GOALS
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To provide internal medicine and medicine/pediatrics residents with an enhanced knowledge base and clinical experience in Geriatrics Medicine.
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To promote careers in geriatrics.
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To enhance sensitivity to the problems of older patients and improve the quality of care our graduating residents provide to the geriatric population.
SPECIFIC BEHAVIORAL OBJECTIVES
Knowledge objectives
By the end of the ‘track’ the resident will be able to:
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Recognize the differing presentations of disease in elderly patients.
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Know the appropriate health care maintenance and preventive medicine strategies for elderly patients at varying levels of function.
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Know the normal changes of aging in major organ systems and changes in the physical exam of older patients.
SKILLS GOALS
By the end of the ‘track’ the resident will be able to:
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Perform inpatient and outpatient comprehensive geriatric assessment.
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Select and dose drugs appropriately for the older population.
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Perform simple gait and balance testing.
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Distinguish dementia from delirium and depression and appropriately diagnose and work up confusional states.
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Perform simple bedside urodynamics.
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Describe and stage pressure ulcers, institute strategies to decrease risk for skin breakdown and initiate simple treatment for pressure ulcers.
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Assess, evaluate and care for frail nursing home patients within less acute institutional settings with their technological and personnel constraints.
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Appropriately access and involve other team members including rehabilitation personnel, other specialty physicians, nursing, social work, elder protective services, nutrition, pastoral care, etc. as appropriate to maximize function and quality of life.
ATTITUDES GOALS
By the end of the ‘track’ experience the resident will:
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Have a positive attitude towards the care of elderly patients across a continuum of function and acuity.
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Have a high degree of comfort in dealing with level of care and end of life decision making.
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Place a high value on the contributions of other medical and non-medical team members in the care of the elderly.
GERIATRIC ROTATION
Activity
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Activity Goals
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Activity Goals
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Frequency
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Inpatient geriatric consultation
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To perform initial and follow up geriatric evaluations for patients in the acute care setting
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x5 sessions weekly
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x5 sessions weekly
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Geriatric Evaluation Clinic
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Perform initial and follow-up comprehensive geriatric assessments for patients in the ambulatory setting
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x2 monthly
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x2 monthly
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Memory Disorders Clinic
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Evaluate and diagnose patients with memory disorders with a multi-disciplinary team
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x1 monthly
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x1 monthly
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Wound evaluation
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Assist at Wound Clinic in the evaluation and treatment of pressure ulcers, venous ulcers and arterial ulcers
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x1-2 monthly
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x1-2 monthly
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Home visits
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Assist VNA dementia team with evaluation and care of home bound elders with memory problems
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x1-2 monthly
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x1-2 monthly
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Geriatric gynecology
evaluation
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Perform geriatric care for older gynecology patients in office and nursing home settings
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x2-4 monthly
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x2-4 monthly
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Functional/physical medicine
evaluations
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Perform functional evaluations on ambulatory and subacute patients with supervision by physiatry attendings in the ambulatory and subacute settings
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x2 monthly
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x2 monthly
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Care of nursing home patients
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Assist in evaluation and ongoing care of acute and chronic problems in the nursing home setting
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x2-3 monthly
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x2-3 monthly
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Geriatric psychiatry
evaluation
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Perform geriatric psychiatry evaluations in the inpatient setting with geropsychiatrist
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x2-3 monthly
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x2-3 monthly
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Teaching presentations
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Research and present a topic of interest in geriatric medicine
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x2 monthly
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x2 monthly
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Community-based geriatrics
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Home visits with elder protective and outreach workers to assess safety, community resources and appropriate interventions for frail elderly poorly supported in the community
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x2 monthly
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x2 monthly
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JOURNAL CLUB
To review academic advances and current state of literature in geriatrics x1 monthly.
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Core Topic Series
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Activity
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Activity Goals
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Frequency
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Core topic discussion series
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Review current state of literature in basic topics in geriatric medicine
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x1 monthly
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The discussion series will run for a two-year cycle before repeating with core topics alternating with subspecialty discussions on more specialized topics by visiting speakers or faculty in other divisions.
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The discussion series will run for a two-year cycle before repeating with core topics alternating with subspecialty discussions on more specialized topics by visiting speakers or faculty in other divisions.
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The discussion series will run for a two-year cycle before repeating with core topics alternating with subspecialty discussions on more specialized topics by visiting speakers or faculty in other divisions.
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Topics to be covered
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Topics to be covered
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Topics to be covered
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- Introduction to Geriatrics and goals of care/ demographics
- Normal aging
- Drugs in the elderly
- Comprehensive geriatric evaluation
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- Abuse/self neglect
- Falls
- Incontinence
- Delirium
- Dementia
- Failure to thrive
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- Health care maintenance in the elderly
- Osteoporosis
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GERIATRIC CONTINUITY CARE
Activity
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Activity Goals
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Frequency
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Required
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Comprehensive outpatient geriatric evaluation
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Dedicated continuity clinic sessions for complex geriatric patients to perform comprehensive evaluation
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x3 yearly
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Optional
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Longitudinal nursing home care
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Provide ongoing continuity care for a small group (4-6 patients) at Heritage Hall
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x1 monthly
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Teaching experience
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Teach medical residents and/or medical students basic geriatric topics
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x2-3 sessions yearly
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Program/project development
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Develop a small project; academic, educational, community outreach program/QI development to enhance geriatric care and knowledge regarding elders
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1 project during track
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READING LIST/SYLLABUS
Selected articles
- Ham RJ, et al. eds. Primary Care Geriatrics: A Case-Based Approach. 3rd ed. St. Louis, MO: Mosby-Year Book, Inc;1997.
- Hazzard WR, et al eds. Principles of Geriatric Medicine and Gerontology. 4th ed. New York, NY: McGraw-Hill, Inc.;1998.
- Kane RL, et al. eds. Essentials of Clinical Geriatrics. 3rd ed. New York, NY: McGraw-Hill;1994.
Director of Geriatric Medicine Track
Maura Brennan, MD
Associate Director, Geriatric Fellowship Program
email Dr. Brennan
