Models of Geriatric Curricula Suzanne Gehl MD Medical

Models of Geriatric Curricula Suzanne Gehl, MD Medical College of Wisconsin Sharon Smaga, MD Southern Illinois University April 30, 2011 www. mcw. edu

Objectives Share “pearls and pitfalls” of geriatric curricula to optimize resident/student education Identify web-based resources to augment geriatric education Implement new methods of teaching geriatrics at your residency www. mcw. edu

“The Guide” ACGME Program Requirement for Graduate Medical Education in Family Medicine-Geriatric Medicine http: //www. acgme. org/ac. Website/RRC 120/120 pr. Index. asp www. mcw. edu

The Basics-Clinical FHC patient panel – Community Care partnership Inpatient Nursing Home/Rehab Center Home Visits Home and Inpatient Hospice Geriatric Assessment Clinic Optional Rotations – Inpatient Geriatric, Palliative www. mcw. edu

Educational Monthly didactics – OSVEs, AGS teaching slides, guests, case reviews NH rounds-article review, bedside CURE conference (Core Units for Resident Education) AGE/ANGEL modules – Sign up for guest access for 1 month! Geriatric Assessment Clinic 1 – Review of web-based resources – Community resources www. mcw. edu

Structure Ambulatory Medicine Months – IDT meeting for Home Hospice, Community Care – Inpatient Hospice – Department of Aging – Clinton Rose/Senior Center – Geriatric Assessment Clinic/Home Visits 3 year cycle for CURE www. mcw. edu

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Geriatric Master Template Screening clinic patients – Identify problems – Early intervention – Refer to geriatric clinic or return for additional clinic visit www. mcw. edu

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Educational/Resource EMR Templates Dementia Falls Home Visits IADLs/ADLs GDS MMSE www. mcw. edu

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Didactics Utilization of Video OSCEs – http: //www. mcw. edu/display/docid 9233. htm AGS powerpoint set – http: //teachingslides. americangeriatrics. org Guest speakers CURE CRIT program www. mcw. edu

CURE Topics Advance Directives/Competency Evaluation Driving/Transportation Functional Assessment Gait/Gait Assessment/Falls Home Visit/Home Care/Home Assessment Geriatric Dermatology/Procedures www. mcw. edu

Web-based Resources http: //www. geronet. med. ucla. edu/professio nals http: //www. eperc. mcw. edu/ http: //www. epec. net http: //www. fmdrl. org http: //www. environmentalgeriatrics. com http: //www. pogoe. org http: //services. aamc. org/30/mededportal/s ervlet/segment/mededportal/information http: //www. geriatricsatyourfingertips. org www. mcw. edu

Benefits Independent learning opportunities from anywhere with computer access One-on-One with faculty Team-based learning Education at point-of-care Variety of stimuli to maintain interest www. mcw. edu

Limitations Volume of Nursing Home/Continuity patients Number of men over 65 in FHC $$$$ – Grant funding – Updating ANGEL – Reimbursement for visits www. mcw. edu

MODELS OF GERIATRIC CURRICULA Sharon Smaga, MD SIU Family Medicine, Carbondale, IL April 30, 2011 ssmaga. 56@gmail. com www. mcw. edu

Background Poor in-training exam scores Lack of interest in geriatrics Lack of organization for nursing home rounds www. mcw. edu

Second Year Block Rotation ½ day clinics with local geriatricians ½ day/week in Memory and Aging Clinic at residency site ½ day/week in Geriatric Assessment clinic at rural site 2 home visits on elderly patients from resident’s panel or post hospital visit “Enhanced” nursing home rounds Presentations to residents, community CQI project Assigned reading/Challenger www. mcw. edu

Third Year Clinics Continue Geriatric and Memory Disorder Clinics during third year Continue community presentations www. mcw. edu

Geriatric Assessment Clinics- Plan Patients referred from in-house or outside 1 ½ hours allotted per patient – – 30 min with LCSW 30 min with attending 10 min with dietician 20 min for review, discussion with patient and family Includes dementia evaluation, depression screening, functional assessment, review of meds, nutritional status, etc Discussion of community resources, advance directives, safety in the home, caregiver support www. mcw. edu

Geriatric Clinic-Pitfalls Delay in hiring a second physician (first geriatrician quit after a few months) Difficulty attracting patients to rural site – Education of residents as to appropriate referrals – Community outreach, education Lack of financial support for LCSW www. mcw. edu

Nursing Home Rounds Plan 2 nursing homes Residents to see patients prior to meeting with attending at the nursing home Point of care teaching Laptops bought to connect to EMR at the office One resident assigned to give short geriatric presentation after rounding Pitfalls Time was cut for nursing home rounds Lack of preparation for presentations Lack of use of laptops www. mcw. edu

Health Maintenance Audit of 10 elderly (>age 65) patients from resident’s panel (if appropriate) Annual flu vaccination Pneumonia vaccination Tetanus vaccination Bone density Colon cancer screening Lipid panel Mammogram Pap Prostate/PSA AAA screening Completed problem list Updated medication list Updated social history Visual acuity BP and vital signs Weight and height documented yearly www. mcw. edu

Resources Challenger Geriatrics at Your Fingertips Geriatric Review Syllabus (AGS) Resource Manual Articles www. mcw. edu

From Challenger Program Table of Contents: Preceptorship--Geriatrics/Psych Not Accessed Pretest: Preceptorship--Geriatrics/Psych Not Accessed Dementia: General Not Accessed Cancer and The Elderly Not Accessed Geriatrics: Assessment I, II Not Accessed Geriatrics: Depression Not Accessed Geriatrics: Falls Not Accessed Geriatrics: Gait Impairment Not Accessed Geriatrics: Medical Conditions Not Accessed Geriatrics: Pharmacotherapy I, II Not Accessed Geriatrics: Special Problems of the Elderly I, II Not Accessed Geriatrics: The Elder Patient: Acute Care Not Accessed Geriatrics: Urinary Incontinence Not Accessed www. mcw. edu

Home Visit Form

Future Directions Rotation is being moved to third year Ideally hire a PA/NP for nursing home stabilization Get all resource material online for residents Encourage EMR use at nursing home www. mcw. edu

Pearls and Pitfalls in Your Program? www. mcw. edu