The Portal of Geriatrics Online Education

15 HCP: When to override standard recommendations for screening tests

15. Accurately identify clinical situations where life expectancy, functional status, patient preference or goals of care should override standard recommendations for screening tests in older adults, noting that risk/benefit, not age alone is not a basis for withholding standard screening or treatment.

Frailty Interactive Cases and A Facilitator’s Guide

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Abstract: 

Introduction: Frailty is a diagnosable and treatable medical condition. It is a common syndrome in older adults, characterized by: physiological decline, marked vulnerability to adverse health outcomes, increased healthcare utilization, disability, high risk of falls, multiple comorbidities, and mortality. Our goal was to create a case-based educational resource in frailty for medical and other healthcare students.

Methods: A multidisciplinary team at the Miami VAHS, Geriatric Research Educational and Clinical Center, designed and implemented an 8-module educational resource on frailty: An Introduction and 7 cases covering screening, diagnosis, management, and comorbidities. This curriculum was used and evaluated by 4th-year medical students from the University of Miami Miller School of Medicine. Evaluation included a pre-/post-test and a curriculum evaluation with questions on content, learning objectives, value of the learning, and multimedia module usability. The Wilcoxon signed rank test was used with unilateral Monte Carlo significance to compare pre-/post-test performance, significant at p<.05.

Results: Fifty-one students completed 4 modules and the pre-/post-test from November 2020 to March 2021. Students’ post-test performance demonstrated significant improvement (p<.05) in knowledge of frailty. Fifty-five percent agreed the multimedia educational activity enhanced their knowledge of frailty and will include frailty assessment in their future practices. The combined “Good + Excellent” rating from evaluations of content linked to learning objectives ranged from 82.3-94.2%. Overall, written comments were positive regarding multimedia usability.

Conclusion: These case-based modules on frailty were highly rated and positively critiqued by students. Pre-/post-test evaluations demonstrated an increase in knowledge of frailty.

Keywords

Frailty, sarcopenia, comorbidities, multimedia, case-based learning

Educational objectives: 

There are twelve (12) learning objectives for the seven (7) cases; two learning objectives repeat for multiple cases. The number(s) in parentheses at the end of each learning objective below designates the cases in which the learning objective applies. All learning objectives start with the statement, “After viewing this module, learners will be able to describe.”

  1. Frailty can be diagnosed using accepted criteria and available tools (1)
  2. Frailty can be managed with literature-based interventions that include exercise nutritional support and optimized treatment of comorbid conditions (1)
  3. Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional (2 through 7)
  4. Frailty is often associated with a reduction in socialization that is often remediable with optimized care across all domains as well as care coordination (2)
  5. As is often the case in caring for patients with complex disease, it takes a team (2, 3, 6, 7)
  6. Frailty is often associated with cognitive deterioration that is often remediable with optimized care across all domains (3)
  7. Frailty is often associated with dependency and the need to recommend palliative care (4)
  8. Frailty is often associated with depression because both are common diseases (5)
  9. Depression can affect frailty by amplifying the symptoms of co-morbid conditions (5)
  10. Frailty coexisting with cognitive impairment need to be recognized early because of their mutual deleterious impact on function (6)
  11. The need to customized cancer care in frail patients based on comorbidities, function and prognosis (7)
  12. The importance of the social domain in care planning for patients with frailty and cancer (7)
Additional information/Special implementation requirements or guidelines: 

 

Facilitator’s Guide

Understanding Frailty: Screening, Diagnosis and Management

Authors

Lubna A. Nasr, MD

Department of Public Health, University of Miami Miller School of Medicine

Bruce W. Carter Miami VAMC, Miami, FL, USA

Raquel Aparicio-Ugarriza, PhD

ImFINE Research Group. Faculty of Physical Activity and Sport Science-INEF

Universidad Politécnica de Madrid, Madrid, Spain

Douglas Salguero, MD

Mount Sinai Medical Center, Miami, FL, USA.

Michael J. Mintzer, MD, AGSF

Director and Associate Director for Education & Evaluation

Miami Geriatric Research, Education and Clinical Center (GRECC), Miami, FL, USA

Acknowledgements

The authors would like to thank:

Rose van Zuilen, PhD, and Corinne B. Ferrari for their help in reviewing the modules and including this frailty training as a component of the MS4 geriatrics clerkship

 

Overview

Frailty is a term widely used in clinical medicine but often ill-defined. The primary purpose of these modules is to teach learners the definition, screening modalities and diagnostic methods for frailty. In addition, the secondary purpose to is display healthcare issues of older adults commonly associated with frailty. These include comorbid conditions, social disruptions, end-of-life care, etc.

This training is composed of eight PowerPoint narrated and animated presentations. PowerPoint was chosen because of its ubiquitous availability to virtually all learners. The introduction presents the basics of frailty definition, screening and diagnosis. The subsequent seven case-based modules ask students to apply their knowledge. We recommend that learners complete a minimum of four modules starting with the introduction and ending with Case 7; learners are free to choose two modules from cases 1 through 6 and are welcome to complete all these optional cases. Finally, case 7 is the most complicated and longest module; if a learner uses the fully narrated and animated features, it will run approximately 25-minutes. To meet individual needs, learners have the option to disable audio (narration and dialog) on some or all of the screens. (These PowerPoint-based modules do not provide the option of varying the speed of audio tracks as in some programs). Most students can complete the minimum of 4 modules in 60-75 minutes; all the modules can be completed in 2-2.5 hours. The list of module titles is included in Learning Objectives below.

All cases use a standardized template. Navigation instructions are included in the Introduction; all cases follow the same instructions. Learners must start with the Introduction followed by cases in numerical sequence; cases become more complex with progression. In evaluating this curriculum, we used: Introduction, followed by Case 1, Case 5 and Case 7. Students can return to the Introduction module at anytime to review terms and definitions.

Materials and Supplies

Access to a computer with Microsoft PowerPoint or other compatible software is required. Headphones or earbuds may be needed if learning is occurring in a congregate environment or because of learner preference. This training requires no other special instructions, materials or supplies. The PowerPoint presentations can be easily uploaded to the school’s learning management system for assignment to learners.

Learning Objectives

Learning objectives are included in each case. These objectives also act as a “preview” for the content within the animated and interactive modules. The introduction has no learning objectives because it is a “definition of terms” module for frailty, sarcopenia, and frailty screening, diagnosis and management. These topics are specifically addressed within the learning objectives of the cases. There are 12 unique learning objectives. Some of the learning objectives appear in more than one case. This is intentional. It allows learners to apply their learning to a new clinical circumstance or a new domain of care. The learning objectives follow the statement, “After viewing this module, learners will be able to describe:” and are listed here by case:

Case 1: Mild Frailty

  • Frailty can be diagnosed using accepted criteria and available tools
  • Frailty can be managed with literature-based interventions that include exercise, nutritional support and optimized treatment of comorbid conditions

Case 2: Moderate Frailty and Falling

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty is often associated with a reduction in socialization that is often remediable with optimized care across all domains as well as care coordination
  • As is often the case in caring for patients with complex disease, it takes a team

Case 3: Frailty and Cognitive Symptoms

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty is often associated with cognitive deterioration that is often remediable with optimized care across all domains
  • As is often the case in caring for patients with complex disease, it takes a team

Case 4: Severe Frailty, Dependency and Palliative Care

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty is often associated with dependency and the need to recommend palliative care

Case 5: Frailty and Depression

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty is often associated with depression because both are common diseases
  • Depression can affect frailty by amplifying the symptoms of co-morbid conditions

Case 6: Frailty and Major Neurocognitive Disorder

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty coexisting with cognitive impairment need to be recognized early because of their mutual deleterious impact on function
  • As is often the case in caring for patients with complex disease, it takes a team

Case 7: Frailty and Cancer

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • The need to customized cancer care in frail patients based on comorbidities, function and prognosis
  • The importance of the social domain in care planning for patients with frailty and cancer
  • As is often the case in caring for patients with complex disease, it takes a team

Evaluation

During this curriculum evaluation, we used identical pre- and post-tests, containing seven questions with twenty correct answers, to measure learning. This pre-/post-test is available upon request. All questions were effective in discriminating an increase in learning. Learner comments on content, presentation and usability of the modules were overwhelmingly positive.

Use of These Modules

These modules are free for use for all teachers, instructors and trainers. They can be used as produced and be incorporated into an existing curriculum, in part or in full. When these frailty modules are used or included in another curriculum, questions from the pre-/post-test may be adapted for assessments of students’ learning. As with all student assessments, these questions would likely require revision after several years of use. If adapted versions of this curriculum, or parts of this curriculum, are published, attribution to original authors must be included and these new materials must be equally accessible to teachers, instructors and trainers as are the original materials. These materials may not be used or adapted for commercial purposes. (See Creative Commons criteria: CC BY-NC-SA [Attribution-NonCommercial-ShareAlike]).

Date posted: 
Wed, 08/11/2021
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 06/09/2021
Contact Person/Corresponding Author:



Suggested Citation:
Frailty Interactive Cases and A Facilitator’s Guide. POGOe - Portal of Geriatrics Online Education; 2021 Available from: https://pogoe.org/taxonomy/term/114

Interdisciplinary Health Profession Module Videos

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

Care teams often don't know how to effectively and efficiently collaborate when addressing a patient’s health. Depending on a patient’s needs, team leadership can shift at any given moment from one person to another. Because of this constant jockeying and adaptation, educating learners about their own interprofessional relationships is becoming incredibly important. These videos and the corresponding text supplements provide a context for interprofessional team members to discover more about what it takes to become a member of another profession. This knowledge, combined with their own experiences and clinical practice, will assist in preparing learners for the next-generation of team-based healthcare.

Educational objectives: 

After watching these short 2-3 minute videos, interprofessional teams will be able to contextualize their own relationship within the group dynamic, understand the educational requirements that go into other disciplines, and formulate an effective team-based learning approach for future activities.

Date posted: 
Tue, 09/27/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 09/27/2016
Contact Person/Corresponding Author:



Suggested Citation:
Interdisciplinary Health Profession Module Videos. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/114

VirginiaGeriatrics.Org

:  
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: 

The VirginiaGeriatrics.Org website consists of 6 primary resources and a secondary list of resources for further research. These primary resources include a video archive of the geriatric grand round lecture series, interactive pre-clinical basic science geriatric case studies for medical students, more advanced geriatric case studies for clinical residents, a quick consult guide for geriatric consults, an "ask the expert" discussion resource, and various educational materials related to the Virginia Geriatrics Society Conference. Additionally, spread through the website are external educational resources to complement the core material. Finally, there are some resources for patients and families that may be interested in contacting clinics and/or geriatricians.

Educational objectives: 

Listed through 6 primary education sections (Grand Rounds, Med Student Materials, Resident Materials, Quick Consults, Ask the Expert, etc)

Date posted: 
Thu, 09/22/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 09/22/2016
Contact Person/Corresponding Author:



Suggested Citation:
VirginiaGeriatrics.Org. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/114

Geriatric Interprofessional Teaching Clinic (GITC)

:  
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: 
•Collaborative interprofessional practice and care are essential to the complex healthcare needs of a rapidly growing older adult population.
•Interprofessional collaboration (IPC) occurs when various health care practitioners, clients and/or caregivers work together to improve a client’s overall health.
•Teaching an IPC model continues to be a major gap in every health professionals’ education.
•To address this gap, the Geriatrics Interprofessional Teaching Clinic (GITC) at the University of Kansas Medical Center's Landon Center on Aging was created. It incorporates six professions: Students and faculty from  Physical Therapy, Medicine, Pharmacy, Social Welfare, Dietitics/Nutrition and Occupational Therapy.
•It is scheduled one half day a week with four patients scheduled on a "rolling" basis allowing for interprofessional teams of three to see patients in a staggered fashion. On average, each visit takes approximately 60-90 minutes.
•Logistically, students from 3 professions review the medical record together, discuss what they want to accomplish in the room, and how they will approach the patient encounter as a team. The students then see the patient and report back to the attending physician and other health professions faculty as a team. The assessment and plan for the patient is developed by the team.
•Team members are asked to define their roles by what the patient needs at that particular visit, starting with their own professional training and scope of practice, but then encouraged to allow themselves to participate in new ways. The interprofessional clinic faculty assist the learners by facilitating reflection on their clinical performance as individuals and as a team at the time of the clinic visit, incorporating their reflections into their next clinical encounter and through debriefing.
•To quantify interprofessional collaboration, evaluation tools are being piloted to assess for team dynamics, and surveys are sent out to each individual learner to assess for behavior and attitude changes. These are both done at the "beginning" and "end" of their GITC experience.
 
 
Educational objectives: 
•Create an interprofessional (IP) clinic involving multiple learners, emphasizing the national interprofessional competencies (values/ethics, roles/responsibilities, interprofessional communication and teams/teamwork).
•Train students in IP teams to evaluate their communication with the patient and with other team members following a patient encounter in GITC using a validated rubric. 
•Monitor changes in IP team behavior through individual learner evaluations.
Date posted: 
Mon, 10/10/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/10/2016
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Interprofessional Teaching Clinic (GITC). POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/114

Building Caregiver Partnerships Through Interprofessional Education

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

Family caregivers are on the frontlines managing complicated chronic illnesses, assisting with day-to-day functioning, and providing direct care to manage symptoms and improve the quality of life of their loved ones. Yet, health professions students, medical/surgical residents, and care providers receive little, if any, training on the vital role that caregivers play on the healthcare team and how, effective partnering optimizes patient care throughout the illness trajectory and at end-of life.

The goal of Building Caregiver Partnerships through Innovative Interprofessional Education is to create effective partnerships between healthcare providers and family caregivers to reduce the burdens, ease suffering, and enhance the meaning of the caregiving experience for the patient, family and health care providers.  The project centers on a 20-minute film, No Roadmap: Caregiver Journeys, which features the compelling stories of four caregiving families. The film and companion discussion guides as well as resources for case-based learning and structured clinical encounters are freely accessible on the website. http://www.neomed.edu/medicine/palliativecare/building-caregiver-partnerships/

The website is designed so that faculty can easily select the materials that best fit their learners’ needs and the time constraints within their programs. The curricula is appropriate for medical, pharmacy, nursing, and other health professions educational programs at both undergraduate and graduate levels. Additionally, tools have been developed for interdisciplinary team-based forums and health provider training.  For medical/surgical residency programs, relevant ACGME milestones are identified. 

Educational objectives: 

The objectives of the educational tools are to prepare learners to:
• Describe home-based eldercare as a shared experience and the importance of building a relationship with family caregivers and care recipients based on trust, compassion and open communication; 
• Describe the vital role of family caregivers as important, but under recognized, members of the health care team;
• Discuss the meaning and challenges of family caregiving;
• Engage caregivers in meaningful discussions to identify the needs, values and goals of their caregiving family;
• Identify resources to address caregiver concerns and provide ongoing support; and
• Provide holistic team-based care to family caregivers that improves the quality of life for the care recipient and the caregivers. 

 

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

~~Date/Location Meeting/Forum Presentation Title Presenter(s)
Jan 28-31, 2016, Phoenix, Arizona; Society of Teachers of Family Medicine; 45 min presentation;  Exploring Caregiver Journeys: A Curricular Tool for Family Medicine Clerks;  D. Sperling; J.T. Thomas

March 10-13, 2016; Chicago, Ill;  American Academy of Hospice and Palliative Medicine;  60-min workshop; Using Film to Foster Empathetic Partnerships between Care Providers and Family Caregivers;  J. Drost; E. Scott; M. Scott; D. Damore; S. Radwany

May 19-21, 2016; Long Beach, Ca; American Geriatrics Society; Poster; Building Caregiver Partnerships Through Innovative Health Professions Education; E. Scott, S. Radwany, D. Drost, K. Baughman, B. Palmisano, M. Sanders

May 19-21, 2016; Long Beach, Ca; American Geriatrics Society; Educational Product Session; Building Caregiver Partnership Through Innovative Health Professions Education; J. Drost; B. Palmisano

May 25, 2016; NEOMED Department of Family and Community Medicine Resident Scholarship Day; 15 min presentation; Exploring Caregiver Journeys: A Curricular Tool for Family Medicine Residents; D. Sperling; J.T. Thomas
 

Date posted: 
Mon, 12/12/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 09/23/2020
Contact Person/Corresponding Author:



Suggested Citation:
Building Caregiver Partnerships Through Interprofessional Education. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/114

Goals of Care Conversation Curriculum (GOCCC) Training

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

We developed a 3-part curriculum for teaching the basics of communication about goals of care (GOC) in older persons targeted towards medical students, residents, fellows, and faculty. There are 3 modules: 

1. Communicating Serious News - identifies strategies for effective communication and especially communicating serious news to patients or family members and improving our ability to transmit this news in an empathic and effective manner.

2. Goals of Care Discussion -focuses on the essential components of a GOC discussion; initiation, understanding the patient and family perspective, surrogate decision making, and concluding remarks clarifying and summarizing key discussion points and areas of understanding.

3. Managing conflict with patients and families - focuses on how to address frustrated and perhaps angry patients or family members who sometimes don’t feel that they are being listened to.  As providers, we are often put in this situation with few resources or skills to help guide us on how to deal with the patient’s and family’s emotions as well as our own. 

Each module contains a didactic lecture (45-60 minutes), examples of faculty role play (10-15 minutes), and instructions for participant role play activities. Each module is focused around a clinical case scenario done in dyads (30 minutes), and a sample evaluation form. Each module is best done in 2-hour sessions and in small groups (10-20 participants) but can be modified for 1-hour sessions. The content is applicable to a range of learners although the participant role play will likely be more meaningful for the more advanced learners.

Educational objectives: 

At the end of Module 1: Discussing Serious News, students, residents, and faculty will be able to:        

a.      Use curiosity and good listening skills to understand patient coping styles

b.      Describe empathic and effective approaches to discussing serious news

c.       Identify strategies for discussing prognosis

At the end of Module 2: Basic GOC, students, residents, and faculty will be able to:

a.       Be comfortable and effective in talking with patients and families about goals of care for patients with serious life-threatening, or chronic conditions

b.      Describe goals of care discussions as an essential component of the practice of medicine accepted within the mainstream of legal, moral, and ethical principles

c.       Articulate the complexity and subtleties of surrogate decision-making,  and the concept of substituted judgment

d.      Practice the key components of goals of care discussions in a simulation as a means of gaining competence and confidence in conducting GOC conversations

At the end of Module 3: Managing Conflict, students, residents, and faculty will be able to:

a.       Manage conflict in an effective and empathic manner to de-escalate anger and frustration experienced by patients and families during serious illness

b.      Recognize that in life-threatening situations, anger is a common response

c.       Describe communication techniques for diffusing anger

d.      Apply recommended skills to manage conflict and guide patients, families, and other clinicians through difficult decisions

Date posted: 
Mon, 06/20/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 08/08/2019
Contact Person/Corresponding Author:



Suggested Citation:
Goals of Care Conversation Curriculum (GOCCC) Training. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/114

Family Meeting OSCE Assessment Tool (FMOSCEAT)

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
0
Abstract: 

A cornerstone procedure in palliative medicine is to perform family meetings, also referred to as family conferences. Family meetings are reported to improve communication between the health care team and the patient and/or their family. Learning how to lead family meetings is an important skill for all physicians, nurses, and others who care for patients with serious illnesses and their families.

The Family Meeting Objective Structured Clinical Exam Assessment Tool (FMOSCEAT) is a validated assessment tool designed to assess trainee’s clinical skill to perform and lead family meetings in an OSCE setting. This tool represents 6 important best practice behaviors building on evidence from literature search, guidelines and competencies with 34 items using Yes/No responses.

 

 

Educational objectives: 

To identify and assess trainee's ability to perform and lead family meetings. 

Publications from, presentations from, and/or citations to this product: 
  1. Hagiwara Y, Healy J, Ghannam S, Lee S, Sanchez-Reilly S. Development and Validation of a Family Meeting OSCE Assessment Tool (FMOSCEAT). J Pain Symptom Manage. 2016;51(2):332-333.
  2. Hagiwara Y. Family Meeting OSCE Assessment Tool. 2016 Feb; Los Angeles, CA.  (2016 Innovations in Medical Education Conference Abstracts)
Date posted: 
Mon, 07/18/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 07/18/2016
Contact Person/Corresponding Author:



Suggested Citation:
Family Meeting OSCE Assessment Tool (FMOSCEAT). POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/114

2015 Quick Reference App: Internal Medicine and Family Medicine Resident Geriatric Competencies

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Abstract: 

In 2010, the essential geriatric competencies for Internal Medicine (IM) and Family Medicine (FM) residents were published. To reinforce and disseminate these critical skills, we created a quick reference mobile application for IM and FM residents that addresses competencies in each of the seven key competency domains: Medication Management; Cognitive, Affective and Behavioral Health; Complex or Chronic Illness; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care.

This application can be used as a comprehensive reference by learners of multiple levels and disciplines while caring for patients in a variety of settings, including inpatient wards, outpatient clinic, nursing homes and home visits. Various screening tools, criteria, mnemonics and guidelines supporting each competency are included in this concise guide to caring for aging adults.

To access the free app:

  1. Go to Geriatrics Quick Reference App on AgileMD
  2. Create a free AgileMD account  
  3. Download the free AgileMD application using your smartphone app store 
  4. Open the AgileMD app and login with the username and password you created
Educational objectives: 
After using this quick reference tool, learners will be able to:
1.) Select and apply evidence-based tools to screen for or assess geriatric syndromes.
2.) Asses for and manage issues affecting older adult health across seven key competency domains: Medication Management; Cognitive, Affective and Behavioral Health; Complex or Chronic Illness; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care.
Publications from, presentations from, and/or citations to this product: 

AGS 2015 Educational Showcase Product Swap

Date posted: 
Mon, 09/28/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 04/03/2018
Contact Person/Corresponding Author:



Suggested Citation:
2015 Quick Reference App: Internal Medicine and Family Medicine Resident Geriatric Competencies. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/114

Patient Complexity and Interprofessional Team Care

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

Patient Complexity and Interprofessional Team Care is a geriatrics block rotation mini-course designed to improve medicine trainee’s understanding of health care teams.  It was developed in the setting of a new model of care collaboration for vulnerable seniors, Geriatric Resources for Assessment and Care of Elders.  The course is a blended curriculum offered during a 4-week residency block rotation in geriatrics. It is composed of a web-based, audio, PowerPoint lecture to introduce the Minnesota Complexity Assessment Method (MCAM) tool and application of the tool using paper cases.  The tool is then applied to actual patients discussed at an interprofessional team meeting of the GRACE care management program.

Educational objectives: 

Given a screening of the patient medical record, attendance at the patient’s GRACE interprofessional team meeting and completion of the Minnesota Complexity Assessment Method (MCAM) tool, the health professional trainee will identify patient situation complexity and describe ways that interprofessional team care members address patient care.

Given a printed Likert scale questionnaire, the resident will indicate positive change in degree of agreement with beliefs about interprofessional teams.

Publications from, presentations from, and/or citations to this product: 
Educational Strategies for Addressing Complex Patient Care Symposium
Aida Wen, MD, Todd James, MD, Miho Bautista, MD
October 21, 2013, 2013 Reynolds Grantee 11th Annual Meeting  in Coronado, CA

 

“Beliefs of Medicine Residents Regarding Interdisciplinary Teams,”  Poster presentation American Geriatrics Society Scientific Meeting, Grapevine, TX, May 2-5, 2013

Citation:  James, TC, Westmoreland, GR, Counsell SR. Beliefs of Medicine Residents Regarding Interdisciplinary Teams. J Am Geriatr Soc 2013; 61: Suppl s1; s157 (abstr C87).  http://onlinelibrary.wiley.com/doi/10.1111/jgs.122...

 

The poster described the 12-item physician survey to assess post-graduate medicine resident beliefs regarding interdisciplinary teams.  Resident responses demonstrated that interdisciplinary team participation is perceived as worthwhile. Yet, residents were uncertain about when their patient needed a team. There was significant agreement for having physicians as leaders of teams, and yet there was not clear agreement on team goals. Survey results support development of curricula for medicine residents geared toward teaching when a team approach is indicated and clarifying roles of various team members.

 

“Complexity and Interdisciplinary Team Care” Curriculum Presentation at Reynolds Grantee 9th Annual Meeting, St. Louis, MO, October 23 – 26, 2012

 

“Using a Complexity Tool with Geriatric Patients Teaches Residents Roles of Interprofessional Teams,” Buzz Session Presentation, InterProfessional Care for the 21st Century: Redefining Education and Care conference, Jefferson InterProfessional Education Center, Philadelphia, PA, May 18 – 19, 2012

 

“A New Strategy for Teaching Residents Roles of Interprofessional Teams” Poster Presentation at American Geriatrics Society Scientific Meeting, Seattle, WA, May 3 – 5, 2012.

Citation: James TC, Westmoreland GR, Arenson S, Counsell SR. A New Strategy for Teaching Residents Roles of Interprofessional Teams. .  J Am Geriatr Soc 2012; 60: Suppl s4;  s45 (abstr A84). http://www.americangeriatrics.org/files/documents/...

 

 “Academic Roles and Scholarly Activities” presentation, Faculty Forum, Indiana University Geriatrics, Indianapolis, IN, January 23, 2012

 

“Pilot Testing of a New Curriculum on Patient Complexity and Interdisciplinary Team Care” Poster Presentation at Collaborating Across Borders III, Tuscon, AZ, November 19 – 21, 2011.

 

 

 

Date posted: 
Wed, 04/03/2019
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 04/03/2019
Contact Person/Corresponding Author:



Suggested Citation:
Patient Complexity and Interprofessional Team Care. POGOe - Portal of Geriatrics Online Education; 2019 Available from: https://pogoe.org/taxonomy/term/114

Chief Resident Workshop in Bad News Communication & Learner Feedback

:  
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/114

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