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

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

“The Guide” ACGME Program Requirement for Graduate Medical Education in Family Medicine-Geriatric Medicine 120/120 prIndex.asp 120/120 prIndex.asp

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

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 –Review of web-based resources 1 –Community resources

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

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

Educational/Resource EMR Templates DementiaFalls Home Visits IADLs/ADLsGDSMMSE

Didactics Utilization of Video OSCEs – AGS powerpoint set – Guest speakers CURE CRIT program

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

Web-based Resources nals nals ervlet/segment/mededportal/information ervlet/segment/mededportal/information

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

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

MODELS OF GERIATRIC CURRICULA Sharon Smaga, MD SIU Family Medicine, Carbondale, IL April 30,2011

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

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

Third Year Clinics Continue Geriatric and Memory Disorder Clinics during third year Continue community presentations

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

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

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

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 MammogramPapProstate/PSA AAA screening Completed problem list Updated medication list Updated social history Visual acuity BP and vital signs Weight and height documented yearly

Resources Challenger Geriatrics at Your Fingertips Geriatric Review Syllabus (AGS) Resource Manual Articles

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 From Challenger Program Table of Contents:

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

Pearls and Pitfalls in Your Program?