journal of Interprofessional Education and Practice · December 1, 2024 Purpose: An academic medical center implemented a yearlong virtual continuing education program to prepare health professions educators to develop, deploy and evaluate new interprofessional educational experiences for providers and learners. Materials and ... Full text Cite

Building an Interprofessional Health Workforce through Pathways, Training, and Retention.

Journal Article N C Med J · May 2024 Population growth in North Carolina is contributing to health care workforce shortages, particularly in rural and underserved areas. Professions affected most include pub-lic health, nursing, behavioral health, and direct care. We describe efforts to grow ... Full text Link to item Cite

Stress First Aid for Health-care Workers: An Indicated Mental Illness Prevention Program for Nursing Education.

Journal Article Nurs Clin North Am · March 2024 Spurred by a global pandemic, the incidence and prevalence of stress-related injury and illness continues to increase amid an overburdened nursing workforce that has remarkably and reliably performed on the frontlines of health care. Indicated mental illne ... Full text Link to item Cite

Development, Implementation, and Assessment of an Online Modular Telehealth Curriculum for Health Professions Students.

Journal Article Adv Med Educ Pract · 2024 PURPOSE: Several national health profession organizations endorse or have developed competencies for telehealth, yet there is no standardized curriculum for teaching telehealth to health professions students. Additionally, implementing telehealth curricula ... Full text Link to item Cite

Creating opportunities for telehealth education, assessment, and care through Hotspotting (CO-TEACH): An interprofessional telehealth delivery curriculum and guide

Journal Article Journal of Interprofessional Education and Practice · June 1, 2023 Telehealth offers a healthcare solution when functional, social, or geographic barriers arise; however, many clinical education curricula are ill-equipped to prepare learners for effective, multidisciplinary telehealth consultations. The COVID-19 pandemic ... Full text Cite

Delirium education for geriatric patients and their families: A quality improvement initiative✰

Journal Article Aging and Health Research · March 1, 2023 Delirium affects up to 50% of hospitalized older adults, contributing to poor outcomes. Family members can be engaged in delirium identification, prevention, and management. Rapid cycle improvement methodology was utilized to create a new educational hando ... Full text Cite

Participatory research to improve medication reconciliation for older adults in the community.

Journal Article J Am Geriatr Soc · February 2023 INTRODUCTION: Medication reconciliation, a technique that assists in aligning a care team's understanding of an individual's true medication regimen, is vital to optimize medication use and prevent medication errors. Historically, most medication reconcili ... Full text Open Access Link to item Cite

The interagency care team: A new model to integrate social and medical care for older adults in primary care.

Journal Article Geriatr Nurs · 2023 To integrate management of social drivers of health with complex clinical needs of older adults, we connected patients aged 60 and above from primary care practices with a nurse practitioner (NP) led Interagency Care Team (ICT) of geriatrics providers and ... Full text Link to item Cite

A Processed Electroencephalogram-Based Brain Anesthetic Resistance Index Is Associated With Postoperative Delirium in Older Adults: A Dual Center Study.

Journal Article Anesth Analg · January 1, 2022 BACKGROUND: Some older adults show exaggerated responses to drugs that act on the brain. The brain's response to anesthetic drugs is often measured clinically by processed electroencephalogram (EEG) indices. Thus, we developed a processed EEG-based measure ... Full text Link to item Cite

Geriatric Preoperative Optimization: A Review.

Journal Article Am J Med · January 2022 This review summarizes best practices for the perioperative care of older adults as recommended by the American Geriatrics Society, American Society of Anesthesiologists, and American College of Surgeons, with practical implementation strategies that can b ... Full text Link to item Cite

Developing a Real-Time Electroencephalogram-Guided Anesthesia-Management Curriculum for Educating Residents: A Single-Center Randomized Controlled Trial.

Journal Article Anesth Analg · January 1, 2022 BACKGROUND: Different anesthetic drugs and patient factors yield unique electroencephalogram (EEG) patterns. Yet, it is unclear how best to teach trainees to interpret EEG time series data and the corresponding spectral information for intraoperative anest ... Full text Link to item Cite

Perioperative Optimization of Senior Health (POSH): A Descriptive Analysis of Cancelled Surgery.

Conference World J Surg · January 2021 BACKGROUND: Geriatric collaborative care models improve postoperative outcomes for older adults. However, there are limited data exploring how preoperative geriatric assessment may affect surgical cancellations. METHODS: This is a single-center retrospecti ... Full text Link to item Cite

Planning for a Safe Discharge: More Than a Capacity Evaluation.

Journal Article J Am Geriatr Soc · April 2020 Discharge decision making for hospitalized older adults can be a complicated process involving functional assessments, capacity evaluation, and coordination of resources. Providers may feel pressured to recommend that an older adult with complex care needs ... Full text Link to item Cite

An innovative educational clinical experience promoting geriatric exercise.

Journal Article Gerontol Geriatr Educ · 2020 Formal educational training in physical activity promotion is relatively sparse throughout the medical education system. The authors describe an innovative clinical experience in physical activity directed at medical clinicians on a geriatrics rotation. Th ... Full text Link to item Cite

Delaying Elective Surgery in Geriatric Patients: An Opportunity for Preoperative Optimization.

Journal Article Anesth Analg · January 2020 Deciding whether to pursue elective surgery is a complex process for older adults. Comprehensive geriatric assessment (CGA) can help refine estimates of benefits and risks, at times leading to a delay of surgery to optimize surgical readiness. We describe ... Full text Open Access Link to item Cite

The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain Inflammation, DeLirium, and PostopErative Cognitive Dysfunction.

Journal Article J Alzheimers Dis · 2020 BACKGROUND: Perioperative neurocognitive disorders (PND) are common complications in older adults associated with increased 1-year mortality and long-term cognitive decline. One risk factor for worsened long-term postoperative cognitive trajectory is the A ... Full text Open Access Link to item Cite

Biology of Aging

Chapter · January 1, 2020 Principles distilled from geroscience, the scientific study of aging, can facilitate surgical decision making by identifying appropriate surgical candidates, anticipating surgical complications, and predicting functional outcomes. Theories of aging can be ... Full text Cite

Geriatric Resource Teams: Equipping Primary Care Practices to Meet the Complex Care Needs of Older Adults.

Journal Article Geriatrics (Basel) · October 21, 2019 Primary care practices lack the time, expertise, and resources to perform traditional comprehensive geriatric assessment. In particular, they need methods to improve their capacity to identify and care for older adults with complex care needs, such as cogn ... Full text Link to item Cite

Exploring patient-provider decision-making for use of anticoagulation for stroke prevention in atrial fibrillation: Results of the INFORM-AF study.

Journal Article Eur J Cardiovasc Nurs · April 2019 BACKGROUND: Atrial fibrillation is associated with stroke, yet approximately 50% of patients are not treated with guideline-directed oral anticoagulants (OACs). AIMS: Given that the etiology of this gap in care is not well understood, we explored decision- ... Full text Link to item Cite

Development and validation of machine learning models to identify high-risk surgical patients using automatically curated electronic health record data (Pythia): A retrospective, single-site study.

Journal Article PLoS Med · November 2018 BACKGROUND: Pythia is an automated, clinically curated surgical data pipeline and repository housing all surgical patient electronic health record (EHR) data from a large, quaternary, multisite health institute for data science initiatives. In an effort to ... Full text Link to item Cite

Association of Integrated Care Coordination With Postsurgical Outcomes in High-Risk Older Adults: The Perioperative Optimization of Senior Health (POSH) Initiative.

Journal Article JAMA Surg · May 1, 2018 IMPORTANCE: Older adults undergoing elective surgery experience higher rates of preventable postoperative complications than younger patients. OBJECTIVE: To assess clinical outcomes for older adults undergoing elective abdominal surgery via a collaborative ... Full text Link to item Cite

Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model.

Journal Article J Am Geriatr Soc · March 2018 OBJECTIVES: To compare postoperative outcomes of individuals with and without cognitive impairment enrolled in the Perioperative Optimization of Senior Health (POSH) program at Duke University, a comanagement model involving surgery, anesthesia, and geriat ... Full text Open Access Link to item Cite

Preoperative Screening.

Journal Article Clin Geriatr Med · February 2018 Older adults undergoing elective surgical procedures suffer higher rates of morbidity and mortality than younger patients. A geriatric-focused preoperative evaluation can identify risk factors for complications and opportunities for health optimization and ... Full text Link to item Cite

A Perioperative Medicine Model for Population Health: An Integrated Approach for an Evolving Clinical Science.

Journal Article Anesth Analg · February 2018 Health care delivery in the United States continues to balance on the tight rope that connects its transition from volume to value. Value in economic terms can be defined as the amount something exceeds its commodity price and is determined by extraordinar ... Full text Link to item Cite

A problem-based learning curriculum in geriatrics for medical students.

Journal Article Gerontol Geriatr Educ · 2018 A geriatrics curriculum delivered to medical students was evaluated in this study. Students were instructed to review real patient cases, interview patients and caregivers, identify community resources to address problems, and present a final care plan. Au ... Full text Link to item Cite

Internal Medicine Residents' Ambulatory Management of Core Geriatric Conditions.

Journal Article J Grad Med Educ · June 2017 BACKGROUND: Adults aged 65 years and older account for more than 33% of annual visits to internal medicine (IM) generalists and specialists. Geriatrics experiences are not standardized for IM residents. Data are lacking on IM residents' continuity experien ... Full text Link to item Cite

In Reply to van den Broek et al.

Journal Article Acad Med · December 2016 Full text Link to item Cite

Incorporating shared decision making into perioperative care of older adults

Journal Article Current Surgery Reports · August 1, 2016 Purpose of review Older patients represent a growing and significant portion of the surgical population. Due to age-related changes in physiology and the presence of multiple comorbidities, older patients are more likely to experience complications, functi ... Full text Cite

Development of a Health Professions Education Research-Specific Institutional Review Board Template.

Journal Article Acad Med · February 2016 PROBLEM: Health professions education (HPE) has become a core component of the mission of academic health centers (AHCs) nationwide. The volume of HPE research projects being reviewed has increased, presenting new challenges for institutional review boards ... Full text Link to item Cite

Cancer Screening in Older Adults.

Journal Article Clin Geriatr Med · February 2016 Cancer screening is an important tool for reducing morbidity and mortality in the elderly. In this article, performance characteristics of commonly used screening tests for colorectal, lung, prostate, breast, and cervical cancers are discussed. Guidelines ... Full text Link to item Cite

Clinical Quality Improvement Curriculum for Faculty in an Academic Medical Center.

Journal Article Am J Med Qual · 2016 Interested faculty enrolled in this 6-month-long quality improvement (QI) course to facilitate independent QI project work. The course included monthly 1.5-hour sessions: 20-minute presentations covering key QI concepts, then small group activities to faci ... Full text Link to item Cite

Health Professions Education Research and the Institutional Review Board.

Journal Article Nurse Educ · 2016 The growth in health professions education (HPE) and a desire on the part of nurse and medical educators to disseminate their work have raised important questions about the ethical conduct of education research. At the center of the debate is the instituti ... Full text Link to item Cite

Surviving the Silver Tsunami: Training a Health Care Workforce to Care for North Carolina's Aging Population.

Journal Article N C Med J · 2016 North Carolina's aging population will require a health care workforce prepared to meet patients' complex care needs. The keys to training this workforce include continuing to mobilize the state's educational infrastructure to provide interprofessional, co ... Full text Link to item Cite

Advancing Geriatrics Education Through a Faculty Development Program for Geriatrics-Oriented Clinician Educators.

Journal Article J Am Geriatr Soc · December 2015 Geriatrician and nongeriatrician faculty need instruction as teachers to provide quality training for a broader community of physicians who can care for the expanding population of older adults. Educators at Duke University designed a program to equip geri ... Full text Open Access Link to item Cite

Effect of a Novel Interdisciplinary Teaching Program in the Care-continuum on Medical Student Knowledge and Self-Efficacy.

Journal Article J Am Med Dir Assoc · October 1, 2015 OBJECTIVES: Medical students report that they receive inadequate training in different levels of care, including care transitions to and from post-acute (PA) and long-term care (LTC). The authors implemented the Medical Students as Teachers in Extended Car ... Full text Link to item Cite

GME Concentrations: A Collaborative Interdisciplinary Approach to Learner-Driven Education.

Journal Article J Grad Med Educ · September 2015 BACKGROUND: Graduate medical education (GME) programs may struggle to provide the knowledge, skills, and experiences necessary to meet trainee career interests and goals beyond a clinical focus. Sponsoring institutions can partner with programs to deliver ... Full text Link to item Cite

Using the jigsaw cooperative learning method to teach medical students about long-term and postacute care.

Journal Article J Am Med Dir Assoc · June 2014 Since many of the frailest and most vulnerable Americans reside in nursing homes, medical students need focused education and training pertaining to this setting. A unique cooperative learning experience utilizing the jigsaw method was developed to engage ... Full text Link to item Cite

An educational intervention to improve internal medicine interns' awareness of hazards of hospitalization in acutely ill older adults.

Journal Article J Am Geriatr Soc · April 2014 Hospitalized older adults are susceptible to complications termed "hazards of hospitalization" (HOH), which collectively result in poor patient outcomes. Previous research has shown that residents are not aware of their patients' risk factors for HOH. This ... Full text Link to item Cite

Development and implementation of a formalized geriatric surgery curriculum for general surgery residents.

Journal Article Gerontol Geriatr Educ · 2014 Despite the growth of the elderly population, most surgical training programs lack formalized geriatric education. The authors' aim was to implement a formalized geriatric surgery curriculum at an academic medical center. Surgery residents were surveyed on ... Full text Link to item Cite

Design and evaluation of a prelicensure interprofessional course on improving care transitions.

Conference Gerontol Geriatr Educ · 2014 Effective management of care transitions for older adults require the coordinated expertise of an interprofessional team. Unfortunately, different health care professions are rarely educated together or trained in teamwork skills. To address this issue, a ... Full text Link to item Cite

Educational interventions to improve recognition of delirium: a systematic review.

Journal Article J Am Geriatr Soc · November 2013 Delirium is a common and serious condition that is underrecognized in older adults in a variety of healthcare settings. It is poorly recognized because of deficiencies in provider knowledge and its atypical presentation. Early recognition of delirium is wa ... Full text Open Access Link to item Cite

An advanced course in long term care for geriatric medicine fellows.

Journal Article J Am Med Dir Assoc · July 2013 Long term care deserves focused attention within a geriatric medicine fellowship curriculum to ensure that graduates are prepared not only for clinical care but also for the leadership, administrative, educational, quality improvement, and health policy as ... Full text Link to item Cite

Exploring predictors of complication in older surgical patients: a deficit accumulation index and the Braden Scale.

Journal Article J Am Geriatr Soc · September 2012 OBJECTIVES: To determine whether readily collected perioperative information might identify older surgical patients at higher risk of complications. DESIGN: Retrospective cohort study. SETTING: Medical chart review at a single academic institution. PARTICI ... Full text Link to item Cite

The Donald W. Reynolds Consortium for Faculty Development to Advance Geriatrics Education (FD~AGE): a model for dissemination of subspecialty educational expertise.

Journal Article Acad Med · May 2012 PURPOSE: Most U.S. medical schools and training programs lack sufficient faculty expertise in geriatrics to train future physicians to care for the growing population of older adults. Thus, to reach clinician-educators at institutions and programs that hav ... Full text Link to item Cite

Health care utilization before and after an outpatient ED visit in older people.

Journal Article Am J Emerg Med · January 2012 BACKGROUND: Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population. OBJECTIVES: ... Full text Link to item Cite

Ensuring vitamin D supplementation in nursing home patients--a quality improvement project.

Journal Article J Nutr Gerontol Geriatr · 2012 Randomized controlled trials have shown that adequate vitamin D supplementation in nursing home (NH) residents reduces the rates of falls and fractures. In our NH, review of medication administration records of all patients (n = 101) revealed that only 34. ... Full text Link to item Cite

The need for an aging and cancer curriculum for hematology/oncology trainees

Journal Article Journal of Geriatric Oncology · October 1, 2010 Purpose: There has long been recognition for the need of education and training in aging and cancer. As the proportion of older individuals in the United States increases, with 20% being over 65 by 2030, it will become increasingly important for hematology ... Full text Cite

'So you want to be a clinician-educator...': designing a clinician-educator curriculum for internal medicine residents.

Journal Article Med Teach · June 2009 BACKGROUND: Despite a growing demand for skilled teachers and administrators in graduate medical education, clinician-educator tracks for residents are rare and though some institutions offer 'resident-as-teacher' programs to assist residents in developing ... Full text Link to item Cite

A qualitative study of physicians' experiences with online learning in a masters degree program: benefits, challenges, and proposed solutions.

Journal Article Med Teach · February 2009 BACKGROUND: In response to challenges to faculty development (e.g. time away from clinical, teaching, and other responsibilities; lack of mentors; and limited resources) online learning has become an important venue to provide education for physicians in c ... Full text Link to item Cite

When home care is not enough.

Journal Article Virtual Mentor · June 1, 2008 Full text Link to item Cite

Post-hospital clinic for older patients and their family caregivers

Journal Article Annals of Long Term Care · May 1, 2008 As a complementary service to our Geriatric Evaluation and Management Clinic, the geriatrics Post-Hospital Clinic (PHC) was recently established for prompt follow-up assessment and care of our geriatric patients and their caregivers after hospital discharg ... Cite

The geriatrics excellence in teaching series: an integrated educational skills curriculum for faculty and fellows development.

Journal Article J Am Geriatr Soc · April 2008 Geriatricians need to acquire skills in teaching and curriculum development to educate physicians caring for the growing population of adults aged 65 and older. To meet this challenge, educators in the Duke University Center for the Study of Aging and Huma ... Full text Link to item Cite

Overview of aging

Chapter · January 1, 2008 Over the course of the twentieth century, the number of Americans over the age of 65 years increased from 3 million to over 35 million. Concurrently, the population of those over age 85 years has grown from 100,000 to over 4 million and, by the end of the ... Cite

Overview of aging

Chapter · November 1, 2007 Cite

Faculty development for the 21st century: lessons from the Society of General Internal Medicine-Hartford Collaborative Centers for the Care of Older Adults.

Journal Article J Am Geriatr Soc · June 2007 In this review of a recent set of faculty development initiatives to promote geriatrics teaching by general internists, nontraditional strategies to promote sustained change were identified, included enrolling a limited number of "star" faculty, creating o ... Full text Link to item Cite

The impact of health status on physicians' intentions to offer cancer screening to older women.

Journal Article J Gerontol A Biol Sci Med Sci · August 2006 BACKGROUND: Screening for breast and cervical cancer reduces disease-specific mortality, but high rates of comorbidity and disability among elderly persons may alter the risks and benefits of screening. METHODS: We performed a mail survey of primary care p ... Full text Link to item Cite

Patterns and predictors of smoking cessation in an elderly cohort.

Journal Article J Am Geriatr Soc · March 2006 OBJECTIVES: To identify subject characteristics that predict smoking cessation and describe patterns of cessation and recidivism in a cohort of elderly smokers. DESIGN: Prospective cohort study. SETTING: Piedmont region, North Carolina. PARTICIPANTS: Five ... Full text Link to item Cite

The Senior Mentor Program at Duke University School of Medicine.

Journal Article Gerontol Geriatr Educ · 2006 The Duke University School of Medicine has a unique curriculum in which students complete basic sciences in year 1 and clinical clerkships in year 2, making way for an entire year of independent study in year 3. Into this compact curriculum, education in g ... Full text Link to item Cite

A systematic review of interventions to improve outcomes for elders discharged from the emergency department.

Journal Article Acad Emerg Med · October 2005 OBJECTIVES: To evaluate the evidence for interventions designed to improve outcomes for elders discharged from the emergency department (ED). METHODS: The study was a systematic review of English-language articles indexed in MEDLINE and CINAHL (1966-2005) ... Full text Link to item Cite

Osteoarthritis: Its course in older patients and current treatment methods

Journal Article Clinical Geriatrics · July 1, 2005 Treatment of osteoarthritis is tailored to a patient's symptoms and functional ability. Patients with mild OA may be managed with nonopioid pain medications such as acetaminophen, physical therapy, and nonpharmacologic therapies. The use of NSAIDs and COX- ... Cite

Duke University School of Medicine.

Journal Article Acad Med · July 2004 Full text Link to item Cite

Cancer in the elderly: to screen or not to screen?

Journal Article J Am Geriatr Soc · December 2003 Full text Link to item Cite

Letter: To the editor [1] (multiple letters)

Journal Article Dermatologic Surgery · September 1, 2003 Full text Cite

The effect of comorbid illness on receipt of cancer screening by older people.

Journal Article J Am Geriatr Soc · October 2002 OBJECTIVES: To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people. DESIGN: Sixth annual follow-up of a community-based survey with 4,162 participants aged 65 a ... Full text Link to item Cite

Cancer screening in the elderly.

Journal Article Hosp Pract (1995) · March 15, 2001 A number of disease- and patient-specific factors need to be taken into account when cancer screening is considered in an older patient. They include the impact of aging on the cancer's biology and screening test performance, the patient's remaining years ... Full text Link to item Cite