Geriatrics Curriculum

Department: Internal Medicine

Faculty Coordinator: Dorothy Sherwood, MD

Hospital: Texas Health Presbyterian Hospital Dallas

Offered: All

Length of Rotation: 4 weeks

Max no. of residents: 1

First Day Contact: Mitch Carroll, M.D. (214) 345-5955

First Day Time: 8:30 am

First Day Place: Jackson Building, 1st Floor, Suite B

Hours: Monday through Friday, 8:00 a.m. to 5:00 p.m., Senior Medical Clinic

1. Course Description:

A course designed to expose residents to the special medical, physical, emotional and social needs of the elderly patient.

The residents will work in the Senior Medical Clinic of Texas Health Presbyterian Hospital Dallas. The resident will see multiple diseases specific to the geriatric population. He/she will work closely with the multi-disciplinary team to facilitate the safe treatment including, physicians, social workers, RN's, and diabetic educators.


II. Course Goals and Objectives: (based on ACGME competencies for resident education)

Patient Care:

Residents are expected to provide care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and at the end of life.

• Objectives:

• Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures. Examples: Skills of history taking in the elderly, including active listening, re-directing, use of open vs. directed questioning when appropriate; Skills of physical exam in the elderly.
  
  
• Make informed recommendations about preventives, diagnostic and therapeutic options and interventions that are based on clinical judgement, scientific evidence, and patient preference. Examples: Prevention of delirium, appropriate referral for rehabilitation, appropriate use of diagnostics and therapeutics based on patient's age, health and functional status.
  
  
• Develop, negotiate and implement effective patient management plans and integration of patient care. Examples: Work with the multi-disciplinary team to develop a plan, work with the patient and family, and work with outpatient resources to provide care to elderly at home.
  
  
• Perform competently the diagnostic and therapeutic procedures considered essential to the practice of internal medicine. Examples: Complete, accurate physical exam, ADL assessment, dementia assessment, and nutritional assessment, skin assessment, depression assessment using scales, hearing and vision assessment, fall risk, and health maintenance.

Medical Knowledge:

Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care and the education of others.

Objectives:

• Apply an open-minded, analytical approach to acquiring new knowledge. Examples: Learning the functional approach vs. pathological approach to an elderly patient; working and learning from the multidisciplinary team.
  
  
• Access and critically evaluate current medical information and scientific evidence. Examples: Present reviews or current clinical trials on such topics as: apoptosis, genetics of aging, impact of exercise on aging, evidence-based evaluation and treatment of dementia, evidence-based treatment of cardiovascular risk factor in the very old, evidence-based treatment of osteoporosis in the very old.
  
  
• Develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of internal medicine. Examples: Understand the normal physiology of aging, understand pharmacology in the aged, understand the impact of risk factors on strokes, MI's, and falls in the elderly.
  
  
• Apply this knowledge to clinical problem-solving, clinical decision-making, and critical thinking. Examples: Treatment of hypertension or hyperlipidemia in the elderly, implementation of fall prevention strategies.

Practice-Based Learning and Improvement:

Residents are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices.

Objectives:

• Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care. Examples: Work with multi-disciplinary team in the clinic to improve patient care; identify inappropriate prescribing practices on the clinic, seek to build knowledge regarding geriatric community resources.
  
  
• Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice. Examples: Actively participate in the quality improvement and review of prescribing practices of physicians.
  
  
• Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care. Examples: Perform self-evaluation regarding knowledge, skills and attitude as it pertains to the care of the geriatric patient.
  
  
• Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education. Example: Use of web-based knowledge systems to review current literature pertaining to the care of the elderly patient.

Interpersonal and Communication Skills:

Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families and other members of health care teams.

Objectives

• Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically, sound, professional relationships with patients, their families, and colleagues. Examples: Demonstrate ability to communicate to a referring physician, demonstrate ability to define role as a member of the health care team in the clinic, demonstrate clear and compassionate communication with the patients and their families.
  
  
• Use effective listening, nonverbal, questioning, and narrative skills to communicate the patients. Examples: Use these skills in performing a history on an elderly patient; demonstrate listening skills in dealing with the depressed or demented patient.
  
  
• Interact with consultants in a respectful, appropriate manner. Examples: Develop the skill of succinctly communicating patient information to the consulting physician.
  
  
• Maintain comprehensive, timely, and legible medical records. Examples: Progress notes will be legible, problem oriented, and complete. A complete up-to-date record of current medications will be included on every note.
  

Professionalism:

Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession, and society.

Objectives:

• Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues. Example: Develop skills of communicating with an angry patient or family member, develop skills of breaking bad news in a compassionate way, and demonstrate willingness to bring the patient and family to comfort.
  
  
• Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues. Example: Be aware of the sensitivity of the elderly to modesty, demonstrate respect for the elderly, avoiding demeaning terms when communicating.
  
  
• Adhere to principles of confidentiality, scientific/academic integrity, and informed consent. Examples: Know the principles of confidentiality pertaining to the demented, elderly patient, and understand the issue of competence as it pertains to the ability to give informed consent.
  
  
• Recognize and identify deficiencies in peer performance. Examples: Identify evidence of ageism in peers and other medical personnel.

Systems-Based Practice:

Residents are expected to demonstrate both an understanding of the contexts and systems in which health care is provided and apply this knowledge to improve and optimize health care.

Objectives:

• Understand, access and utilize the resources, providers and systems necessary to provide optimal care. Examples: Demonstrate knowledge of the resources offered by the multi-disciplinary care team in the clinic and demonstrate knowledge of community resources for the elderly.
  
  
• Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient. Examples: Demonstrate knowledge of the Medicare requirements for home health care and skilled nursing care and demonstrate knowledge of the payment systems for home health care, skilled nursing care, custodial care.
  
  
• Apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management. Examples: Review practices of the clinic, including prescribing, lab ordering, nursing care and documentation.
  
  
• Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care. Examples: See above.

III. Methods of instruction:

1. Didactic (schedule, topic, faculty)
   
   Daily residents conference 12:00-1:00 p.m. - IM Training Room
   Wednesday mornings 7:30-8:00 a.m. - Clinical Ground Rounds - IM Training Room
   Wednesday afternoons 12:15-1:00 p.m. - Internal Medicine Update - Haggar Hall
   
   
2. Clinical
   
   See above.