PGY 1: Geriatric Medicine At Reno VAMC

Student Handbook, Appendix A

PGY-1 Two Month Rotation In Geriatric Medicine At Reno VAMC

Medical Knowledge

  1. To identify physiologic changes associated with aging versus those associated with disease
  2. To demonstrate knowledge of the etiology and management of common geriatric syndromes and diseases commonly associated with aging including but not limited to the following:
    • Incontinence, Dementia, CHF, OA, DM, Osteoporosis, Falls, Sensory impairment, Malnutrition, Depression, Anxiety, CAD, PAD, arrhythmias, Polypharmacy, Parkinson’s, acute and chronic pain, various terminal cancers
  3. To understand the unique needs of the older veteran population
  4. To know and understand the contributions of geriatricians, physician extenders, nurses, psychologist, psychiatrist, social workers, therapists, and pharmacist in an outpatient setting.

Patient Care

  1. To complete comprehensive evaluations of new patients, formulate a differential diagnosis, and develop a plan of care with a focus on preserving and improving functional status.
  2. To demonstrate appropriate geriatric consultation technique including clarifying the consulting physician’s questions, evaluation the patient, ordering appropriate diagnostic work-up and providing concise feedback to the consulting physician.
  3. To master prescribing medications for the elderly, avoiding polypharmacy, avoiding side effects, respecting cost
  4. To work with the patient, caregiver, and utilize the interdisciplinary team appropriately
  5. To appropriately demonstrate use of other clinicians into the assessment phase of care

Practice-based Learning

  1. To practice evidence based medicine in the care of elderly in various institutional settings
  2. To research topics relevant to patient care using web based resources
  3. To review patient outcomes, and how these might have been improved
  4. To present clinical cases at appropriate in mortality and morbidity conferences.
  5. To become competent in assessing cognitive, functional, medical, social, environmental and economic status and life values in the frail elderly

Communication and Interpersonal Skills

  1. To demonstrate proficiency in handling potentially litigious geriatric care issues with medical and legal providers
  2. To communicate in a timely and effective manner with patient and family members in response to questions
  3. To write a concise consult note detailing the findings and recommendations for plan of care
  4. To write a detailed progress note and care conference note with a geriatrics focus
  5. To learn how to conduct an interdisciplinary team meeting
  6. To learn how to conduct an effective patient-family meeting

Professionalism

  1. To respond to nurses and social workers for patient related questions in a timely manner
  2. To demonstrate follow up of diagnostic test results and notifying the patient and family
  3. To demonstrate proficiency in discussing advance directives and limitations of care
  4. To document in a timely manner all elements required for the medical record system including H&P, progress notes, discharge summary, transfer notes
  5. To complete and update the computerized problem list
  6. To understand the ethical and legal implications of caring for frail older persons

System based Practice

  1. To demonstrate knowledge of the resources available for elderly care in the community
  2. Demonstrate efficient use of consultations
  3. To practice cost-effective medicine
  4. To know the role of guardians, adult protective services, power of attorneys