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					Course/Rotation Title: GERIATRICS

Date of Last Review/Update:
3/07
Course/Rotation Director: Karen Kelly, MD

Location of clinical encounters

Inpatient % time = less than 5%
(Check all that apply)
[X]    Wards
[X]    ICU
[X]    ED
[ ]    Other (please specify)

Outpatient% time = greater than 95%
(Check all that apply)
[X]    Clinic
[X]    Home
[X]    Hospice, Nursing Home, VNA, Memory Clinic, Physiatry & Rehab

Course/Rotation description with educational purpose/value
A solid foundation in issues (both medical and social) affecting the geriatric population is critical
to the development of a good internist. Therefore, all residents participate in a mandatory
Geriatrics rotation in both their PG2 and PG3 years under the direction of Dr. Karen G Kelly, a
Board certified geriatrician. These clinical rotations occur as distinct parts of the ambulatory
block to which all PG2 and PG3 residents are assigned (please see Ambulatory Block Rotation
description) for other parts of the curriculum during these blocks.

Chief Medical Residents work with Dr. Kelley to assign all PG2&3 residents to the following
assignment during their geriatrics block: nursing home rounds, memory clinic, physiatry / rehab,
VNA home visits, Hospice home visits, outpatient & inpatient consults, and pain clinic.
Resident will attend assigned sessions under the supervision of a multidisciplinary faculty.
Residents will be distributed a schedule at the beginning of the rotation.

In addition to the formal “geriatrics” curriculum outline below, residents are exposed to geriatric
patients in all aspect of their residency training. Many of the conferences attended by the
residents, including grand rounds, morning report, weekly continuity clinic conference, noon
lecture series and multidisciplinary rounds include topics which are pertinent to geriatrics. Dr.
Kelly will cover 6 topics/year at noon conference by formal lecture. In addition, Dr. Kelly
brings geriatric expertise to morning report and multidisciplinary rounds.

Types of Clinical Encounters during Geriatric Rotation:
    Geriatric Assessment in an office setting under the supervision of a geriatrician
    Memory assessment and management in the Memory disorders clinic



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         Hospice assessment and management in the home and hospital under the supervision of
          the Hospice physician
         Nursing home assessment and management under the supervision of physicians who care
          for nursing home patients
         Home visits under the supervision of the VNA and/or Hospice service
         Pain assessment and management in the elderly under the supervision of physicians who
          specialize in the management of pain
         Rehabilitation assessment and management under the supervision of the department of
          rehabilitation physicians
         Weekly two hour conference under the supervision of Dr. Kelly. The residents will read
          and discuss assigned articles covering geriatric topics. They will present cases of geriatric
          patients seen during the rotation for discussion of issues regarding workup or
          management

Types of Patients: (PLEASE SPECIFY)

[ ]       Adults of all ages
[X]       Male
[X]       Female
[ ]       Children < 18 years old
[ ]       Other (please specify)

Mix of Diseases: (PLEASE SPECIFY ANY ADDITIONAL DISEASES
See below under competencies.

Types of Procedures: (PLEASE SPECIFY):
As appropriate to the site.

Describe the level of supervision by faculty:

[X]       Attending staff will supervise and precept all patient care activity directly or indirectly.
[X]       Attending staff will provide mid rotation feedback
[X]       Attending staff will provide end-of-rotation feedback
[ ]       Other (please specify)

Responsibilities of trainee: Please see Roman Numeral III above for graded
responsibilities and expectations.
         Know how to evaluate and manage the patient who is falling
         Know how to evaluate and treat osteoporosis
         Know how to evaluate and treat sexual dysfunction in the elderly
         Know how to evaluate incontinence and other common urinary tract complaints
         Understand appropriate use of preventive strategies in the elderly and be able to
          individualize them for each patient
         Understand delirium and how to approach it
         Understand how to manage common symptoms at the end of life


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      Understand options for pain management in the elderly
      Understand pharmocokinetics and pharmacodynamics and common drug-drug
       interactions in the elderly
      Understand the common causes of dementia and how to evaluate
      Understand the dangers of hospitalization in the frail elderly and how they might be
       mitigated
      Understand the elderly: life expectancy, normal physiologic changes with aging, common
       diseases and causes of death

Describe the level of supervision by faculty:

The director of the rotation will be responsible for collecting evaluations from the faculty and
giving feedback and evaluation to the resident at mid and end rotation. The residents will
evaluate the rotation at its completion.

Competency Based Objectives/Expectations. Please see Roman Numeral II
with additional objectives specific to this rotation as below:
Patient Care
      Appreciate the importance of excellent palliative care, including pain relief
      Appreciate the importance of improving or maintaining the older person’s functioning as
       well as treating their diseases
      Appreciate the importance of quality as well as quantity of life
      Feel concern for the older patient’s goals
      Feel respect for older patients even when they are frail or demented
      Be able to do a cognitive assessment
      Be able to evaluate for delirium
      Be able to do assessment for depression
      Be able to do functional assessment
      Be able to do gait assessment
      Be able to do falls evaluation
      Please See Roman Numeral II

Medical Knowledge
      Know drugs which are especially dangerous in older patients
      Know how to evaluate and manage the patient who is falling
      Know how to evaluate and treat osteoporosis
      Know how to evaluate and treat sexual dysfunction in the elderly
      Know how to evaluate incontinence and other common urinary tract complaints
      Understand appropriate use of preventive strategies in the elderly and be able to
       individualize them for each patient
      Understand delirium and how to approach it
      Understand how to manage common symptoms at the end of life
      Understand options for pain management in the elderly



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     Understand pharmocokinetics and pharmacodynamics and common drug-drug
      interactions in the elderly
     Understand the common causes of dementia and how to evaluate
     Understand the dangers of hospitalization in the frail elderly and how they might be
      mitigated
     Understand the elderly: life expectancy, normal physiologic changes with aging, common
      diseases and causes of death
     Please see Roman Numeral II

Practice-Based Learning
     See Roman Numeral II

Interpersonal and Communication Skills
     Be able to assess the patient’s pain
     Be able to discuss advance directives and goals of care
     Be able to discuss sexual functioning with older patients
     Be able to evaluate decision making competence

Professionalism
     See Roman Numeral II

System-Based Practice
     Be able to assess eligibility for hospice
     Be able to interact with other professionals during/after hospitalization to ensure adequate
      care/ follow up after hospitalization
     Be able to assess for appropriate placement and to know what services are offered in
      what setting and who pays for them
     Be able to do a home visit

Check Any Methods Used For Teaching and Assessment:

      [X] Ambulatory Clinic (feedback written & verbal)
      [ ] Annual In-service Exam (feedback written)
      [X] Attending Rounds (feedback written & verbal)
      [ ] Board Review (feedback written examination)
      [ ] Cancer Conference
      [ ] Case Management Evaluation (360 degree written evaluation)
      [X] Chart Stimulated Recall & Feedback (feedback verbal)
      [X] Direct Observation and Feedback (feedback written & verbal)
      [ ] GME Core Curriculum
      [ ] Interns Report (feedback written & verbal)
      [ ] Journal Club (feedback written & verbal)
      [X] Medical Record Review (feedback written & verbal)
      [ ] Mentor Feedback (feedback written & verbal)


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       [ ] Monthly End of Elective Exam (feedback written)
       [X] Monthly Mini CEX (feedback written & verbal)
       [X] Monthly Competency Based Written Evaluation
       [ ] Morning Report (feedback written & verbal)
       [ ] Multidisciplinary Rounds Feedback (feedback verbal)
       [ ] Nursing Evaluation (360 degree written evaluation)
       [ ] Patient Evaluation (360 degree written evaluation)
       [ ] Patient Management Discussions (feedback written & verbal)
       [ ] Procedure Logs
       [ ] Performance improvement Multidisciplinary Morbidity and Mortality
                (feedback written & verbal)
       [ ] Semi Annual Program Director Feedback (feedback written & verbal)
       [ ] Student Evaluation (feedback written & verbal)
       [ ] Supervised Sign-In Rounds (feedback written & verbal)
       [ ] Supervised Sign-Out Rounds (feedback verbal)

Other Policies:
The Course Director recognizes that the trainee is accountable to all BMC Residency and GME
Personnel Policies and Procedures. The Course Director recognizes that the residents are
expected to attend all continuity clinics and mandatory educational conferences unless excused
by the Program Director or Chief Medical Resident with advanced notice.

Check The Educational Materials Used (beyond direct patient care):
[X] Reading List (Please Specify):
      “I’m Not Ready for Hospice”: Strategies for Timely and Effective Hospice
       Discussions. David J. Casarett, MD, MA, and Timothy E. Quill, MD
      Adherence to Medication. Lars Osterberg, M.D., and Terrence Blaschke, M.D.
      Initial Treatment of Hypertension. Phyllis August, M.D., M.P.H.
      Alzheimer’s disease. Jeffrey L Cummings.
      Delirium in Older Persons. Sharon K. Inouye, M.D., M.P.H.
      A practical program for preventing delirium in hospitalized elderly patients. Sharon
       K Inouye.
      Principles of drug therapy for the elderly patient. R Bressler and JJ Bahl.
      Osteoporosis in Men. Peter Ebeling, MD.
      Preventive Health care in the elderly population: a guide for practicing physicians.
       PY Takahashi, HR Okhravi, LS Lim and MJ Kasten.
      Preventing Falls in elderly persons. Mary E Tinetti.
      Recovery from disability among community-dwelling older persons. SE Hardy, TM
       Gill.
      Management of overactive bladder. Joseph G Ouslander.
      Diagnosis, Screening, Prevention, and Treatment of Osteoporosis. KAREN F .
       MAUCK, MD, MSc, AND BART L . CLARKE, MD

   Geriatric textbooks as needed:
    Geriatric Medicine Christine Cassel et al


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      Principles of Geriatric Medicine and Gerontology. William R. Hazzard et al

[X] Review of Appropriate Radiology Images (Please Specify):
    As Appropriate to patient care

[ ] Review of Appropriate Pathology (Please Specify):
     As Appropriate to patient care

[ ] Review of Appropriate Laboratory Data (Please Specify):
     As Appropriate to patient care

[ ] Articles from the Literature (Please Specify):

[ ] Case Studies:




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posted:1/26/2012
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