This is a 1-2 week geriatrics rotation. You will either be assign to Geriatrics Outpatient or Geriatrics consults at CUH. The weekend days before the outpatient clinics and consults week are off.
Geriatrics Outpatient:
The orientation email sent to you before you begin will let you know where to report the first day. Each intern or resident will be given a schedule for the rotation and you will be attending different clinics.
Geriatrics Consults:
This will be an in-person consult service at CUH. Please contact the assigned first call for the geriatrics consult service at 8am for further instructions.
Geriatrics Consult Service Rotation Description
Objectives
Educational Objectives and Curriculum
Curriculum and educational objectives can be found on the Southwestern Aging and Geriatrics Education program website:
There is a checklist of required competencies that you will need to complete by the end of the rotation (see SAGE website). There is some study time set aside to complete the online modules.
Goals and Objectives
- Assess acute and chronic diseases seen in older patients in the outpatient setting
- PGY-1: Learn the initial assessment of acute and chronic diseases seen in older patients in the outpatient setting
- Competency: Patient Care
- Understand the principles of chronic disease management in older patients
- PGY-1: Learn the principles of chronic disease management in older patients including the development of problem lists and preventive care principles
- Competency: Patient Care
- Learn pharmacological management of common disorders seen in older patients
- PGY-1: Learn the medications utilized for the management of common disorders seen in the elderly
- Competency: Medical knowledge
- Understand the differential diagnosis of common clinical scenarios
- PGY-1: Develop a basic differential diagnosis for common clinical scenarios seen in older patients
- Competency: Medical knowledge
- Understand the unique outpatient needs of older patients
- PGY-1: Recognize the unique outpatient needs of older patients and understand the community resources available
- Competency: Patient care, Systems-based practice
- Developing diagnosis skills
- PGY-1: Learn how to effectively use bedside clinical examination in older patients
- Competency: Patient care, Medical knowledge
- Communication and teamwork
- PGY-1: Recognize the core members of the patient care team involved in care of older patients, to include nurses, patient technicians, physical therapists, occupational therapists, social work
- Competency: Professionalism, Interpersonal and communication skills
- Rational ordering of lab tests and imaging studies
- PGY-1: Learn the indications for basic laboratory investigations and imaging in older patients
- Competency: Practice-based learning and improvement, Medical knowledge
- Familiarity with the electronic health record and optimization of its use
- PGY-1: Develop a basic understanding of The EHR and its core components and how it can be used to care for older patients
- Competency: Systems-based practice
Locations
Locations where you may see patients:
Outpatient:
Sprague Building: Located on the east side of Old Parkland. From the school on the library level, walk all the way through G level of Old Parkland through the east side past the radiology area. You will pass some coke machines on your right as you turn a corner. Keep walking straight and you will be in a gray colored hallway. Take the elevators on your right to 8. Turn left when you get off the elevators and the Geriatrics department is at the end of the hall on the right.
Parkland Geriatrics and Palliative Care clinics: Located at 1936 Amelia Court, at the corner of Harry Hines and Medical District Drive. There is parking. Geriatrics clinic is on the second floor, Palliative Care is on the first floor.
- Palliative Care Clinic Note template is PALLICLINIC and Discharge Instructions note template is PALLIBYEBY. One of the attendings will assign you patients to see.
- In Geriatrics Clinic, there are specific teaching patients set aside for the residents to see. Be sure to incorporate Geriatrics concepts such as functional status and cognitive status into your assessment and plan. They have in-person interpreters to help with Spanish speakers. For this clinic, you will place orders. Be sure to change the "Ordering Provider" to the attending who is precepting you.
UTSW Geriatrics Clinic: is located in Professional Office Building 2 on the 8th floor. You can park in the POB parking garage at Harry Hines and Record Crossing or you can take the shuttle from South Campus. The attendings will assign you patients to see. For this clinic, you will place orders. Be sure to change the "Ordering Provider" to the attending who is precepting you.
VA Rheumatology Clinic: Clinic 4 at the VA in the Clinical Addition (the big atrium area at the front where all the clinics are). The attendings and nurses will orient you when you get there. You may be doing joint injections here, so watch the knee arthrocentesis video before you go (link is below) .
VA Community Living Center (CLC) - Is attached to the VA hospital. It is the one-story red brick building separate from the hospital but attached by a long hallway. If you are in the VA, you can walk there on the ground level by going to Building 2, turning left past the Starbucks area and little store and following the long hallway and signs to the Home of the Brave/CLC. It is on the left side of the front parking lot, and you can also enter from there. The attending will orient you on the first day and will assign you patients to see.
Consults:
POB1 Geriatrics academic offices
Resources
Helpful Resources
2015 Update Beers Criteria for Potentially Inappropriate Medication Use in Older Adults
http://resolver.ebscohost.com.foyer.swmed.edu/openurl?sid=Entrez:PubMed&id=pmid:26446832
Montreal Cognitive Assessment (MOCA)- more sensitive for detecting mild cognitive impairment than the Mini Mental Status Exam
http://www.mocatest.org/
Mini Mental Status Exam- (This test is actually copyrighted and is thus falling out of favor somewhat)
https://www.mountsinai.on.ca/care/psych/on-call-resources/on-call-resources/mmse.pdf
Mini Cog-
http://www.alz.org/documents_custom/minicog.pdf
Activities of Daily Living- (Note that independence is typically lost in order from top to bottom)
http://consultgerirn.org/uploads/File/trythis/try_this_2.pdf
Instrumental Activities of Daily Living-
http://consultgerirn.org/uploads/File/trythis/try_this_23.pdf
Palliative Care Fast Facts- (Very helpful to look up any Palliative Care topics, especially the Palliative Performance Scale and
http://www.mypcnow.org/#!fast-facts/c6xb
ECOG Performance Scale-
http://www.mypcnow.org/#!fast-facts/c6xb
Knee Arthrocentesis Video- (watch before VA Rheumatology Clinic)
http://www.nejm.org.foyer.swmed.edu/doi/full/10.1056/NEJMvcm051914