Rotation Goals and Objectives

  1. General Description
    1. Family Physicians actual practices vary considerably in the extent to which they provide care to the elderly. This portion of the curriculum is designed to provide residents with the skills and expertise expected of family physicians with active practices involving this area. This rotation will provide a concentrated experience in the care of elderly patients and will be the intensive experience that complements the longitudinal experience in geriatrics. 
    2. The resident will be precepted by a faculty member specializing in Geriatrics and/or Hospice and Palliative Medicine. The resident has responsibility for the comprehensive care and coordination of care for all patients assigned to them in the extended care facility or the home. The resident will work alongside the geriatrician throughout the rotation. Assigned readings will also be a part of the learning process.
    3. Residents are expected to follow their patients in the Family Medicine Center during this rotation.
    4. Level: PGY 2, 3 or 4 year
    5. Location: the extended care facility at the VAMC, home of VAMC patients
    6. Duration: One four week block
    7. Geriatrics is a full time rotation.
    8. Four half days per week will be spent in the Family Medicine Center
    9. Work hour form submission is required at the completion of this rotation during work hour submission months.
    10. Evaluation of Rotation
      1. The evaluation of the resident on this rotation will be done by the completion of an evaluation form by the attending physicians at the end of the rotation.
      2. The resident will fill out a rotation evaluation for at the end of the rotation.
      3. The knowledge, skills and competencies acquired during this rotation will be evaluated by a Family Medicine attending as the resident provides care to patients in the Family Medicine Center.
      4. The resident's performance on the American Board of Family Medicine In-Training examination will also be used to assess knowledge in this area.
  2. Patient Care skills to be mastered
    1. Performance of complete history taking for elderly patients
    2. Performance of complete physical examination of elderly
    3. The evaluation and treatment of disorders common to the eldery population including incontinence, dementia, delirium, depression, gait disorders, falls, osteoporosis, pressure sores, medication induced illness, and terminal care.
    4. The coordination of comprehensive care for geriatric patients who reside in a long term care facility.
    5. Recognition of the role of the family and other psychosocial factors in the care of elderly patients.
    6. Develop an understanding of what multidisciplinary services are useful to elderly patients
  3. Medical Knowledge skills to be mastered
    1. An increasing knowledge base to care for the breadth of disorders of elderly patients will be achieved. Specific topics to be mastered include:
      1. The physiology of "normal aging"
      2. Pharmacology for the elderly
      3. Medication-induced disorders
      4. Incontinence
      5. Dementia and delirium
      6. Depression in the elderly
      7. Movement disorders
      8. Osteoporosis
      9. Pressure sores
      10. Terminal care
  4. Practice Based Learning and Improvement
    1. This competency is addressed longitudinally throughout the rotation.
      1. Scientific evidence will be reviewed by the resident and attending physician in the context of their patients.
      2. The practical implementation of evidence-based medicine will be discussed as the medical decision making is reviewed.
      3. Information technology will be utilized by the resident as he or she is required to research topics as directed by the attending physician.
      4. Information technology will be utilized with the extended care facilities electronic health record
      5. The resident will also be evaluated on the steps they took during the rotation to improve their shortcomings.
  5. Interpersonal and Communication Skills
    1. This competency is addressed longitudinally throughout the rotation.
      1. The resident will observe and be observed, taught and evaluated in the performance of obtaining patient histories, documenting histories, writing prescriptions and orders, educating patients and families about treatment plans and prognosis, teaching medical support staff and physicians.
  6. Professionalism
    1. This competency is addressed longitudinally throughout the rotation.
      1. The attending physician will observe and assess the resident's sense of personal responsibility including attendance, promptness, motivation, completion of duties, and appropriate dress.
      2. Ethical and legal practice skills will be taught
      3. Respect for cultural, age, and gender differences will be taught, observed and evaluated.
      4. The resident is expected to treat patients, families and colleagues with respect, understanding, sympathy and honesty
  7. Systems Based Practice
    1. This competency is addressed longitudinally throughout the rotation.
      1. The resident will learn to become aware of available resources and the cost effectiveness of testing and therapeutic options
      2. The resident will gain an increasing understanding of the role of the patient, physician, support staff, and insurer in the health care environment
      3. The resident will gain an increasing understanding in the role of the extended care facility in the health care environment.
      4. Through the coordination of care for the patients, the resident will become aware of the breadth of available resources in our community as well as to the limitations of the resources in our community. In this regard, the resident will be expected to work very closely with social workers and case coordinators to assist in providing the best care available to our patients.

Revision: May 5, 2018 by Richard D. Williams, MD