GeriatricsGeriatrics______________________________________________________________________________________________________________________
At Carle, a 2 week PGY II block rotation under the supervision of Dr. Suma Peter, a Carle Clinic Association physician, board certified in Geriatrics. At VAIHCS, a 4 week block rotation the supervision of U. Paruchuri, MD, Craig Elliott, MD, A. Mani, MD, and M. Paturi, MD.
Additionally, geriatric training takes place longitudinally throughout all 3 years. PGY III residents receive longitudinal training in primary care at Helia HealthCare Centre of Champaign.
Block rotations in Ambulatory Medicine, Adult Medicine, Cardiology, Critical Care, Gastroenterology, Hematology, Neurology, Oncology, Pulmonary, and Rheumatology, Continuity Clinic and weekly conferences also include a geriatrics component
Develop the attitudes, knowledge, and skills for competent care of healthy and frail elderly, including disease prevention, recognition of disease presentation and promotion of optimal functional independence.
A. PATIENT CARE:
Objective 1: Demonstrate clinical skills of medical history and physical examination, including comprehensive geriatric functional assessment and mental status.
Objective 2: Demonstrate clinical skill in the diagnosis and management of both acute and chronic multiple illnesses in elderly patients including skills in cognitive and functional assessment, needs assessment upon discharge from hospital or extended care facility, and rehabilitation needs.
Objective 3: Demonstrate clinical skill in medical management of patients in ambulatory and long-term care settings, including extended care facilities, palliative care and hospice care.
B. MEDICAL KNOWLEDGE:
Objective 1: Describe normal human aging, including biology of aging, life expectancy, life span, common theories of aging; age-related changes in tissues and organs, and physiologic function; and homeostasis and the changes in therapeutic range of interventions.
Objective 2: Describe common presentation of illnesses, and responses to therapy, including pharmacokinetics and pharmacodynamics.
Objective 3: Identify nutritional needs, recognition and treatment of malnutrition, including the use of tube feedings, enteral and parenteral supplements.
Objective 4: Preventive care, including primary, secondary, and tertiary interventions with special knowledge about iatrogenic disease and prevention.
Objective 5: Evaluation and treatment of multiple geriatric syndromes including Alzheimer’s Disease and related dementia’s, drug-induced illness, elder abuse and neglect, failure to thrive and weight loss, falls and gait disorders, fecal and urinary incontinence, geriatric psychiatric conditions, immobility and pressure ulcers, and sleep disorders.
C. PRACTICE-BASED LEARNING AND IMPROVEMENT
Objective 1: Recognize the heterogeneity among older persons with respect to physiologic age, health status, belief systems, values, and personal preferences. Demonstrate a willingness to interact with the patient and family objectives, for diagnosis and therapy with consideration of the individual patient’s values and preferences.
Objective 2: Demonstrate ability in medical decision making for the elderly, and incorporate medical assessment, and patient values and preferences.
D. INTERPERSONAL AND COMMUNICATION SKILLS
Objective 1: Communicate clearly when writing medical orders and when giving directions with attention to language. Avoid abbreviations.
Objective 2: Communicate clearly, audibly, and with respect when speaking to patients and families with attention to language, and tone. Avoid medical jargon.
Objective 3: Create a positive relationship with the patient and family to assure optimal medical care, assuring the emotional and cultural needs and expectations of geriatric patients.
Objective 4: Participate and work effectively with others on interdisciplinary and/or multidisciplinary teams to promote optimal patient care.
E. PROFESSIONALISM
Objective 1: Demonstrate respect and compassionate use of medical skills for the elderly. This includes the utility of high-quality care and technology and, in the event of terminal illness, an awareness of the limits of medical intervention and the obligation to provide humane care.
Objective 2: Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities.
Objective 3: Recognize the legal requirements of advanced directives and describe the process of assessing a patient's advance directives, including the patient's perspective.
F. SYSTEM-BASED PRACTICE
Objective 1: Recognize financial issues of heath care, with emphasis on understanding acute and chronic care, and medication coverage; and the role of the Centers for Medicare and Medicaid Services (CMS), and other third party payers.
Objective 2: Actively participate in the multidisciplinary approach to caring for older persons, including appropriate recognition of other health professional and paraprofessionals roles and demonstrate competence in team interactions, i.e. pharmacist, physician’s assistant, advanced practice nurse, occupational and physical therapist, social worker, case manager.
Ambulatory :
PGY II residents receive geriatric training primarily in the ambulatory setting in the 2 week Geriatric block. Geriatric Consultation Clinic is scheduled on Wednesday afternoons. Consultative assistance with geriatricians, social services, nursing, and restorative services is available as needed. PGY II residents may be expected to have responsibilities on Saturdays, e.g. phone coverage, office visits, or hospital rounds.
In addition, in the ambulatory setting, residents evaluate and manage geriatric patients in Continuity Clinic, longitudinally. Consultative assistance with geriatricians, social services, nursing, and restorative services is available as needed.
Inpatient - Acute Care:
Inpatient - Acute Care is taught longitudinally. The patient populations of all 3 clinical training sites, i.e. Carle Foundation Hospital, Provena Covenant Medical Center, Danville Veterans Administration Illiana Health Care System, provide extensive opportunity for the care of the elderly throughout Residency training. Six faculty physicians in the Departments of Medicine and Family Practice are certified in Geriatric Medicine. Each clinical training site provides a comprehensive approach to the special needs of elderly patients, including nursing, social services, and rehabilitative services as needed.
During PGY I or PGY II, residents spend a block rotation with the DVAIHS Geriatric and Palliative Care service. Residents learn special topics in geriatrics, such as geropharmacology, aspects of geropsychiatry, the role and limitations of rehabilitative and other ancillary services, home care options, pain management, end-of-life issues, and financial and sociological issues associated with aged care in America. The knowledge is intended to supplement, not repeat, the day-to-day disease management teaching and learning provided on other inpatient and ambulatory rotations, where care of older patients constitutes a large part of the experience.
Extended Care :
PGY III residents are assigned a one to two patients for primary care. Residents are required to make monthly patient visits and document monthly progress. To assure continuity of care, coverage for leave must be secured by the resident, with backup by the assigned senior resident on-call at Carle.
Each month, PGY III residents participate in teaching rounds conducted by the attending at the extended care facility for case review of selected patients, and specific management issues. A resident is assigned a 45 minute geriatric topic for presentation and discussion. Additionally, peer-reviewed chart audits are performed twice a year as a tool for teaching rounds. The schedule is online : 2008-09 Geriatric Teaching Rounds Schedule.
Core Conference Curriculum :
The core conference curriculum is an 18 month curriculum including a core conference in Geriatric Medicine. The topics covered include syndromes specific to the elderly patient. Topics addressed on the 18 month rotating calendar include biology, theory and demographics of aging; depression and anxiety in elderly; chronic pain; dementia evaluation and management; osteoporosis; polypharmacy; recurrent falls; and urinary and fecal incontinence.
According to Accreditation Council of Graduate Medical Education (ACGME), training and evaluation must include the following competencies: Patient Care, Medical Knowledge, Practice – Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and System-Based Practice.
Patient Care will be evaluated by global assessment of the attending physician and additional information from nursing staff. Procedures performed will be documented.
Medical Knowledge will be evaluated by non-weighted pre/post test, global assessment of the attending physician, and peer-reviewed chart audit.
Practice-Based Learning and Improvement will be evaluated by peer-reviewed chart audit.
Interpersonal and Communication Skills will be evaluated by global assessment of attending physician and additional information from nursing staff, patients and families.
Professionalism will be evaluated by global assessment of attending physician and additional information from nursing staff, patients and families; and peer-reviewed chart audit.
System-Based Practice will be evaluated by global assessment of attending physician, and peer-reviewed chart audit.
The evaluation method is primarily accomplished electronically. Residents' performance in Geriatrics is evaluated by the attending geriatrician physician. Resident performance in the extended care facilities is evaluated twice yearly by written evaluations of the responsible attending physician and additional information from nursing staff, patients and families. Evaluations are reviewed with the residents for formal feedback. Face to face interaction between the attending physician and the resident is the required method. At the midway point of the rotation, the resident is encouraged to approach the attending to assess and discuss performance. In addition, ongoing feedback is provided related to residents’ patient care responsibilities and activities.
Residents will document the Geriatric rotation in portfolios, e.g. procedures performed, peer-reviewed chart audit. This tool will provide individual learning, reflection and assessment. Additionally, residents will evaluate the geriatric rotation and extended care experience.
Residents provide input on the Geriatric Medicine core lecture series, which is used in scheduling future topics and speakers. Periodically, residents are surveyed to evaluate the geriatric curriculum and teaching faculty.
Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine, Fifth Edition (GRS5) (current edition)
Journal of the American Geriatric Society
Kane , R.L. Ouslander J.G. and Abras I.B, Essentials of Clinical Geriatrics, McGraw Hill Book Co. (current edition)
Revised 8/2/05, 7/1/06, 10/10/06, 7/1/07