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Geriatrics
Overview
The Geriatrics rotation will
provide the resident with exposure to management of elderly patients throughout
the continuum of care – home care to acute hospitalized to nursing home.
Residents will also learn to manage and assess patients through
multidisciplinary teams at the Geriatric Assessment center. Resident will also
learn how to perform functional assessments and gain an understanding of the
support systems needed to care for the elderly.
Principle Teaching/Learning
Activities
Morning Report
This conference occurs from 8:30
to 9:30AM (M,T,TH,F) in the resident resource room. Residents present cases to
either a subspecialty attending or to a core faculty. Generalist. Residents
are expected to prepare educational bullets to share with the group.
Grand Rounds
This conference is a lecture
driven format and occurs on Wednesday mornings in the Beardwood classroom.
Geriatric Grand Rounds
This conference occurs once a
month where cases are presented and discussed utilizing a multidisciplinary
approach.
Attending Rounds
Attending rounds occur at least
three times a week for 1 ˝ hours (total 4 ˝ hours per week). Residents present
cases to the primary teaching attending and receive both didactic and bedside
teaching.
Noon Conference
This conference occurs daily from
12 to1PM. A variety of presentations occur during this sessions including but
not limited to: journal club, autopsy rounds, clinical didactics, communication
video tape review, ethics topics etc.
Principle Educational Goals by
Competency
In the tables below the principle
educational goals for the General Medical Floors are outlined by competency.
The second column of the table indicates the teaching activity that is most
relevant to that competency.
MR= Morning Report
AR=Attending Rounds NC=Noon Conference
DPC =Direct Patient Care
GR= Grand Rounds
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Patient Care- Principle Educational Goals |
Learning Activities |
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Refine skills in history taking |
DPC |
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Refine skills in physical examination |
DPC |
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Recognize common inpatient medicine problems and
generate relevant differential diagnosis |
DPC, MR, GR, AR, NC |
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Refine skills in ordering and interpreting diagnostic
tests |
DPC, MR, GR, AR, NC |
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Medical Knowledge –Principle Educational Goals |
Learning Activities |
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Increase clinical medical knowledge of geriatric
medical problems |
DPC, MR, GR, AR, NC |
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Increase basic science knowledge of geriatric medical
problems |
DPC, MR, GR, AR, NC |
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Demonstrate ability to find relevant medical literature |
DPC, AR |
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Practice Based Learning and Improvement -Principle
Educational Goals |
Learning Activities |
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Identify areas that need improvement in medical
knowledge, decision making, and communication in regards to the care of
geriatric patients |
DPC, AR |
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Develop mechanisms to improve on identified areas of
weakness |
DPC, AR |
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Interpersonal Skills and Communication- Principle
Educational Goals |
Learning Activities |
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Communicate plan of care with patients |
DPC, AR |
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Communicate effectively with nursing |
DPC |
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Communicate effectively with other physicians involved
in the care of geriatric patients |
DPC |
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Present cases to other members of the care team and in
educational conferences |
AR, GR |
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Professionalism -Principle Educational Goals |
Learning Activities |
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Behave professionally towards patients and other
members of the care team |
DPC, MR, GR, AR, NC |
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Systems Based Practice – Principle Educational Goals |
Learning Activities |
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Gain an understanding on how best to utilize and access
hospital resources for the care of geriatric hospitalized patients |
DPC, MR, GR, AR, NC |
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Gain an understanding on how best to establish and
maintain services for patients leaving the hospital |
DPC, MR, GR, AR, NC |
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Use evidence based and cost conscious strategies to
care for geriatric patients |
DPC, MR, GR, AR, NC |
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Accident risk |
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Falls |
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Gait disorders |
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Poor safety awareness |
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Cardiovascular |
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Angina/Myocardial infarction |
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Atrial fibrillation |
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Congestive heart failure |
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Hypertension |
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Lower-extremity edema |
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Orthostatic hypotension |
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Peripheral vascular disease |
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Death and dying |
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Elder Abuse |
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End of life care |
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Bereavement |
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Bowel obstruction |
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Dyspnea |
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Pain management |
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Endocrine/metabolic |
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Dehydration |
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Diabetes, type 2 |
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Disorders of temperature regulation |
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Thyroid disorder |
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Hyperthyroid |
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Hypothyroid |
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Maltinodular goiter |
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Sick euthyroid |
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Ethical issues (advance directives, health care proxy, unrealistic
expectations of family and patient) |
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Failure to thrive |
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Gastroenterology |
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Colon cancer |
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Constipation, obstipation |
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Diverticular disease |
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Fecal incontinence |
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GERD |
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Ischemic bowel |
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Swallowing disorders |
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Health care financing/delivery system |
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Community-based services |
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Managed Medicare |
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Medicaid |
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Medicare |
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Hematology |
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Anemia of chronic disease |
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Iron deficiency anemia |
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Leukemias and lymphproliferative disorders |
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Multiple myeloma |
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Hospital discharge planning |
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Iatrogenic disease |
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Adverse drug reactions |
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Nosocomial complications |
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Polypharmacy, drug interactions |
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Procedure complications |
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Neurologic |
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Carotid artery disease |
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Normal pressure hyprocephalus |
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Parkinson’s disease |
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Spinal stenosis |
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Stroke |
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Transient ischemic attack |
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Nutrition |
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Aspiration |
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Aspiration pneumonia |
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Feeding disorders |
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Malnutrition, under nutrition |
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Oral health problems |
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Pain
control |
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Pneumonia |
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Psychiatric |
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Alcoholism, drug abuse |
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Delirium |
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Dementia |
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Depression |
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Late-onset psychotic disorders |
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Neurobehavioral disorders |
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Social Isolation |
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Renal/Urologic |
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Age related changes in renal function |
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Prostate disease |
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Sexual dysfunction |
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Urinary incontinence |
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Urinary retention |
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Urinary tract infection |
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Rheumatologic/Musculoskeletal |
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Contractures |
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Crystal diseases (gout, pseudogout) |
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Deconditioning |
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Degenerative joint disease |
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Fractures |
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Hip |
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Vertebral compression fracture |
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Wrist |
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Giant cell arteritis |
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Immobility |
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Low back pain |
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Osteoporosis |
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Polymyalgia rheumatica |
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Pressure ulcers |
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Spinal stenosis |
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Subacromial bursitis |
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Trochanteric bursitis |
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Sensory impairment |
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Hearing |
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Cerumen impaction |
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Presbycusis |
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Peripheral neuropathy |
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Vestibular disorders |
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Vision |
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Cataracts |
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Glaucoma |
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Macular degeneration |
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Skin |
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Cancers |
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Pruritis |
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Seborrheic keratosis |
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Xerosis |
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Sleep disorders |
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Syncope |
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Tuberculosis |
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