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SAGE Intrinsic Aging: A Histological Perspective: Blood & Defense System

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
1
Abstract: 

This module demonstrates the normal age-related changes in the blood and defense systems and their clinical implications. A highlight of these modules are side by side comparison of young and aged tissues with interactive slides and summary drawings which reinforce the main points on the histology slides. The curriculum is appealing to clinical learners as it is anchored in showing clinically relevant changes and the implications of these changes in older patients. The main audience is the pre-clinical first or second year medical student, but these could be used by other trainees to teach the basic science of aging.

Educational objectives: 

Learning Objectives for Blood & Defense System module:

Identify the major aging associated changes in each of the following and describe the clinical implications of these changes:

  1. Blood and innate immunity
  2. Hematopoiesis
  3. Lymphocytes & adaptive immunity
Additional information/Special implementation requirements or guidelines: 

Southwestern Aging and Geriatrics Education (SAGE) Program

Lead Author: Judith R. Head, PhD

Medical Illustrator: Lindsay Oksenberg, MA

Geriatrician Author/Clinical Correlations: Amit Shah, MD

Special thanks to histology technician: Brie Thaden Pirkle

 

Contact Person/Corresponding Author:



Suggested Citation:
SAGE Intrinsic Aging: A Histological Perspective: Blood & Defense System. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/1077

Evaluation and Management of Late Life Psychosis

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
1
Abstract: 

This self-directed, web-based, interactive educational module addresses the evaluation and management of psychosis in older adults.

Educational objectives: 

After reviewing this module, learners should be able to:

1) list examples of psychotic symptoms.

2) describe the steps involved in performing a diagnostic work-up.

3) summarize treatment principles.

Additional information/Special implementation requirements or guidelines: 

Author:  Mary Camp, MD

Geriarician:  Amit Shah, MD

Medical Illustrator:  Lindsay Oksenberg, MA

Date posted: 
Tue, 01/20/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/20/2015
Contact Person/Corresponding Author:



Suggested Citation:
Evaluation and Management of Late Life Psychosis. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/1077

Cognitive Assessment in the Elderly

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
1
Abstract: 

This module demonstrates how to administer the Montreal Cognitive Assessment Test (MoCA).  The MoCA was created to screen patients who present with mild cognitive complaints and who usually perform in the normal range on the Mini-Mental State Examination or MMSE.

Educational objectives: 

After reviewing the module, learners should be able:

  • to know when to utilize the MoCA to screen a patient.
  • to know how to perform and score the MoCA.
Additional information/Special implementation requirements or guidelines: 

Quicktime is needed to view this video.

Author:  Mary Ellen Quiceno, MD

Geriatrician:  Belinda Vicioso, MD

Medical Illustrator: Lindsay Oksenberg, MA

Date posted: 
Tue, 12/02/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 12/02/2014
Contact Person/Corresponding Author:



Suggested Citation:
Cognitive Assessment in the Elderly. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/1077

Degenerative Aortic Stenosis

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
1
Abstract: 

The UT Southwestern SAGE Aortic Stenosis module is self-directed learning of degenerative aortic stenosis in the elderly. After completion of the program, medical students will have reviewed the disease, patient presentation, physical exam and treatment of aortic stenosis.

Educational objectives: 

After completion of the aortic stenosis module, learners will be able to describe:

  • anatomy and physiology of aortic stenosis
  • patient symptoms of aortic stenosis
  • diagnosis of aortic stenosis
  • treatment of aortic stenosis
Additional information/Special implementation requirements or guidelines: 

Quicktime is needed to view this material.

Author:  Melane Sulistio, MD

Geriatrician:  Kathryn Eubank, MD

Medical Illustrator: Lindsay Oksenberg, MA

Date posted: 
Tue, 12/02/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 12/02/2014
Contact Person/Corresponding Author:



Suggested Citation:
Degenerative Aortic Stenosis. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/1077

Geriatric Nephrology OSCE

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
2
Abstract: 

At the Medical College of Wisconsin (MCW), geriatricians, nephrologists and medical educators worked together to create and implement a geriatric nephrology OSCE for nephrology fellows. Key curriculum content gaps (pathophysiology of the aging kidney, medication and renal dosing and renal toxicity in elderly patients) were identified through a needs assessment including:

  1. ACGME nephrology requirements
  2. Nephrology fellows' in-service exam scores
  3. Survey of fellows and faculty to identify areas of perceived weakness
  4. Literature review, and
  5. Brief MCQ of basic science linked to clinical case questions.

Curriculum content was delivered using the Objective Structured Clinical Examination (OSCE) educational / assessment method. The curriculum session highlighted kidney injury and pharmacology topics: drug toxicity + underlying science through an OSCE session with post session debriefing provided by faculty. Fellows were evaluated by faculty and standardized patients using a checklist, and fellows evaluated the session at its completion. This submission contains all materials for the geriatric nephrology OSCE session.

Educational objectives: 

1. Demonstrate competence in the prevention, evaluation and management of geriatric aspects of nephrology, including disorders of the aging kidney and urinary tract.

2. Apply knowledge of physiology and pathology of the aging kidney + drug dosing and renal toxicity in the elderly patient.

3. When called as a consultant, to quickly: a. Identify signs of adverse drug reactions (drug overdose/toxicity) in an elderly patient and, b. Communicate a management plan to the patient and family.

Additional information/Special implementation requirements or guidelines: 

Additional details may be found in the detailed Instructors' Guide included in the submission.

Publications from, presentations from, and/or citations to this product: 

Denson K, Manzi G, Foy P, Vasudev B, Malmsten C, Rehm J, Brown D, Simpson D, Duthie E, Using Teaching Objective Structured Clinical Examination (OSCEs) to Expand Fellows' Perceptions Around Quality Care for Older Adults, American Geriatrics Society Annual Meeting, Orlando, FL 04/2014.

Date posted: 
Fri, 09/25/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 09/25/2015
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Nephrology OSCE. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/1077

Chief Resident Workshop in Bad News Communication & Learner Feedback

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Estimated time to complete: 
2
Abstract: 

Incoming chief residents from all departments participate in a 90 minutes workshop with the dual objectives of teaching a model for sharing bad news and preparing these physician leaders to give feedback to learners about this important skill.  After reviewing a 6 step model for bad news communication, the chief residents share bad news with standardized patients using two cases of older adults with a new or recurrent cancer diagnosis.  The standardized patients all receive training about the workshop's objectives in a separate session prior to the workshop.  After communicating with the standardized patient, the chief resident receives feedback from the patient, a trained faculty small group facilitator and 1-2 other chief residents.  After both cases are completed, the chief residents gather for a large group discussion about the challenges and opportunities in providing feedback to learners about sensitive topics.  This workshop has been conducted for the past three years, and has received positive evaluations from the participating physicians and the school's Graduate Medical Education Office.

Educational objectives: 
  1. Recognize bad news communication as a core physician skill
  2. Understand the 6 basic steps used to initially deliver bad news
  3. Practice giving feedback to a resident whom delivered bad news
  4. Identify & discuss challenges of providing feedback about a sensitive topic
Date posted: 
Thu, 10/02/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 10/02/2014
Contact Person/Corresponding Author:



Suggested Citation:
Chief Resident Workshop in Bad News Communication & Learner Feedback. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/1077

An Inter-Professional Education Delirium Simulation Pilot Project

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Case Overview: Ida Mae Homer is an 80 year-old woman with a 5-year history of Alzheimer’s disease.  Her granddaughter has been staying with her for the last 3 days while her daughter (her usual caregiver) is out of town.  Mrs. Homer is becoming increasingly confused and agitated with increased urinary frequency and incontinence as well as insomnia.  Her granddaughter has tried using Benadryl to help her sleep, however nothing seems to be helping.

Simulation: The set-up for the simulation includes the medical and nursing students reviewing a delirium web module (POGOe #20503) as well as a Situation, Background, Assessment, Recommendation (SBAR) video attached on the right side of this page, then completing pre-test delirium assessment (Delirium Knowledge Survey) and an assessment of attitudes toward teams in training (KidSIM) prior to the simulation.  Next, each medical and nursing student pair meets approximately 10 minutes prior to the simulation to review instructions, introduce themselves, and discuss thoughts and plans for caring for an agitated patient.  The team is then escorted to the “Emergency Room” where the patient and granddaughter (both are standardized patients) are waiting (faculty observes from control room).  The patient is agitated and anxious and is trying to get out of bed.  The team should elicit information from the granddaughter and recognize that the use of Benadryl and the probable urinary tract infection are the likely etiologies of delirium.  The team has a variety of medications available on the med cart (lorazepam, haloperidol, morphine, and hydroxyzine) as well as restraints, and the patient has “IV” access.  The simulation lasts 20 minutes, and approximately 10-15 minutes into the simulation, once the patient is stable and a plan has been established, the medical student calls the “attending” in the control room, and using SBAR, checks out the patient over the phone.  The faculty member then ends the simulation, and the entire team (faculty member, 2 students, and 2 standardized patients) leave the room for an approximately 15-20 minute debriefing session.  Simulations can run staggered if there are resources to have 2 teams and 2 standardized patients, otherwise the next simulation would begin once the debriefing session ends.

Goals for the simulation and topics for discussion during debriefing session:

  1. Diagnose delirium using CAM
  2. Identify potential causes for delirium
  3. Identify appropriate pharmacologic management for delirium (medication as well as dosage)
  4. Inter-professional collaborative practice
  5. Situation, Background, Assessment, Recommendation (SBAR)
Educational objectives: 
  1. The students will be able to evaluate a patient with agitated delirium.
  2. The students will be able to outline appropriate treatment for a patient with delirium.
  3. The students will be able to work effectively with students in other professions in the care of a patient with agitated delirium.
  4. The students will be able to achieve 80% on post-test Delirium Survey.
  5. The students will improve their attitudes and beliefs about teams in training (KidSIM).
Publications from, presentations from, and/or citations to this product: 

The results of this inter-professional education delirium simulation has been presented at the American Academy of Neurology's Consortium of Neurology Clerkship Director's annual meeting, highlighting educational tools.  The results have also been presented at the Johnson County Community College's Annual Healthcare Simulation Conference.  This pilot project has also served as preliminary data for the University of Kansas' successful Reynold’s Foundation Next Steps grant application.

Date posted: 
Mon, 09/29/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 09/29/2014
Contact Person/Corresponding Author:



Suggested Citation:
An Inter-Professional Education Delirium Simulation Pilot Project. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/1077

Geriatric Cardiology OSCE: The Hidden Curriculum, Identifying Hypoactive Delirium When Obtaining Procedural Consent

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Fellowship Programs must soon comply with the ACGME's Next Accreditation System (NAS) milestone performance tracking and reporting requirement and consider Entrustable Professional Activities (EPAs) to measure learner performance. At the Medical College of Wisconsin (MCW), geriatricians and cardiologists worked together to create and implement a geriatric cardiology educational OSCE for cardiology fellows. Key curriculum content gaps (hypoactive delirium recognition, use of cognitive assessment tools) were identified through cardiology fellow and faculty knowledge/performance gaps on a needs assessment survey/pretest. Curriculum content was delivered using the Objective Structured Clinical Examination (OSCE) educational/assessment method. Fellows self-assessed their competency level in those EPAs both pre and post OSCE curriculum intervention (Unable to Perform (1) - Teach Others (5)). The curriculum session included the OSCEs station followed by a debriefing session and learner self-evaluation.

This OSCE station may be given alone or combined in a two station OSCE session, with our other geriatric cardiology OSCE titled, "Geriatric Cardiology OSCE: The Hidden Curriculum, Identifying End Stage Heart Disease & Clarifying Care Goals."

This resource, also available on MedEDPortal.

Educational objectives: 
  1. Identify subacute delirium in an undiagnosed early-moderate stage dementia patient
  2. Elicit a history substantiating dementia from the patient and daughter
  3. Recognize delirium using the CAM criteria and tool
  4. Determine decisionality of the patient (non-decisional) in regards to medical decision making
  5. Determine decisionality based on the 3 primary requirements for medical decision making (take in information, apply it to self, express a choice)
  6. Identify the decision-maker in the patient’s care (POAHC—daughter) to obtain consent for the cardiac catheterization procedure

Purpose of OSCE station:

By the conclusion of this session, learners will be able to better provide care to geriatric patients in the ACGME Competency Domains including:

  1. Medical Knowledge: through identification of delirium and potential contributing factors.​
  2. Patient Care: applying knowledge of delirium identification to the process of obtaining informed consent for a cardiac procedure.
Additional information/Special implementation requirements or guidelines: 

​Two standardized patients are required for each OSCE learner case (one geriatric "patient" and one "family member/caregiver"). Examination room to conduct OSCE, either with an examination table or bed for the "patient" and two chairs, one for the "family member/caregiver" and one for the fellow.

Publications from, presentations from, and/or citations to this product: 
Date posted: 
Tue, 08/26/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 08/26/2014
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Cardiology OSCE: The Hidden Curriculum, Identifying Hypoactive Delirium When Obtaining Procedural Consent. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/1077

Geriatric Cardiology OSCE: The Hidden Curriculum, Identifying End Stage Heart Disease & Clarifying Care Goals

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

Fellowship Programs must soon comply with the ACGME's Next Accreditation System (NAS) Milestone performance tracking and reporting requirement and consider Entrustable Professional Activities (EPAs) to measure fellow performance. At the Medical College of Wisconsin (MCW), geriatricians and cardiologists worked together to create and implement a geriatric cardiology education OSCE for cardiology fellows. Key curriculum content gaps (identifying end stage heart disease, identifying and discussing palliative care goals in cardiac patients), were identified through cardiology fellow and faculty knowledge/performance gaps on a needs assessment survey/pretest. Curriculum content was delivered using the Objective Structured Clinical Examination (OSCE) educational method. Fellows self-assessed their competency level in those EPAs both pre and post OSCE curriculum intervention. The curriculum session included the OSCEs station followed by a debriefing session and learner self-evaluation.

This OSCE station may be given alone or combined in a two station OSCE session, with our other geriatric cardiology OSCE titled, "Geriatric Cardiology OSCE: The Hidden curriculum, Identifying Hypoactive Delirium when Obtaining Procedural Consent."

This resource, also available on MedEDPortal, contains all materials for the geriatric cardiology OSCE regarding end stage heart disease and end of life goal setting, but also contains an additional agenda & timeline and a second evaluation form to be used if the two stations are combined.

Educational objectives: 
  1. Identify end stage cardiac disease in an elderly patient.
  2. Determine the patient’s cognitive and functional capabilities.
  3. Elicit the patient’s goals of care.
  4. Make care recommendations that are consistent with the patient’s life and care goals.

As educators, our goal was to see if the learners were able to recognize that the cardiac disease was at an end stage process, and then follow with an exploration of cognitive, functional and social situations in the context of the patient's goals and wishes to discuss a hospice/palliative care approach. To increase clinical relevance and keep the simulation closer to the reality of clinical care, learners were asked to review the patient's case and discuss plans for his treatment and care. This allows for some learners to make the clinical error of only adjusting medications and suggesting AICD battery replacement if they do not fully assess the patient holistically and delve into their care goals. We believe that this to be a more realistic and powerful way to learn.

Additional information/Special implementation requirements or guidelines: 

This curriculum was successfully implemented in the cardiology fellowship core curriculum but could also be implemented with other levels and types of learners (residents, medical students). Resource limitations may include space and standardized patients.

Publications from, presentations from, and/or citations to this product: 

Published first on MedEDPortal

Date posted: 
Tue, 08/26/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 08/26/2014
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Cardiology OSCE: The Hidden Curriculum, Identifying End Stage Heart Disease & Clarifying Care Goals. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/1077

Can You Swallow This? A Practical Approach to Dysphagia

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
1
Abstract: 

This interactive, "hands-on", small group session emphasizes a practical approach to the diagnosis and management of dysphagia in older adults.  Created by a speech and language pathologist and geriatrician team, the session begins with a brief overview of swallowing anatomy and phases.  A small group brainstorming session then highlights potential etiologies of dysphagia, followed by the use of video fluoroscopic studies and the learners' sampling of thickened liquids and trials of swallowing manoeuvers to make learning "stick".

1) The session starts with the facilitator reviewing a PowerPoint presentation (9 slides).  These slides cover the session learning objectives, the definition of dysphagia and review of  health consequences of dysphagia, and orient the learner to swallowing basics through cross-sectional diagrams of the head and neck describing swallowing anatomy and phases of swallowing.

2) The session continues with a small group brainstorming session with learners working in groups of two or three to fill in a chart listing "what conditions/diseases may lead to dysphagia or aspiration?" The group lists the etiologies under the three headings of swallowing phases (e.g., oral, pharyngeal, esophageal).  The facilitator has the groups share findings with the large group, highlighting key points.

3) The facilitator returns to the PowerPoint Presentation, reviewing key factors in identifying dysphagia through history and physical examination (4 slides).  Evaluation through video fluoroscopy is demonstrated through 5 short video clips (e.g. normal swallow, aging swallow, aspiration, thick/thin liquids modifications).

4) Learners try nectar and honey thickened liquids to experience potential therapy/treatment options and to then practice basic compensatory swallowing strategies.

 

Educational objectives: 

Educational Objectives:

1. Identify the 3 phases of swallowing (oral, pharyngeal, esophageal) and conditions causing potential dysphagia.

2. List 5 factors (clues) that a patient may be at risk for aspiration.

3. List treatment options for aspiration (swallowing exercises, position changes, dietary modification).

Additional information/Special implementation requirements or guidelines: 

Educational Objectives:

1. Identify the 3 phases of swallowing (oral, pharyngeal, esophageal) and conditions causing potential dysphagia

2. LIst 5 factors (clues) that a patient may be at risk for aspiration

3. List treatment options for aspiration (swallowing exercises, position changes, dietary modification)

 

Of Note:

This exercise is designed to cover the practical aspects of swallowing and dysphagia.  It's goal is to help learners identify risk factors for aspiration in older adults and to be able to then implement an initial assessment plan to evaluate the condition further.  Trial of the liquids is done to increase empathy and understanding of the risks and benefits of modifying liquid consistence for patients and the challenges of postural and behavioral modifications as well.  The teacher/facilitator does not need to be an expert in swallowing and dysphagia.  The materials provided are an initial point for teaching and the Frequently Asked Questions/References  (Ask the Speech Therapist Sheet) is designed to supplement the session and to provide a starting place for further study.

While the session is most easily taught as a small group session (6-8 learners), it was taught at the American Geriatrics Society Clinical Skills session to approximately 60 learners.  The small group portions were completed by having learners work with one or two persons next to them to complete the Dysphagia Etiologies Chart, and liquids were passed on trays.

Materials needed for the session:

1. Session Agenda - facilitator (one)

2. Session Agenda - Participants (one for each participant)

3. PowerPoint presentation with included 5 video clips

4. Dysphagia Etiologies sheets - blank (one for each participant or for each small group)

5. Dysphagia Etiologies sheet - answer key (one for the facilitator)

6. Nectar and honey consistency thickened liquids.  These may be made with a starch/thickener product such as "Thickit" (mix the starch with water according to ratios in the product directions - be aware that the liquids thicken further upon standing, so you may need to thin the liquid out with more water), or by purchasing pre-thickened liquids in the two consistencies ( a more expensive, but easier approach).  It is a time-saver and stress-reducer to have the liquids prepared in the small cups prior to the session.  They may be place on the table or passed around via a tray.  It is important to identify which liquid (nectar or honey thickened) is in which cup.  This may be done with a marker "N" or "H" on the cups, or by simply using two different style/color of cups.

7. Small, disposable cups (2 per learner)

8. Spoons and napkins, tray (optional)

9. Frequently Asked Questions/Reference Sheet

 

Publications from, presentations from, and/or citations to this product: 

Presented at:

Wisconsin Geriatrics Board Review Course and Update, Lake Geneva, WI, Sept, 2013

Wisconsin Family Medicine Winter Refresher Course, Oconomowoc, WI February 2014

 American Geriatrics Society Annual Meeting, Clinical Skills Session, Orlando, FL, May 2014

Date posted: 
Mon, 09/29/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 09/29/2014
Contact Person/Corresponding Author:



Suggested Citation:
Can You Swallow This? A Practical Approach to Dysphagia. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/1077

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