Specialisation study programme for specialised field No A 023 GERIATRIC MEDICINE a) Characteristics of the field and the duration of the specialised study Geriatric medicine is a specialised branch of medicine dealing with prevention, diagnostics, treatment and rehabilitation of seniors i.e. persons at the age over 65. Geriatric medicine respects the speciality of disease in higher age, social conditionality and social consequences of chronic diseases. Its goal is maintenance of the functional potential of seniors, integrity of their personality, dignity and the quality of life at the highest possible level. The minimal length of the specialised study according to the relevant regulations of the EU is 4 years. The length of the specialised study in the Slovak Republic on the basis of the decision of the Accreditation Commission of the Ministry of Health of the Slovak Republic for the health workers education of 14 June 2005 is 5 years. b) Establishing of the level of education, length and content of professional health practice needed for enrolment into specialised training in specialised field The condition for enrolment to specialised study in specialised field neurosurgery is the graduation of university medical study in study field general medicine (MUDr. - MD). c) Scope of theoretical knowledge, practical skills and experience needed for the performance of the specialised working activities Scope of theoretical knowledge needed for the performance of the specialised working activities Within the common internal medicine trunk: Aetiology, pathogenesis, clinical pictures, diagnostics, differential diagnostics, treatment and prevention of internal diseases. Indication, contraindications, interpretation of the results, diagnostic and therapeutic performances, laboratory and auxiliary examinations in the internal medicine. Diagnostic and treatment procedures at failing of internal organs and systems (heart, lungs, kidneys, liver and the others). The basis of intensive care, monitoring, diagnostic and therapeutic procedures in the emergency situation in the internal medicine. The principles and practice of the institutional and outpatient care of the ill with the internal diseases. The indications and interpretation of the consultative examination in the internal medicine practice. Within the scope of the specialisation study geriatric medicine: The aging as a biological process and the theory of the aging. The theory of the aging. The epidemiology of the most common diseases in the old age. The demography of the aging. The multimorbidity. The specialities of the diseases in the old age. The disabling diseases. The geriatric syndromes. The diet in the old age. The specialities of pharmacotherapy in the old age. The most common internal diseases in the old age. The basis of the rehabilitation of old people. The most common mental and neurological disorders in the old age. The geriatric evaluation. The prevention in geriatric medicine. The home and institutional care of the old people, the care of inhabitants of retirements homes. The organisation of the social care of old people. The ethical problems in the old age. Palliative care. The legal regulations related to the field of providing of the health care. The research in geriatric medicine. The knowledge in the related branches: psychiatry, balneology and therapeutical rehabilitation, neurology relevant to old people and gerontopsychiatry. Scope of theoretical knowledge, practical skills and experience needed for performance of specialised working activities Standard clinical inpatient clinical practice: patient’s admission, anamnesis, physical examination, description of ECG, description of X-ray of thorax, interpretation of auxiliary and consultant examinations, monitoring and treatment, discharge 400 patients ECG description 400 Description of the X-ray scan of thorax 400 Description of X-ray of abdomen 50 Venepunction, leading in of venous catheter 50 Infusion and injection treatment 50 Taking of arterial blood, interpretation of the examination 20 Blood transfusion and blood derivates transfusion 20 Examination of blood smear 20 Examination of urine and urinary sediment 20 Puncture of bodily cavities 20 Sucking of secretion out of airways, inhalation treatment, ventilation 20 Bladder catheterisation in a man and a woman 20 Rectoscopy 10 Insertion of the probe into upper part of GIT (gastrointestinal tract) 8 Cardiopulmocerebral resuscitation 5 Assistance at the performance Minimal number Insertion of central venous catheter 5 Tracheal intubation 5 Defibrillation, cardioversion 5 Cardiostimulation (temporary, permanent change of exchange of 5 cardiostimulator, electrode) Echocardiography 20 Functional examination of cardiovascular system: 24-hour record of ECG, Blood 20 pressure (BP), ergometrics, „head-up tilt“ test and the others Functional examination of respiratory system: spirometry, bronchoscopy 20 Radiodiagnostics: interventional radiology, CT, MRI, radionuclide examination, 40 PET Ultrasonography: USG of the abdomen, thyroid, duplex ultrasonography of veins 40 and the others Gastrointestinal endoscopy: gastroscopy, colonoscopy... 20 Biopsy of organs and tissues 10 Dissection 3 Within the specialisation study programme geriatric medicine the applicant has to master: diagnostics and treatment of acute diseases in the higher age, diagnostics and treatment of chronic diseases, diagnostics and the care of patients with geriatric syndromes, planning of home care, neurological, rehabilitation and gerontopsychiatric examination in the adequate scope, to master specific geriatric performance, among which belong: evaluation of self- sufficiency, evaluation of cognitive functions and the grade of severity of their disorders, evaluation of behaviour disorders of old people, evaluation of mobility, evaluation of the balance, functional examination in patients with repeated falls, evaluation of nutrition, causes and severity of urine incontinence and stool. Perform 200 following geriatric performance: Geriatric evaluation of self-sufficiency 20 Functional evaluation of the course of dementia 10 Test for evaluation of depression 10 Examination of a patient with falls 20 Examination of cognitive functions 40 Examination of patients with disorders of behaviour 10 Evaluation of the patient’s risk rate 10 Evaluation of nutritional state 10 Assessment of decubital ulcer risk 20 Assessment of the nursing people burden 10 Assessment of operational risk 10 Catheterisation of a man 20 Insertion of a nasogastric probe 20 Discharge from psychiatric department 5 patients Discharge from neurological department 10 patients Discharge from geriatric department 40 patients Examination in geriatric outpatient clinic 40 patients Discharge from department for long-term patients 40 patients To perform 40 other geriatric performances: Urodynamic examination 10 Head-up tilt test 10 Densitometry 10 Other performance 10 d) Organisational form of the specialised study Specialisation study in the field of geriatric medicine lasts at least 5 years. It starts by common internal medicine trunk with recommended length of duration 24 months. To common trunk is related to the other specialised study in geriatric medicine in the duration of 36 months. Specialised study has the theoretical and practical part of the education. Specialised study is completed by specialised examination the part of which is the defence of the written work. e) Scope and the focus of the professional health practice performed on particular work places of the health care institutions, its minimal length and the time flow. Within the frame of common internal medicine trunk in the length of 24 months: Practice at standard internal department 12 months. Practice at the intensive care unit 2 months. Practice in the admission outpatient clinic of the internal department or in the central admission department or at central admission department of a hospital 1 month. Practice in the optional internal medicine dicipline (internal medicine, gastroenterology, geriatric medicine, pneumology and ftisiology, occupational medicine and the others) 2 months. Practice in the department of infectology 1 month. Within this stay he/she will become familiar with the basis of clinical microbiology and parasitology. Practice in the department of clinical oncology 1 month. Practice at the workplace of laboratory medicine 1 month, or at the workplace of haematology and transfusology 0.5 month and at the workplace of clinical biochemistry 0.5 month. Practice at the surgical department 2 months. Practice at the neurological department 1 month. Practice at the department of anaesthesiology and resuscitation 1 month. Further specialisation study in the field of geriatric medicine in the duration of 36 months. Out of it: 2 months at the psychiatric department. 2 months at the neurological department. 0.5 month at the department of dermatovenerology. 1 month at the department of psychiatry, balneology and therapeutical rehabilitation. 1.5 month at some of the stated departments: palliative medicine, hospice medicine, orthopedic department, ORL (otorhinolaryngology), anaestesiology and intensive medicine, or eventually prolonging of the stay at some of this above mentioned departments. 29 months at the geriatric workplaces of the educational institution. 3 months at the department of long–term diseased patients. 1 month at the geriatric outpatient office. Within the frame of geriatric workplaces the applicant will do 60 emergency services. NOTE: Model programme was: approved by working group of Accreditation Committee of Ministry of Health, Slovak Republic for further education of health workers for the category doctor of 28 February 20095, submitted and approved by the Accreditation Committee of Ministry of Health for further education of health workers of 14 June 2005, approved by the Ministry of Health of 11 July 2005.