Geriatrics PGY III: The care of elderly patients is an
increasing responsibility of family physicians. Care of the elderly patient
occurs longitudinally throughout the three years of training in inpatient,
outpatient and nursing home sites. The geriatrics block rotation will occur
during the PGYIII year and will be for two-weeks in duration. The resident will
participate in the care of the geriatric inpatients on the 5200 ward of
Washington Regional Medical Center which is the designated geriatric ward. The
primary preceptor for this rotation is Dr. Randy Shinn, Geriatrician.
PGY-III resident is expected to:
Round on geriatric inpatients on 5200 ward of WRMC beginning at 8:00 a.m. each
morning Monday through Friday, and actively participate in the care of these
patients.
Participate in multidisciplinary staff sessions at 11:00 a.m. each day.
Maintain problem list/medication profile for all patients in the resident's
care
On Tuesday afternoon at 1:00 p.m. residents will work with Dr. Randy Shinn in
the evaluation of a new patient in the Memory Center at WRMC.
On Thursday afternoon at 1:00 p.m. residents will work with Dr. Stephen
Gemmell, Geriatric Neuropsychologist, for Neuropsych evaluations on new
patients.
On Friday at 2:30 p.m. the resident will take part in the multidisciplinary
staffing meeting at the Memory Center
The resident will have continuity clinic at the FMC on Monday p.m. and
Wednesday p.m.
Goal I: Provide optimal and comprehensive care to
elderly patients within the context of family medicine.
Goal II: To achieve competence in systems based
practice working with placement coordination with social services, pharmacy,
and other community-based providers.
Goal III: To achieve competence in recognizing and
referring complex problems
Patient Care
Goal
Residents must be able to provide patient care that is
compassionate, appropriate, and effective for the treatment of health problems
and the promotion of health. Residents are expected to have a measurable
and progressive knowledge of the following.
Competencies
Communicate to the patient and/or caregivers the proposed investigation and
treatment plans in such a way as to promote understanding, compliance and
appropriate attitudes.
Counsel about psychologic, social and physical stresses and changes of age,
dying and death.
Coordinate the range of services with the patient's support systems and needs.
Integrate factors in the patient's family, home and general lifestyle into the
diagnostic and therapeutic process.
Consult with physicians and other healthcare professionals, including the
critical evaluation and selective use of consultant advice and the integration
of management in critical care situations.
Medical Knowledge
Goal
Residents must demonstrate knowledge of established and
evolving biomedical, clinical, epidemiological, and social-behavioral sciences,
as well as the application of this knowledge to care of the elderly
patient. Residents are expected to demonstrate knowledge and
understanding in the diagnosis and management of the following:
The underlying physiological changes of aging in the body systems including
diminished abilities, altered metabolism and effects of drugs, and other
atypical presentations of common diseases and changes that directly related to
the assessment and treatment of elderly patients.
The normal psychological, social and environmental changes of aging including
reactions to common stresses and changes such as retirement, bereavement,
relocation and ill health, and the changes in family relationships that affect
health care of the elderly.
Pharmacology and prescription writing in the elderly.
The tendency of elderly patients toward iatrogenic disease, immobilization and
its consequences, dependency or long-term institutionalization while in the
process of receiving medical care.
The means for promoting health and health maintenance through screening,
preventive care and early diagnosis, and the assessment of risk factors.
(iatrogenic disease, immobilization, incontinence, and inappropriate
institutionalization)
The means to actively promote health in the elderly through exercise, nutrition
and psycho-social counseling.
The evaluation of the functional status of the elderly patient.
The following problems, which are either especially
characteristic of older patients, or differ significantly in their presentation
and/or management in order adults:
Abuse of the elderly, both physical and psychological
Acute abdominal problems
Alcoholism and other substance abuse
Altered mental status
Anemia
Bacteriuria
Bereavement
Catheterization
Completed stroke
Confusion
Congestive heart failure
Constipation
Contractures
Degenerative joint disease
Dehydration
Dementia
Dentition
Depression
Diabetes
Dizziness
Drug-induced illness
Falls
Fecal impaction
Femoral (and other) fractures
Gait disorders
Hearing loss
Hypertension
Hypothyroidism
Incontinence
Malnutrition/anorexia
Memory loss
Myocardial infarction
Osteopenia/osteoporosis
Pneumonia and other respiratory infections
Podiatric problems
Postural hypotension
Pressure sores
Skin cancers
Speech disorders
Terminal care
Transient ischemic attacks
Tremor/parkinsonism
Thromboembolism
Urinary tract infection
Visual loss
The Family Medicine resident should:
A.Obtain a comprehensive history and mental status examination, utilizing all available
sources of information.
B.Comprehensively conduct an efficient physical examination, mindful of the patient's
modesty and mobility while balancing the need for full examination.
C.Select and interpret diagnostic procedures.
D.Develop an awareness of his/her own attitudes to aging, disability and death.
E.Promote the individual's dignity through self-care and self-determination.
F.Recognize the importance of the family and home in the overall life and health of
patients.
G.Display an awareness of the importance of a multi-disciplinary approach to the
enhancement of individualized care.
H.Develop problem lists in practical, clinical, functional, psychological and social
terms.
Practice- Based Learning and Improvement
Goal
Residents must demonstrate the ability to investigate and
evaluate their care of patients, to appraise and assimilate scientific
evidence, and to continuously improve patient care based on constant
self-evaluation and life long learning. Residents are expected to develop
skills and habits to be able to:
Locate, appraise and assimilate evidence from scientific
studies related to their patients' health problems
Use information technology to manage information and access
on-line medical information.
Objectives
The resident becomes
competent in the use of UpToDate, DynaMed, and journal searches.
The resident will learn to utilize of availability of a variety of
knowledge sources.
The resident will become
competent in the use of EMR to track patients, recover lab data and
medical reports. The resident will become competent to use the PDA
with Epocrates and 5-Minute Medical Consult.
Systems Based Practice
Goal
Residents must demonstrate an awareness of and responsiveness
to the larger context and system of health care, as well as the ability to call
effectively on other resources in the system to provide optimal health
care. Residents are expected to:
Understand the range of services available to promote rehabilitation or
maintenance of an independent lifestyle for elderly people, increasing their
ability to function as long as possible in their existing family, home and
social environments.
Understand characteristics of the various types of long-term care facilities
and alternative housings available to the elderly.
Demonstrate knowledge of specific regulations for the care of patients in
long-term facilities.
Demonstrate understanding of financial implications of geriatric care such as
polypharmacy, iatrogenic illness, over-dependency, inappropriate
institutionalization, nonrecognition of treatable illness, over treatment, the
unsupported family, etc.
Understand the benefits and limitations of advanced directives, living wills
and durable powers of attorney.
Professionalism
Goal
Residents must
demonstrate a commitment to carrying out professional responsibilities
and an adherence to ethical principles. Residents are expected to
demonstrate:
Competencies
Compassion,
integrity, and respect for others.
Objectives
The resident will:
Demonstrate
adherence to ethical principles
Show
sensitivity and respect to diverse patient populations.
Know when to
seek consultation from other appropriate specialists to either
manage or co-manage a patient for optimal care.
Respond to
pages and other consultations in a timely manner.
Dictate
comprehensive history and physical exams and discharge summaries in
a timely manner
Interpersonal and Communication Skills
Goal
Residents must demonstrate interpersonal and communication
skills that result in the effective exchange of information and teaming with
patients, their families, and professional associates. Residents are
expected to:
Competencies
Communicate effectively with physicians, other health
professionals, and health related agencies.
Demonstrate an awareness of the importance of physician and
patient working as partners to promote optimal health.
Demonstrate interpersonal and communication skills that result
in effective information exchange with patients, families and colleagues
Work effectively with others as a member of a healthcare team.
Recognize the psychosocial and economic impact of disease on the
individual and family.
Objectives
The resident will learn appropriate consultation, timely
transfers, and other options of care for acute and chronic problems.
Assessment Method
At the conclusion of each resident rotation, the residency coordinator sends a
formative-type, rotation-specific performance evaluation form to the rotations'
supervising physician. When the completed evaluation is returned, the
resident physician and the resident's faculty advisor review the evaluation and
attest to reviewing it by signing/initialing the form. Next, the program
director reviews and attests to the document. Once all three have
reviewed and attested the evaluation, it is included in the resident's
permanent file.
Each resident is asked to evaluate the rotation and supervising
physician(s) at the end of the rotation. The resident's faculty advisor
and program director review the evaluation and attest to reviewing it by
signing/initialing the form. These evaluations are filed together by resident
year.
Level of Supervision
Dr. Randy Shinn, Geriatrician, will be the primary preceptor.
