The Reynolds Geriatrics Experience at Emory Family Medicine

The Reynold’s Geriatrics Experience at Emory Family Medicine Residency Program Eddie Needham, MD, FAAFP Assistant Professor/Program Director Emory Family Medicine Residency Program Department of Family and Preventive Medicine Emory University School of Medicine

Agenda RRC requirements in Family Medicine n Geriatrics curriculum to date n Emory Reynold’s Resources n

RRC Requirements – July 2006 n n n “The residents must have clinical supervised experiences dealing with common acute and chronic diseases of aging. ” “Residents must develop competency in assessingand meeting the healthcare needs of declining elders, episodic, illness-related care, delivery of healthcare in the home, FMC, hospital, and long-term facility, and end-of-life care. ” www. ACGME. org

Where we were in 2003…

2003 Geriatrics Curriculum in Family Medicine There were multiple facets to this curriculum: 1. Inpatient rotations caring for the older adult. 2. A four week Geriatrics rotation in the PGY 2 year. 3. Home visits. 4. Dedicated Geriatrics didactics during our residency lecture series. 5. Continuity care clinics over three years

2003 Geriatrics Curriculum in Family Medicine n Inpatient rotations Residents rotate on internal medicine, family medicine, cardiology, and psychiatry. n A large portion of these patients are older adults, thus allowing residents to incorporate the principles of geriatrics into the medical care they render. n

2003 Geriatrics Curriculum in Family Medicine n We desired to solidify our geriatrics rotation in the PGY 2 year. Rotating through the geriatrics division was an excellent educational opportunity for our residents. n We needed a dedicated nursing home experience. n

2003 Geriatrics Curriculum in Family Medicine n We desired to establish a site where we could send and care for our own patients who needed nursing home care.

Where we are April 2006…

Geriatrics at EFMRP Continuity care clinic (FMC) n Dedicated geriatrics rotation in the PGY 2 year n Nursing home experience in PGY 2 and PGY 3 years n Residency didactics once a week n Reynold’s involvement n

Current Geriatrics Curriculum in Family Medicine n Continuity Care Clinics n n Residents are in clinic with the same patients over the three year residency. This fosters an excellent physician patient relationship. Residents are able to assess and care for the organic, psychosocial, and spiritual aspects of their patients. Access to the Emory’s geriatrics web site for ready access to clinical tools

Prior Geriatrics Curriculum in Family Medicine (pre-2003) n The Geriatrics rotation n In the past, this consisted of the following: n n n 3 half days per week at Sunrise Assisted Living of Decatur 2 half days per week in geriatrics clinic in the family medicine clinics Geriatric inpatient consults 2 half days with the ostomy/wound care nurse at Crawford Long Hospital 2 half days at the Wesley Woods Health Center 3 half days at Peachtree Hospice

Current PGY 2 Geriatrics rotation Occurs at the Atlanta VAMC with Emory Geriatrics faculty n Inpatient nursing home experience n Wound care clinic n Home visits n Geriatrics clinic n Excellent learning environment from resident feedback n

PGY 2 Geriatrics rotation n n Of note, each resident does a presentation while in the geriatrics rotation. One resident won 2 nd place at the GAFP poster presentation 2005 for a poster on osteoporosis in men. One resident is going to the AGS meeting to present on geriatric patients and the use of call buttons. Excellent scholarly output from this rotation!

Nursing Home Experience Beverly Northside Nursing Home n Once a month, PGY 2 and PGY 3 residents visits their patients at the nursing home. n They round with a geriatrics attending and then share a didactics topic from our geriatrics nursing home curriculum. n

Residency Didactics Residents have required didactics every week. n Lecture topics are covered on a regular basis. n EFMRP didactics calendar on-line n n www. fpm. emory. edu/Family/didactics/index. cfm

Current Geriatrics Curriculum in Family Medicine n Geriatrics lecture topics n There are dedicated geriatric lecture topics that are covered every 12 -18 months so that a topic is given at least twice during a three residency (36 months).

Emory Reynold’s Involvement n The Reynold’s Foundation Grant has opened doors for EFMRP to have access to superior educational resources Atlanta VAMC geriatrics rotation n Beverly Northside Nursing Home n Web Resources at: n www. cha. emory. edu/ n

How have you measured this? Ah yes, the continual JCAHO/RRC/ “pick an acronym” question… n Glad you asked n

Geriatrics ITE Scores 2002 Geriatrics % for program 52 2003 57 2004 50 2005 64 Average 2002 -2004 53

Resident Feedback This site is “A credit to our residency!” n “Dr. House is an excellent educator. ” n “I liked this rotation because I was involved in different outpatient clinics. ” n

Other Benefits One faculty member has been funded for a Reynold’s Faculty Scholarship. n Another faculty has received funding as a Core Faculty member – dedicated Geriatrics time n Many networking opportunities as a result of Reynold’s activities n Resident scholarly output n

Summary Markedly improved PGY 2 geriatrics rotation n Initiation and continued development of a continuity nursing home experience n Improved ITE scores n Excellent web resources n

The beginning of the end