MEDU-4033 - Geriatrics in the Community

MEDU-4033 - Geriatrics in the Community

Elective Title: Geriatrics in the Community
Course Number: MEDU-4033
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Dr. Cecil Kumfa Periods Offered: 1-13 including holiday period 8 
Coordinator: Kiki Baldwin Other Faculty: Vinod Kaushik, MD; Mukaila Raji, MD; Anna Rotkiewicz, MD
Location to Report on First Day:
Rebecca Sealy, Rm. 6.608 (Kayla Shamburger) at 8:30am on first day of elective, unless otherwise indicated in the course correspondence, phone # 409-266-9635

1. To discover the available care options for the community dwelling older adult through experiences at various clinical sites
2. To develop an understanding of comprehensive geriatric assessment focusing on complex medical disease , geriatric syndromes, preventative health and goals of care.
3. To enhance communication skills with the older adult with an enhanced sensitivity to gender, age, ethnicitiy, and socioeconomic status as relates to medical care.

1. Perform a comprehensive history and physical on a community dwelling older adult with attention to presence of geriatric syndromes
2. Create a comprehensive assessment and plan for a community dwelling older adult with multiple comorbidities and geriatric syndromes taking into account patient expressed goals of care
3. Describe the benefits and limitations of care options for the debilitated older adult including skilled nursing, long term nursing home, hospice, home care, and assisted living

Description of course activities
1. The student will accompany a faculty member and geriatric fellows in the ambulatory geriatric clinic, skilled nursing facility/nursing home, and in home visits.
2. The student will participate in geriatric didactic noon conferences and internal medicine grand rounds.
3. The student will participate in older adult health prevention and promotion in the community as opportunity affords.

Students will spend about 40 hours a week in clinic or doing self directed study.

Type of students who would benefit from the course
Knowledge and experience gained will benefit: those pursuing a career in primary care or as a hospitalist, those pursuing adult surgical specialties or adult medical specialties, those with aging loved ones

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday PCP Geriatric Clinic PCP Geriatric Clinic
Tuesday League City Geriatric Clinic Skilled Nursing Facility
Wednesday Skilled Nursing Facility House Call
Thursday Specialty Experiences Specialty Experiences
Friday League City Geriatric Clinic League City Geriatric Clinic

 Average number of patients seen per week: 25
 Call Schedule: none

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?
    Daily at nursing homes, skilled nursing facilities, clinics and patients' homes, always with a geriatric fellow or a geriatric faculty.
  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?
    Attending physicians and geriatric fellows
  B. Frequency / Duration of Presentation(s)?
    Daily Presentations of patients seen in House Call, Clinics and Nursing Home/Skilled Nursing facility
  C. Format - What guidelines are set for the student's presentation?
    Standard UTMB Internal Medicine oral format containing all components of H and P and care plans, with emphasis on activities of daily living functions, psycho-social issues and common geriatric syndromes
  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)?
    Single comprehensive H&P submitted during rotation, Daily progress notes at discretion of faculty physician
  B. Format - What guidelines are set for the student's written work?
    Standard UTMB Internal Medicine format with addition of details specific to geriatric assessment including psychosocial aspects of care, geriatric syndromes, and goals of care
  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?
    However, pertinent literature review is expected to show depth of understanding of covered differential diagnosis and care needs.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Cases under discussion and assigned topics by attendings
  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)?
    The students will attend Tuesday and Wednesday noon Geriatric conferences as well as Thursday noon Internal Medicine Grand Rounds (time permitting).

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.
    Observation by faculty.
Fellow report on the student's clinical skills and professionalism.
Attendings will fill the evaluation forms sent from the Dept of Internal Medicine

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.