Training Internal Medicine Residents to Integrate Community-Based Resources into Care Plans for Older Adults

Training Internal Medicine Residents to Integrate Community-Based Resources into Care Plans for Older Adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Training Internal Medicine Residents to Integrate Community-Based Resources into Care Plans for Older Adults Joan L. Ilardo, Supratik Rayamajhi, Manoj Rai, Cristian Meghea, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5899437/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Physician training incorporates how to care for individuals with chronic conditions but typically not ways to integrate community-based resources into care plans. To address this educational gap, we developed the Caring for Patients with Chronic Conditions (CPCC) curriculum, introducing internal medicine residents to local organizations that provide self-management workshops and connections to non-medical services and supports. Objective This study evaluates the impact of a didactic curriculum on internal medicine residents’ confidence in integrating community-based resources into the care plans of older adults. Methods We piloted the CPCC curriculum from 2019 to 2021 in two internal medicine residency programs. The curriculum included didactic sessions and visits to community facilities. Data were collected via Qualtrics surveys to assess changes in residents' confidence in applying knowledge gained. The study was deemed exempt by the institutional review board. Results Among the 82 participating internal medicine residents, survey response rates were 37.8% for diabetes and 34.0% for dementia modules. Residents reported statistically significant confidence increases (p < 0.01) in dementia-related knowledge and in integrating diabetes self-management workshops (p = 0.03). Confidence in incorporating self-management skills into care plans also improved significantly (p = 0.05). Conclusions The CPCC curriculum effectively enhances internal medicine residents’ confidence in integrating community-based, non-medical resources into patient care plans. Such training can bridge gaps between graduate medical education and practical patient care, particularly for managing chronic conditions among older adults. Future expansions could incorporate interdisciplinary approaches, additional chronic diseases, and longitudinal assessments to evaluate impact on clinical outcomes and patient quality of life. Figures Figure 1 Figure 2 Introduction The integration of community-based resources into care plans for older adults is a critical component of comprehensive healthcare, yet it remains underemphasized in many training programs. Chronic conditions such as Type 2 Diabetes Mellitus (T2DM) and dementia are on the rise, with the Centers for Disease Control and Prevention (CDC) projecting their prevalence to double by 2050 [ 1 ]. These conditions not only compromise individual quality of life but also impose substantial economic burdens. For instance, the annual cost of diagnosed diabetes in the United States rose to $ 327 billion in 2017, up from $ 245 billion in 2012 [ 2 ], while dementia care costs for individuals aged 65 and older reached an estimated $ 305 billion in 2020 [ 3 ]. Moreover, projections suggest that the global population aged 65 and over will more than double by 2050 [ 4 ], emphasizing the urgent need for geriatric-focused training that addresses both clinical and non-medical factors. Addressing social determinants of health (SDOH)—such as access to nutritious food, transportation, and social support—is essential for effectively managing chronic conditions [ 5 ]. However, many physicians report inadequate preparation for these challenges. For example, a survey revealed that 22% of primary care physicians had no residency training in dementia care, while 65% of those who did receive training found it insufficient [ 6 ]. Similarly, only a minority of residents feel sufficiently equipped to discuss lifestyle interventions or refer patients to evidence-based workshops that support chronic disease self-management [ 7 ]. Recognizing these gaps in traditional medical education, researchers have stressed the need for geriatric-focused programs that incorporate both clinical and community-based elements [ 8 ]. In response, we developed the Caring for Patients with Chronic Conditions (CPCC) curriculum to enhance internal medicine residents’ competence in integrating community-based resources into care. Informed by studies highlighting the importance of bridging gaps in primary care training [ 9 ], the CPCC curriculum emphasizes practical engagement with community organizations. Additionally, the complexity of managing older adults with multiple comorbidities is underscored by resources such as the AGS Beers Criteria, which highlight how non-clinical factors can exacerbate polypharmacy risks [ 10 ]. This study evaluates the curriculum’s impact on internal medicine residents’ confidence in caring for older adults with dementia and diabetes, with a view to informing broader implementation in diverse residency settings. Methods The CPCC curriculum was piloted between 2019 and 2021 in two internal medicine residency programs, involving a total of 82 residents (45 in one program and 37 in the other). The curriculum was structured around three core components: Didactic Sessions: Presentations by experts from organizations such as Adult Protective Services, the Alzheimer’s Association, and the Area Agency on Aging covered topics including early detection and treatment of dementia, diabetes self-management, options counseling, and discharge planning. Community Site Visits: Residents visited facilities such as independent living centers, assisted-living facilities, Programs for All-Inclusive Care of the Elderly (PACE), Medicaid home and community-based waiver clients, and adult day care programs. These visits provided first-hand exposure to how non-medical supports can enhance clinical management. Interactive Discussions: Virtual or in-person discussions with program staff and participants enriched residents’ understanding of the lived experiences of patients and caregivers, particularly during the COVID-19 pandemic when in-person visits were constrained. These sessions also reinforced teamwork and communication skills. Data Collection and Analysis: Pre- and post-training surveys (administered via an online survey platform) were used to measure changes in residents’ confidence. These surveys employed a questionnaire specifically developed for this study’s curriculum content, which had not been used in prior versions of the program or in other studies. Residents rated their confidence on a 1–10 scale (1 = not confident, 10 = fully confident) for key skills and knowledge areas addressed by the CPCC curriculum. Paired t-tests were used to evaluate the statistical significance of changes in confidence scores. The study focused on two modules (dementia and diabetes). In accordance with ethical standards, the project was submitted to the Michigan State University Institutional Review Board (IRB) and was officially determined not to constitute “research” involving human subjects under the U.S. Department of Health and Human Services definition​ (MSU IRB Study ID: STUDY00001801). Because this initiative was deemed a program evaluation rather than research​, formal IRB approval was not required. Participation was completely voluntary, and informed consent was obtained via survey submission, as participants indicated their voluntary agreement to partake in the study by submitting the online survey​. This consent process was outlined in the CPCC online consent form, and respondents were free to skip any questions or withdraw at any time. Results Demographic Information Among the participating internal medicine residents: Gender: 30.5% female, 69.5% male. Ages ranged from the twenties to thirties. Residency Year: 32.9% PGY-1, 30.5% PGY-2, 36.6% PGY-3. Dementia Module Results Pre-training confidence scores ranged from 4.4 to 5.9. After the training, significant improvements (p < 0.01) were observed in all assessed dimensions: Confidence in explaining the importance of early detection/assessment increased by 2.1 points. Recognizing benefits of early detection improved by 2.3 points. Confidence in identifying dementia clinical trials increased by 2.3 points. Recognizing availability of standardized toolkits and training showed the greatest improvement, increasing by 2.9 points (66%). Diabetes Module Results Pre-training scores for diabetes-related knowledge ranged from 6.2 to 7.1. Statistically significant improvements included: Confidence in assisting patients with self-management skill workshops increased by 1.2 points (p = 0.03). Confidence in incorporating self-management skills into care plans improved by 1.1 points (p = 0.05). Although other areas showed positive trends (e.g., understanding the broader impact of diabetes on families), these changes did not reach statistical significance. Qualitative feedback indicated that residents highly valued hands-on exposure to community-based resources, suggesting potential benefits of further curriculum expansion. Discussion The CPCC curriculum effectively addresses deficits in traditional medical education by equipping internal medicine residents with the competencies necessary to integrate community-based resources into patient care plans. This alignment of clinical and non-medical factors is particularly vital in geriatric care, where multiple comorbidities, social isolation, and the need for interdisciplinary support often intersect. Residents’ increased confidence underscores how even brief exposures to community organizations can reshape their understanding of chronic disease management, especially for conditions like dementia and diabetes that significantly impact quality of life. Moreover, leveraging external support systems can help reduce healthcare fragmentation, improve patient adherence to therapies, and lower the risk of preventable hospital readmissions [ 1 , 2 ]. Collaborating with entities such as the Alzheimer’s Association and local aging agencies provides residents with practical insights into community partnerships that extend beyond routine clinical practice. Such interactions highlight the importance of social determinants of health—like transportation, housing, and nutrition—and demonstrate how seamless coordination across medical and non-medical settings can enhance overall health outcomes. Although the shift to virtual site visits during the COVID-19 pandemic presented challenges, it also created opportunities for broader participation and telehealth-based innovations. Future expansions of the curriculum might incorporate more robust remote learning tools, such as teleconferencing with community providers or virtual reality simulations that replicate home environments. Additionally, integrating longitudinal tracking of patient outcomes would offer deeper insight into how these community-based interventions affect medication adherence, self-management practices, and overall quality of life. By including conditions beyond dementia and diabetes, such as COPD or heart failure, subsequent iterations of the CPCC curriculum could address a wider range of geriatric conditions and tailor training to both clinical complexity and essential community support. Key Insights Dementia Care: Significant gains in dementia-related confidence underscore the importance of early detection, proactive management, and strong community ties to address the multifaceted needs of this patient population. Diabetes Management: Despite relatively higher baseline knowledge, residents still benefited from learning how to bridge clinical recommendations with self-management workshops and community interventions. Implications for Practice Broader Adaptation: Scaling the CPCC curriculum to other internal medicine training sites could mainstream the inclusion of non-medical resources in chronic disease management. Longitudinal Evaluations: Future research should measure outcomes like readmission rates, patient-reported quality of life, and functional independence. Interprofessional Collaboration: Deeper involvement of social workers, nurses, pharmacists, and allied health professionals can strengthen interdisciplinary care models. Cultural and Socioeconomic Considerations: Tailoring modules to diverse patient populations ensures equitable access to community-based supports. Challenges and Opportunities While virtual programs may lack some of the tangible benefits of in-person experiences, they allow broader reach and flexibility. Emerging technologies—including telemonitoring, remote patient education platforms, and AI-assisted care coordination—could transform how internal medicine residents learn to harness community resources. By refining both virtual and hybrid learning modalities, residency programs can maintain adaptability, ensuring the CPCC curriculum remains relevant and sustainable even in rapidly evolving healthcare landscapes. Future Directions: Expanding the curriculum to cover COPD, heart failure, and other chronic conditions. Longitudinal studies to assess patient outcomes such as readmission rates and quality of life. Incorporating interprofessional collaboration with social workers, pharmacists, and allied health professionals. Conclusions The CPCC curriculum shows significant potential for improving internal medicine residents’ confidence in integrating community-based resources into care plans for older adults, especially regarding dementia and diabetes management. By addressing both clinical and non-clinical elements of disease management, the program fosters a holistic, patient-centered approach that better serves an aging population. As geriatric healthcare becomes increasingly complex, widespread implementation of the CPCC curriculum could help optimize patient outcomes, reduce unnecessary healthcare expenditures, and guide residency training toward more collaborative and community-aligned models. Abbreviations CPCC: Caring for Patients with Chronic Conditions PACE: Program for All-Inclusive Care of the Elderly SDOH: Social Determinants of Health IRB: Institutional Review Board Declarations Ethics approval and consent to participate: This study was submitted to the Michigan State University Institutional Review Board (IRB) and determined not to constitute “research” involving human subjects according to the U.S. Department of Health and Human Services definition (MSU Study ID: STUDY00001801). Formal IRB approval was therefore not required. Participation was voluntary, and informed consent was obtained through participants' submission of the online survey. Participants were informed that they could skip any questions or withdraw at any time. The study adhered to ethical standards consistent with the Declaration of Helsinki. Consent for publication: Not applicable. Availability of data and materials: The datasets used and analyzed during this study are available from the corresponding author upon reasonable request. Competing Interests: The authors declare that they have no competing interests. Funding: This study was supported by an award from the Michigan Health Endowment Fund Healthy Aging Initiative (Grant number: G-1807-143204). Authors' contributions Joan L. Ilardo, Cristian Meghea, and Angela M. Zell conceptualized the study. Cristian Meghea and Angela M. Zell led data collection and statistical analysis. Supratik Rayamajhi contributed to the conceptual framework. Manoj Rai assisted with manuscript editing and submission processes. Adesuwa Olomu contributed to manuscript writing. All authors reviewed, provided feedback on, and approved the final manuscript. Acknowledgements: We thank the participating residents and community partners who contributed significantly to the success of the CPCC curriculum evaluation. References Centers for Disease Control and Prevention. Chronic Diseases and Their Impact on Public Health. Available at: https://www.cdc.gov/chronicdisease/index.htm . Accessed November 15, 2023. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917–28. 10.2337/dci18-0007 . Alzheimer’s A. 2020 Alzheimer’s Disease Facts and Figures. Alzheimers Dement. 2020;16(3):391–460. 10.1002/alz.12068 U.S. Census Bureau. 2017 National Population Projections Tables. Available at: https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html . Accessed June 10, 2023. National Institute on Aging. Social Determinants of Health in Older Adults. Available at: https://www.nia.nih.gov/research Alzheimer’s Association. Primary Care Physicians on the Front Lines of Diagnosing and Providing Alzheimer’s and Dementia Care. Available at: https://alz.org/news/2020/primary-care-physicians-on-the-front-lines-of-diag . Accessed January 20, 2021. Administration for Community Living. Evidence-Based Disease Prevention and Health Promotion Programs. Available at: https://acl.gov/programs/health-wellness/disease-prevention . Accessed February 2, 2022. Institute of Medicine (US) Committee on the Future Health Care Workforce for Older Americans. Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: National Academies; 2008. 10.17226/12089 . Smith RC, Laird-Fick H, Dwamena FC, et al. Teaching Residents Mental Health Care. Patient Educ Couns. 2018;101(12):2145–55. 10.1016/j.pec.2018.07.023 . American Geriatrics Society. 2022 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2022;70(6):1741–1757. 10.1111/jgs.17722 Tables Table 1. Pre-Post Changes in Residents’ Knowledge Dimension Pre-Score Post-Score Change P-Value Dementia Importance of early detection 5.7 7.8 +2.1 <0.01 Recognizing benefits of early detection 5.7 8.0 +2.3 <0.01 Recognizing availability of toolkits 4.4 7.3 +2.9 <0.01 Diabetes Assisting with self-management workshops 6.2 7.4 +1.2 0.03 Incorporating self-management into care plans 6.3 7.4 +1.1 0.05 Additional Declarations No competing interests reported. Supplementary Files CPCCQuestionnaires.docx CorrespondenceforSTUDY00001801d1.pdf Threetakeawaysallvisitdates.docx CPCCResidentSiteVisitFeedbackOct20andJan20.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5899437","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":434342684,"identity":"7fae7cf3-ff01-4205-b91b-5e39e622aa2b","order_by":0,"name":"Joan L. 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Chronic conditions such as Type 2 Diabetes Mellitus (T2DM) and dementia are on the rise, with the Centers for Disease Control and Prevention (CDC) projecting their prevalence to double by 2050 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These conditions not only compromise individual quality of life but also impose substantial economic burdens. For instance, the annual cost of diagnosed diabetes in the United States rose to \u003cspan\u003e$\u003c/span\u003e327\u0026nbsp;billion in 2017, up from \u003cspan\u003e$\u003c/span\u003e245\u0026nbsp;billion in 2012 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], while dementia care costs for individuals aged 65 and older reached an estimated \u003cspan\u003e$\u003c/span\u003e305\u0026nbsp;billion in 2020 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Moreover, projections suggest that the global population aged 65 and over will more than double by 2050 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], emphasizing the urgent need for geriatric-focused training that addresses both clinical and non-medical factors.\u003c/p\u003e \u003cp\u003eAddressing social determinants of health (SDOH)—such as access to nutritious food, transportation, and social support—is essential for effectively managing chronic conditions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, many physicians report inadequate preparation for these challenges. For example, a survey revealed that 22% of primary care physicians had no residency training in dementia care, while 65% of those who did receive training found it insufficient [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Similarly, only a minority of residents feel sufficiently equipped to discuss lifestyle interventions or refer patients to evidence-based workshops that support chronic disease self-management [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Recognizing these gaps in traditional medical education, researchers have stressed the need for geriatric-focused programs that incorporate both clinical and community-based elements [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn response, we developed the Caring for Patients with Chronic Conditions (CPCC) curriculum to enhance internal medicine residents’ competence in integrating community-based resources into care. Informed by studies highlighting the importance of bridging gaps in primary care training [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the CPCC curriculum emphasizes practical engagement with community organizations. Additionally, the complexity of managing older adults with multiple comorbidities is underscored by resources such as the AGS Beers Criteria, which highlight how non-clinical factors can exacerbate polypharmacy risks [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This study evaluates the curriculum’s impact on internal medicine residents’ confidence in caring for older adults with dementia and diabetes, with a view to informing broader implementation in diverse residency settings.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eThe CPCC curriculum was piloted between 2019 and 2021 in two internal medicine residency programs, involving a total of 82 residents (45 in one program and 37 in the other).\u003c/p\u003e\u003cp\u003eThe curriculum was structured around three core components: Didactic Sessions: Presentations by experts from organizations such as Adult Protective Services, the Alzheimer’s Association, and the Area Agency on Aging covered topics including early detection and treatment of dementia, diabetes self-management, options counseling, and discharge planning.\u003c/p\u003e\u003cp\u003eCommunity Site Visits: Residents visited facilities such as independent living centers, assisted-living facilities, Programs for All-Inclusive Care of the Elderly (PACE), Medicaid home and community-based waiver clients, and adult day care programs. These visits provided first-hand exposure to how non-medical supports can enhance clinical management.\u003c/p\u003e\u003cp\u003eInteractive Discussions: Virtual or in-person discussions with program staff and participants enriched residents’ understanding of the lived experiences of patients and caregivers, particularly during the COVID-19 pandemic when in-person visits were constrained. These sessions also reinforced teamwork and communication skills.\u003c/p\u003e\u003cp\u003eData Collection and Analysis: Pre- and post-training surveys (administered via an online survey platform) were used to measure changes in residents’ confidence. These surveys employed a questionnaire specifically developed for this study’s curriculum content, which had not been used in prior versions of the program or in other studies. Residents rated their confidence on a 1–10 scale (1 = not confident, 10 = fully confident) for key skills and knowledge areas addressed by the CPCC curriculum. Paired t-tests were used to evaluate the statistical significance of changes in confidence scores. The study focused on two modules (dementia and diabetes).\u003c/p\u003e\u003cp\u003e In accordance with ethical standards, the project was submitted to the Michigan State University Institutional Review Board (IRB) and was officially determined not to constitute “research” involving human subjects under the U.S. Department of Health and Human Services definition​ (MSU IRB Study ID: STUDY00001801). Because this initiative was deemed a program evaluation rather than research​, formal IRB approval was not required. Participation was completely voluntary, and informed consent was obtained via survey submission, as participants indicated their voluntary agreement to partake in the study by submitting the online survey​.\u003c/p\u003e\u003cp\u003eThis consent process was outlined in the CPCC online consent form, and respondents were free to skip any questions or withdraw at any time.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic Information\u003c/p\u003e \u003cp\u003eAmong the participating internal medicine residents:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eGender: 30.5% female, 69.5% male.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAges ranged from the twenties to thirties.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eResidency Year: 32.9% PGY-1, 30.5% PGY-2, 36.6% PGY-3.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eDementia Module Results\u003c/p\u003e \u003cp\u003ePre-training confidence scores ranged from 4.4 to 5.9. After the training, significant improvements (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) were observed in all assessed dimensions:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eConfidence in explaining the importance of early detection/assessment increased by 2.1 points.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRecognizing benefits of early detection improved by 2.3 points.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eConfidence in identifying dementia clinical trials increased by 2.3 points.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRecognizing availability of standardized toolkits and training showed the greatest improvement, increasing by 2.9 points (66%).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eDiabetes Module Results\u003c/p\u003e \u003cp\u003ePre-training scores for diabetes-related knowledge ranged from 6.2 to 7.1. Statistically significant improvements included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eConfidence in assisting patients with self-management skill workshops increased by 1.2 points (p\u0026thinsp;=\u0026thinsp;0.03).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eConfidence in incorporating self-management skills into care plans improved by 1.1 points (p\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAlthough other areas showed positive trends (e.g., understanding the broader impact of diabetes on families), these changes did not reach statistical significance. Qualitative feedback indicated that residents highly valued hands-on exposure to community-based resources, suggesting potential benefits of further curriculum expansion.\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eThe CPCC curriculum effectively addresses deficits in traditional medical education by equipping internal medicine residents with the competencies necessary to integrate community-based resources into patient care plans. This alignment of clinical and non-medical factors is particularly vital in geriatric care, where multiple comorbidities, social isolation, and the need for interdisciplinary support often intersect. Residents\u0026rsquo; increased confidence underscores how even brief exposures to community organizations can reshape their understanding of chronic disease management, especially for conditions like dementia and diabetes that significantly impact quality of life.\u003c/p\u003e \u003cp\u003eMoreover, leveraging external support systems can help reduce healthcare fragmentation, improve patient adherence to therapies, and lower the risk of preventable hospital readmissions [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Collaborating with entities such as the Alzheimer\u0026rsquo;s Association and local aging agencies provides residents with practical insights into community partnerships that extend beyond routine clinical practice. Such interactions highlight the importance of social determinants of health\u0026mdash;like transportation, housing, and nutrition\u0026mdash;and demonstrate how seamless coordination across medical and non-medical settings can enhance overall health outcomes.\u003c/p\u003e \u003cp\u003eAlthough the shift to virtual site visits during the COVID-19 pandemic presented challenges, it also created opportunities for broader participation and telehealth-based innovations. Future expansions of the curriculum might incorporate more robust remote learning tools, such as teleconferencing with community providers or virtual reality simulations that replicate home environments. Additionally, integrating longitudinal tracking of patient outcomes would offer deeper insight into how these community-based interventions affect medication adherence, self-management practices, and overall quality of life. By including conditions beyond dementia and diabetes, such as COPD or heart failure, subsequent iterations of the CPCC curriculum could address a wider range of geriatric conditions and tailor training to both clinical complexity and essential community support.\u003c/p\u003e \u003cp\u003eKey Insights\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eDementia Care: Significant gains in dementia-related confidence underscore the importance of early detection, proactive management, and strong community ties to address the multifaceted needs of this patient population.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDiabetes Management: Despite relatively higher baseline knowledge, residents still benefited from learning how to bridge clinical recommendations with self-management workshops and community interventions.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eImplications for Practice\u003c/p\u003e \u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eBroader Adaptation: Scaling the CPCC curriculum to other internal medicine training sites could mainstream the inclusion of non-medical resources in chronic disease management.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eLongitudinal Evaluations: Future research should measure outcomes like readmission rates, patient-reported quality of life, and functional independence.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e Interprofessional Collaboration: Deeper involvement of social workers, nurses, pharmacists, and allied health professionals can strengthen interdisciplinary care models.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCultural and Socioeconomic Considerations: Tailoring modules to diverse patient populations ensures equitable access to community-based supports.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e \u003cp\u003eChallenges and Opportunities\u003c/p\u003e \u003cp\u003eWhile virtual programs may lack some of the tangible benefits of in-person experiences, they allow broader reach and flexibility. Emerging technologies\u0026mdash;including telemonitoring, remote patient education platforms, and AI-assisted care coordination\u0026mdash;could transform how internal medicine residents learn to harness community resources. By refining both virtual and hybrid learning modalities, residency programs can maintain adaptability, ensuring the CPCC curriculum remains relevant and sustainable even in rapidly evolving healthcare landscapes.\u003c/p\u003e \u003cp\u003eFuture Directions:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eExpanding the curriculum to cover COPD, heart failure, and other chronic conditions.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLongitudinal studies to assess patient outcomes such as readmission rates and quality of life.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIncorporating interprofessional collaboration with social workers, pharmacists, and allied health professionals.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe CPCC curriculum shows significant potential for improving internal medicine residents\u0026rsquo; confidence in integrating community-based resources into care plans for older adults, especially regarding dementia and diabetes management. By addressing both clinical and non-clinical elements of disease management, the program fosters a holistic, patient-centered approach that better serves an aging population. As geriatric healthcare becomes increasingly complex, widespread implementation of the CPCC curriculum could help optimize patient outcomes, reduce unnecessary healthcare expenditures, and guide residency training toward more collaborative and community-aligned models.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003col\u003e\n \u003cli\u003eCPCC: Caring for Patients with Chronic Conditions\u003c/li\u003e\n \u003cli\u003ePACE: Program for All-Inclusive Care of the Elderly\u003c/li\u003e\n \u003cli\u003eSDOH: Social Determinants of Health\u003c/li\u003e\n \u003cli\u003eIRB: Institutional Review Board\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: This study was submitted to the Michigan State University Institutional Review Board (IRB) and determined not to constitute \u0026ldquo;research\u0026rdquo; involving human subjects according to the U.S. Department of Health and Human Services definition (MSU Study ID: STUDY00001801). Formal IRB approval was therefore not required. Participation was voluntary, and informed consent was obtained through participants\u0026apos; submission of the online survey. Participants were informed that they could skip any questions or withdraw at any time. The study adhered to ethical standards consistent with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The datasets used and analyzed during this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting Interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: This study was supported by an award from the Michigan Health Endowment Fund Healthy Aging Initiative (Grant number: G-1807-143204).\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003cbr\u003e\u0026nbsp;Joan L. Ilardo, Cristian Meghea, and Angela M. Zell conceptualized the study. Cristian Meghea and Angela M. Zell led data collection and statistical analysis. Supratik Rayamajhi contributed to the conceptual framework. Manoj Rai assisted with manuscript editing and submission processes. Adesuwa Olomu contributed to manuscript writing. All authors reviewed, provided feedback on, and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: We thank the participating residents and community partners who contributed significantly to the success of the CPCC curriculum evaluation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention. Chronic Diseases and Their Impact on Public Health. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/chronicdisease/index.htm\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/chronicdisease/index.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed November 15, 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917\u0026ndash;28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2337/dci18-0007\u003c/span\u003e\u003cspan address=\"10.2337/dci18-0007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlzheimer\u0026rsquo;s A. 2020 Alzheimer\u0026rsquo;s Disease Facts and Figures. \u003cem\u003eAlzheimers Dement.\u003c/em\u003e 2020;16(3):391\u0026ndash;460. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/alz.12068\u003c/span\u003e\u003cspan address=\"10.1002/alz.12068\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eU.S. Census Bureau. 2017 National Population Projections Tables. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html\u003c/span\u003e\u003cspan address=\"https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed June 10, 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Institute on Aging. Social Determinants of Health in Older Adults. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nia.nih.gov/research\u003c/span\u003e\u003cspan address=\"https://www.nia.nih.gov/research\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlzheimer\u0026rsquo;s Association. Primary Care Physicians on the Front Lines of Diagnosing and Providing Alzheimer\u0026rsquo;s and Dementia Care. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://alz.org/news/2020/primary-care-physicians-on-the-front-lines-of-diag\u003c/span\u003e\u003cspan address=\"https://alz.org/news/2020/primary-care-physicians-on-the-front-lines-of-diag\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed January 20, 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdministration for Community Living. Evidence-Based Disease Prevention and Health Promotion Programs. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://acl.gov/programs/health-wellness/disease-prevention\u003c/span\u003e\u003cspan address=\"https://acl.gov/programs/health-wellness/disease-prevention\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed February 2, 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInstitute of Medicine (US) Committee on the Future Health Care Workforce for Older Americans. Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: National Academies; 2008. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17226/12089\u003c/span\u003e\u003cspan address=\"10.17226/12089\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith RC, Laird-Fick H, Dwamena FC, et al. Teaching Residents Mental Health Care. Patient Educ Couns. 2018;101(12):2145\u0026ndash;55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pec.2018.07.023\u003c/span\u003e\u003cspan address=\"10.1016/j.pec.2018.07.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Geriatrics Society. 2022 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. \u003cem\u003eJ Am Geriatr Soc.\u003c/em\u003e 2022;70(6):1741\u0026ndash;1757. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jgs.17722\u003c/span\u003e\u003cspan address=\"10.1111/jgs.17722\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Pre-Post Changes in Residents\u0026rsquo; Knowledge\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"622\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003eDimension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003ePre-Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003ePost-Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eChange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003eDementia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003eImportance of early detection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e+2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003eRecognizing benefits of early detection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e+2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003eRecognizing availability of toolkits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e+2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003eAssisting with self-management workshops\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e+1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 314px;\"\u003e\n \u003cp\u003eIncorporating self-management into care plans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e+1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5899437/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5899437/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePhysician training incorporates how to care for individuals with chronic conditions but typically not ways to integrate community-based resources into care plans. To address this educational gap, we developed the Caring for Patients with Chronic Conditions (CPCC) curriculum, introducing internal medicine residents to local organizations that provide self-management workshops and connections to non-medical services and supports.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003e This study evaluates the impact of a didactic curriculum on internal medicine residents\u0026rsquo; confidence in integrating community-based resources into the care plans of older adults.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe piloted the CPCC curriculum from 2019 to 2021 in two internal medicine residency programs. The curriculum included didactic sessions and visits to community facilities. Data were collected via Qualtrics surveys to assess changes in residents' confidence in applying knowledge gained. The study was deemed exempt by the institutional review board.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 82 participating internal medicine residents, survey response rates were 37.8% for diabetes and 34.0% for dementia modules. Residents reported statistically significant confidence increases (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) in dementia-related knowledge and in integrating diabetes self-management workshops (p\u0026thinsp;=\u0026thinsp;0.03). Confidence in incorporating self-management skills into care plans also improved significantly (p\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe CPCC curriculum effectively enhances internal medicine residents\u0026rsquo; confidence in integrating community-based, non-medical resources into patient care plans. Such training can bridge gaps between graduate medical education and practical patient care, particularly for managing chronic conditions among older adults. Future expansions could incorporate interdisciplinary approaches, additional chronic diseases, and longitudinal assessments to evaluate impact on clinical outcomes and patient quality of life.\u003c/p\u003e","manuscriptTitle":"Training Internal Medicine Residents to Integrate Community-Based Resources into Care Plans for Older Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-31 06:41:53","doi":"10.21203/rs.3.rs-5899437/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"721e26a0-a9fb-4fd5-8eb7-236e8fceb616","owner":[],"postedDate":"March 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-08T14:09:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-31 06:41:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5899437","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5899437","identity":"rs-5899437","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}