The Portal of Geriatrics Online Education

Icahn School of Medicine at Mount Sinai

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Yes

Ambulatory Geriatrics Curriculum for Internal Medicine Residents Module on BPSD: Agitation and Behavioral Problems in Dementia

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

In 2012, 5.4 million Americans are diagnosed with Alzheimer’s Disease.  Lifetime risk of experiencing BPSD (Behavioral and Psychological Symptoms of Dementia) is nearly 100%.  BPSD is associated with increased morbidity and nursing home placement and is potentially treatable.  The information in this curriculum has been created to help the general internal medicine residents have a structured approach to the evaluation and management of BPSD.  This is the 3rd topic covered in a four part ambulatory geriatric curriculum that was developed for internal medicine residents.  To learn more about the successful ambulatory curriculum developed, please  check out  manuscript by Chang C1, Callahan EH, Hung WW, Thomas DC, Leipzig RM, DeCherrie LV. A Model for Integrating the Assessment and Management of Geriatric Syndromes Into Internal Medicine Continuity Practice: 5-Year Report. Gerontol Geriatr Educ. 2015 Jul 9:1-15.

Educational objectives: 

At the conclusion of this module, learners will be able to:

  1. Define BPSD
  2. Evaluate BPSD
  3. Discuss the Guidelines for Management of BPSD
    • Nonpharmacologic Interventions
    • Pharmacologic Interventions
Publications from, presentations from, and/or citations to this product: 

Christine Changab*, Eileen H. Callahanab, William W. Hungc, David C. Thomasb, Rosanne M. Leipzigab & Linda V. DeCherrieab A Model for Integrating the Assessment and Management of Geriatric Syndromes Into Internal Medicine Continuity Practice: 5-Year Report Gerontology & Geriatrics Education. Published online: 09 Jul 2015. DOI:10.1080/02701960.2015.1031897.

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



Suggested Citation:
Ambulatory Geriatrics Curriculum for Internal Medicine Residents Module on BPSD: Agitation and Behavioral Problems in Dementia. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1168

Nonpharmacologic Management of BPSD: Behavioral and Psychological Symptoms of Dementia

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

In 2012, 5.4 million Americans were diagnosed with Alzheimer’s Disease.  Lifetime risk of experiencing BPSD (Behavioral and Psychological Symptoms of Dementia) is nearly 100%.  BPSD is associated with increased morbidity and nursing home placement and is potentially treatable.  The information in this curriculum has been created to help the general internist have a structured approach to the evaluation and management of BPSD. 

Educational objectives: 

Participants will be able to:

  1. Define BPSD
  2. Evaluate BPSD
  3. Discuss the Guidelines for Management of BPSD
Date posted: 
Mon, 09/12/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 09/12/2016
Contact Person/Corresponding Author:



Suggested Citation:
Nonpharmacologic Management of BPSD: Behavioral and Psychological Symptoms of Dementia. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1168

Working with Interpreters in Family Meetings

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

This pocket card was developed to provide guidance on the use of interpreters in family meetings.

Educational objectives: 

By utilizing this communication card, learners will:

  1. Become familiar with recommended best practices when conducting language-discordant family meetings.
  2. Provide guidance when working with interpreters in family meetings.
  3. Identify suggested phrases that may be used when speaking with families and interpreters.
Date posted: 
Wed, 03/13/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 03/13/2013
Contact Person/Corresponding Author:



Suggested Citation:
Working with Interpreters in Family Meetings. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/1168

Communication Skills Workshop for Medicine Residents During Geriatrics Elective

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

Effective communication is essential to health care delivery, especially in care of the elderly, and is associated with increased adherence to treatment and patient satisfaction. This communication skills workshop was created to be integrated in the 4-week Geriatrics block in the first year of Internal Medicine residency training. The workshop consists of 2 small group sessions, ~75 minutes each, requiring a facilitator and 2 or more trainees. Learning format includes didactic learning, discussion, role-play and self-study. Skills taught include Active Listening, Ask-Tell-Ask and SPIKES [Baile WF, et al., Oncologist 2000; 5:302–311]. The product includes a faculty guide and a trainee guide for each of the 2 sessions; a pre-test questionnaire to be completed by trainees prior to session 1, a post-test questionnaire to be completed by trainees after session 2, and a follow-up questionnaire to be completed at 3 months after completion of the curriculum. These questionnaires collect anonymous demographic information about the participants, comfort and confidence in use of communication skills before and after the course, and feedback from the students about the different components of the workshop. There are no right or wrong answers, but information gathered should be used to improve future sessions of the course.

Educational objectives: 

At the end of the 2 sessions of this communication skills workshop, participants will:

  1. Recognize the importance of effective communication in a physician-patient relationship.
  2. Practice specific skills to improve communication in regular and challenging situations, such as Ask-Tell-Ask and SPIKES.
  3. Demonstrate increased comfort and confidence in their communication with older patients.
Publications from, presentations from, and/or citations to this product: 

Session 2 is based on an article describing the SPIKES protocol:
Breaking bad news: the S-P-I-K-E-S strategy. Buckman, RA. Commun Oncol 2005; 2:138–142.

Date posted: 
Thu, 06/21/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 03/19/2018
Contact Person/Corresponding Author:



Suggested Citation:
and . Communication Skills Workshop for Medicine Residents During Geriatrics Elective. POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/1168

Standardized Patient Case for Informed Consent for Colonoscopy in Elderly Patients

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

This product includes an OSCE standardized patient case around the topic of informed consent for colonoscopy in an elderly patient with functional and cognitive limitations. The product was developed for GI fellows but could be used for any provider who is consenting for colonoscopy. The product contains an SP script, station overview, and two checklists for evaluation.

Educational objectives: 
  • Practice the informed consent process for a procedure in a geriatric patient in a professional manner
  • Discuss risks and benefits of colonoscopy in a geriatric patient with comorbidities and functional limitations
  • Address patients’ beliefs and life expectancy in the context of obtaining consent for colonoscopy






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

Shah B, Miler R, Pole M et al. Informed Consent in the Older Adult: OSCEs for Assessing Fellows' ACGME and Geriatric Gastroenterology Competencies. Am J Gastroenterol 2011; 106:1575-179.

Date posted: 
Thu, 06/28/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 02/28/2018
Contact Person/Corresponding Author:



Suggested Citation:
, and . Standardized Patient Case for Informed Consent for Colonoscopy in Elderly Patients. POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/1168

Fall Risk Assessment Experience

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

The recent AAMC/Hartford Foundation Minimum Geriatrics Competencies for medical students (MSs) recommended that all graduating students ask about falls and conduct a brief fall risk assessment on a patient. The goal of this resource is to improve MSs´ understanding of the impact of falls on the lives of older adults, fall risk factors, and evidence based interventions to reduce fall risk, by performing a Fall Risk Assessment on an older adult patient. At Mount Sinai School of Medicine, the Fall Risk Assessment occurs during the third year Integrated Internal Medicine-Geriatrics Clerkship.

Educational objectives: 
  1. To be able to recognize the impact of falls on the lives of older adults.
  2. To be able to identify risk factors for falls in the elderly.
  3. To be able to perform the 3 Chair Rise and Timed Up and Go tests to assess functional status.
  4. To be able to describe interventions to reduce an older patient's risk of falling.
Additional information/Special implementation requirements or guidelines: 

The Fall Risk Assessment Experience Student Guide provides background information about falls, fall risk factors, interventions to prevent falls, and patient education material. The Guide directs the student to read a comprehensive fall assessment and management article, obtain relevant information from the patient´s medical record (documented fall risk factors, medications, etc.) and then conduct a fall risk assessment (including questions about fall risk factors, orthostatic vital signs, observed gait and balance, 3 chair rise and the timed up and go test) on their patient. Findings are then reviewed with the patient´s doctor and recommendations offered to the patient. This hands-on student directed approach activates learning, as the student plays a primary role in the patient's care by identifying risk factors, recommending treatment, and providing counseling.

Falls are common in older adults and result in significant morbidity, including injury, pain, disability, and even death. Risk factors for falling have been identified and interventions to improve these risk factors have been found to reduce fall rates by more than 30%. However, medical students (MSs) are frequently not instructed on fall risk assessment and management.

During the 2007-2008 academic year third year MSs performed the Fall Risk Assessment Experience with 19 of 27 (70%) of eligible senior mentors. Falls were common even among this highly functional community dwelling population as 79% of the mentors reported previously falls on the Fall Risk Assessment Questionnaire. In spite of this, at the start of the assessment, 11/19 (61%) did not think they were at risk of having another fall. Patients reported low rates of being asked about falls and of feeling they were at risk of falling. 36% of senior mentors said they were "almost never" asked about falls by their doctor while only 29% noted that their physician "almost always" asked them about falls.

The student-directed fall risk assessment module identified multiple fall risk factors and students were able to make important recommendations to reduce their senior mentors´ risk of future falls. All mentors had at least one risk factor for falling in addition to age. The mean number of fall risk reduction strategies recommended was 3.3 (range 0-8).

73% of the older adults found the intervention to be helpful in recognizing their own fall risks. The assessment changed the mentors' perceptions of their own risk of having a fall from 39% thinking they were at risk to 50% thinking they were at risk afterwards. 
53% said there are things that they are going to do differently after the assessment to reduce their risk of falling. These included "being more careful", doing exercises, taking tai chi, taking their time when first getting up, and using a walker.

Our resource is student driven and this makes it very easy to incorporate into any clerkship or rotation. In addition, highlighting the importance of chart review as a method for health care providers to evaluate the quality of their care and make important practice changes is helpful when incorporating this resource into a curriculum. This cueing facilitates an appreciation for reflection and self assessment in the student.

Scheduling time for the assessment is imperative as the actual assessment takes between 20 to 30 minutes to complete. Informing the patient about the assessment before the visit is also very useful. Patients can then bring questions they have to the assesment and many misconceptions can be clarified during the visit.

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

1. Bradley S, Atanous A, Karani R. Impact of a Student-directed Fall Risk Module in Ambulatory Geriatrics, Innovations in Medical Education Poster Session, Society of General Internal Medicine Annual Meeting, Miami, Fl, May 14, 2009.

2. Bradley S, Atanous A, Karani R. A Fall Risk Module in Ambulatory Geriatrics, accepted for Poster Session, The Association for Medical Education in Europe Annual Conference, Malaga, Spain, August, 2009.

3. Bradley S , Karani R, Fall Risk Assessment Experience. MedEdPORTAL; 2010. Available from: http://services.aamc.org/30/mededportal/servlet/s/...

Date posted: 
Mon, 06/14/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 10/12/2012
Contact Person/Corresponding Author:



Suggested Citation:
and . Fall Risk Assessment Experience. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/1168

Making SOAPS safer

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

A model for providing feedback on oral presentations to students and residents.

Educational objectives: 

To assist medical educators in providing feedback to medical student or residents on their oral presentation skills of patients. Medical educators should be able to: 1) identify five qualities of an effective oral presentation of a patient 2) identify possible correctable deficits of the oral presenation 3) provide feedback to the medical student or resident on their oral presentation

Additional information/Special implementation requirements or guidelines: 

Has been used with attendings who have interaction with medical students and/or residents in teaching hospitals. Also was presented at SGIM and CDIM workshops.

Date posted: 
Mon, 11/06/2006
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 08/01/2012
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , , and . Making SOAPS safer. POGOe - Portal of Geriatrics Online Education; 2006 Available from: https://pogoe.org/taxonomy/term/1168

Dementia: A Risk Factor for Delirium

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

Dementia is common in older adults and while it is not an inherent part of aging, delirium is common when patients with dementia are admitted to the hospital. This product enables hospital staff to differentiate between the two. Treatment of delirium starts with determining underlying causes and correcting them.

Educational objectives: 

To educate hospital staff on the difference between delirium and dementia, and to identify who is at risk for dementia or delirium. Learners should be able to: 1.) Distinguish between dementia and delirium; 2.) Learn ways to decrease the incidence of delirium in patients with dementia when they are admitted to the hospital; and 3.) Understand the differential for delirium.

Date posted: 
Mon, 11/06/2006
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 11/06/2006
Contact Person/Corresponding Author:



Suggested Citation:
Dementia: A Risk Factor for Delirium. POGOe - Portal of Geriatrics Online Education; 2006 Available from: https://pogoe.org/taxonomy/term/1168

Geriatric Health Maintenance: Cancer Screening

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

A presentation for geriatricians to educate seniors on the importance of cancer screening.

Educational objectives: 

To educate seniors on the importance of cancer screening. Learners should be able to 1.) discuss with their physician the risks and benefits of cancer screening. 2.) identify the different methods of screening for cancer.

Date posted: 
Wed, 11/01/2006
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 11/06/2006
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Health Maintenance: Cancer Screening. POGOe - Portal of Geriatrics Online Education; 2006 Available from: https://pogoe.org/taxonomy/term/1168

Hazards of Hospitalization

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

A lecture presentation on the hazards of hospitalization and the risks for functional decline for hospitalized older adults. Includes an image by M.C. Creditor of the Hazards of Bedrest and Hospitalization from Ann Intern Med 1993;118:219-223, and a pocket card for interns showing the risks for hazards of hospitalization and tools for assessing the hazards of hospitalization.

Educational objectives: 

The learners (interns) will be able to:

  • Recognize factors that increase the risk of harm to older adults who are hospitalized.
  • Recognize the major hazards associated with hospitalization for older adults including:
    • Decrease in functional capacity
    • Weight loss and nutritional decline
    • Dehydration
    • Delirium and/or depression
    • Polypharmacy
  • Know how to assess for the hazards of hospitalization.
  • Recognize the importance of early discharge planning.
Additional information/Special implementation requirements or guidelines: 

We try to offer this presentation to all first year residents in all disciplines.

Date posted: 
Wed, 06/29/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 03/15/2018
Contact Person/Corresponding Author:



Suggested Citation:
, and . Hazards of Hospitalization. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/1168

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