Geriatric Curriculum Application in One Family Medicine Residency

Geriatric Curriculum: Application in One Family Medicine Residency Program Suzanne Gehl MD Columbia St. Mary’s Family Medicine Residency Program, Medical College of Wisconsin March 2008

Objectives Broad-based experience with geriatric patients at all levels of functional ability Foster greater knowledge, skills and attitudes in caring for older patients Meet AAFP recommendations for residency education in geriatrics Incorporate ACGME competencies into residency teaching Meet RRC requirements

Overview of Methods Inpatient Service Didactics Ambulatory Medicine Experience Nursing Home—Rehab and Long Term Care Geriatric Clinic Home Visits

A Closer Look…. Inpatient Service – traditional teaching ground for care of elderly patients – Typically, more frail, less functioning, “in crisis”

Didactics One hour monthly lectures on geriatric topics which rotate on 2 -year calendar. Lectures given by geriatric-focused faculty or guest speakers Topics include…………

Lecture Topics Functional Decline Diagnosis/Treatment of Dementia Urinary Incontinence Falls Geriatric Assessment Prevention Hospice and Palliative Care Advance Directives Symptom Management at End-of-Life Polypharmacy Failure to Thrive Osteoporosis Geriatric Sexuality Nursing Home Issues Dermatology VOSCEs…. .

Video OSCEs Improves interest by incorporating video clips and patient cases Stimulates discussion on a variety of topics pertinent to Family Medicine and care of the geriatric patient Documents ACGME competency instruction and evaluates residents Identifies areas in need of further education 1 VOSCEs used for 1 -hour session, or segments incorporated into lecture

A Review of the ACGME Competencies Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-Based Practice

A Closer Look at a VOSCE….

Resident Assessment Sheet and Score Key

Video

Ambulatory Medicine Months I – Inpatient Hospice – Lapham Park (subsidized housing with clinic) – Home Visits with faculty II – Clinton Rose (Community Senior Center) – Outpatient Hospice III – Hospice IDT Meeting/discussion of Palliative Care and Medical Directorships – Community Care for the Elderly-tour of facility and discussion of services for community-dwelling seniors

Long Term Care and Rehab Monday afternoons: 1 -5 pm Monthly visits Complete physical yearly-beginning July 2006 – – – Goal is 4 -6 patients per resident. CPE when new patient admitted Rehab and LTC patients Bedside teaching with faculty Mini-didactics --focused on problems encountered Some flexibility with schedule of residents

Geriatric Clinic Focus on problems specific to elderly 6% of CSM-FHC patients 65 yrs or older – Uncertain amount of resident exposure to this group 1 st and 3 rd Weds. of each month Counseling room and procedure room used One-on-one precepting Application of knowledge, “pearls” of physical exam skills Utilize community resources Community Care for the Elderly- IDT monthly meeting with faculty and resident

2 E-learning (ANGEL) Modules accessible through Medical College website. “Blackboard”-type program May access from any computer with internet access. Allows “distance learning” Independent study

ANGEL(cont. ) Modules include: – Prevention and Assessment – Chronic Disease (Diabetes) and Polypharmacy – Palliative Care and Failure to Thrive May work ahead MUST take pre-test AND post-test Down-loadable to PDA Resource for many geriatric links

Home Visits Faculty member with resident – Multiple patient home visits Residentifies at least one geriatric continuity patient to perform periodic home visits

Additional Resources http: //www. pogoe. org http: //www. geriatricsatyourfingertips. org The American Geriatric Society (http: //www. americangeriatrics. org) http: //eperc. mcw. edu

Summary Curriculum provides longitudinal geriatric care at various stages of health and functional ability Combination of didactics, independent learning, one-on-one instruction, and distance learning provides diverse educational opportunities ACGME competencies reinforced

References 1. Simpson, D, Helm, R, Drewniak, T, Ziebert, M, Brown, D, Mitchell, J, Havas, N, Denson, K, Gehl, S, Kerwin, D, Bragg, D, Denson, S, Heffron, M, Harsch, H, Duthie, E, : Objective Structured Video Examinations (OSVEs) for Geriatrics Education. Gerontology & Geriatrics Education 26(4): 7 -24, 2006 2. Gehl, S, Helm, R, Lillich, D, Ahmed, S, Asynchronous Geriatric Education (A. G. E. ): Training Family Physicians to Care for Older Adults, Society of Teachers of Medicine Annual Spring Conference, San Francisco, CA (04/26/2006 – 04/30/2006) (Available on fmdrl)