FAMU-4003 - Geriatrics for the Family Physician

FAMU-4003 - Geriatrics for the Family Physician

Elective Title: Geriatrics for the Family Physician
Course Number: FAMU-4003
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Must have a successful completion of one clerkship. Contact Course Coordinator: Chris Pleasant (chpleasa@utmb.edu) or Jessica Prescott (jlpresco@utmb.edu)
Responsible Faculty Director: Barbara Thompson, MD Periods Offered: 1-7; 9-13 excluding holiday period 8 
Coordinator: Jessica Prescott & Christopher Pleasant Other Faculty:
Location to Report on First Day:
Contact Course Director for scheduling and assigned locations.

1. The student will develop an understanding of the delivery of health care to elderly patients in a variety of settings.
2. The student will develop the knowledge and skills needed to assist elderly patients in improving or maintaining quality of life by achieving:
- independent functioning
- health maintenance
- appropriate disease management
3. The student will integrate an understanding of the biopsychosocial and economic issues of the older patient into the delivery of health care.

By the completion of the course the student will:
1. Recognize, evaluate, and develop a treatment plan for common diseases of the elderly.
2. Describe normal changes of aging on the various body systems
3. Recognize, evaluate, and develop a plan for common problems encountered with the nursing home patient.
4. Recognize, evaluate, and develop a plan for common problems of the homebound patient.
5. Describe and be able to assist with various end-of-life issues, including palliative care, advanced directives, patient and family support and education, hospice, etc.
6. Develop a patient-specific plan of health maintenance/risk modification/ and screening.
7. Describe pitfalls of geriatric care, including polypharmacy, iatrogenic illness, non-recognition of treatable illness, under-utilization and over-utilization of technology, ageism, etc.
8. Describe the economic issues for the elderly patient utilizing health care services, especially Medicare and Medicaid.
9. List community resources available for geriatric patients in Galveston.
10. Observe and participate in community-based activities with health elderly people at Osher Lifelong Learning Institute (OLLI).

Description of course activities
Students will receive individual supervision as they assess geriatric patients in various settings (including time with OLLI). Patients will be encountered in the office, nursing home, home and hospital settings. Documentation of patient contacts and a short paper on a geriatric topic will be required. Attendance at selected Department of Family Medicine conferences and teaching rounds will be expected. There will be no night call or weekend duties. There will be some required reading on selected topics.

Type of students who would benefit from the course
Students who will care for elderly patients in their chosen specialty. Students who desire a better understanding of the elderly people that they encounter in their personal lives.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8AM Orientation 5PM Libby's Place
Tuesday 8AM Clinic with BT 5PM Care Giver Support Group
Wednesday 8AM OLLI/Self Study 5PM OLLI/Home Visits
Thursday 8AM Libby's Place 5PM Resident Didactics
Friday 8AM OLLI 5PM Nursing Home/Self Study

 Average number of patients seen per week: 20
 Call Schedule: NA

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    3-4 half days a week
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty, NP and Social worker
  B. Frequency / Duration of Presentation(s)?
    20-30 a week, 2-3 minutes each
  C. Format - What guidelines are set for the student's presentation?
    Similar to 3rd year clerkship presentation
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Select a topic and write 8-10 page paper about it.
  B. Format - What guidelines are set for the student's written work?
    Show student previous student's papers and discuss format,etc.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    Minimum of 5 references
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Student-selected from limited options.
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Attend clinical sessions, meet with faculty weekly regarding reading materials provided. Also keep appts with community-based resources and at the nursing home where student will work with faculty, resident and NP.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    The oral discussion includes questions about common Geriatric problems which students have reviewed as well as discussion about the major lessons learned during the elective.
Individual critique and feedback on patient presentations. Direct observation of student/patient encounters by responsible faculty. Feedback on the required paper.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.