The Portal of Geriatrics Online Education

16 HCP: When to override recommendations for treatment

16. Accurately identify clinical situations where life expectancy, functional status, patient preference or goals of care should override standard recommendations for treatment in older adults.

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/119

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/119

Palliative Care Case

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Estimated time to complete: 
3
Abstract: 

Using a case study participants will follow an older patient who requires increasing levels of care. After breaking into interdisciplinary teams led by leaders in transitions of care, participants will discuss goals, long-term care planning, and transitions in and out of hospital.

 

Educational objectives: 

Upon completion participants will be able to:

  • Describe how a multidisciplinary team approach enhances quality of life for patients throughout the aging process.
  • Recognize the importance of understanding a patient’s values, goals, and beliefs while assisting with transitions of care and long-term care planning.
Date posted: 
Wed, 09/30/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 09/30/2015
Contact Person/Corresponding Author:



Suggested Citation:
Palliative Care Case. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/119

It Takes a Village: Interprofessional Geriatrics Case Conference

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

Residency programs are grappling with the best ways to improve their curriculua to meet the requirements of the Next Accreditation System and ACGME Milestones.  Our review identified NAS requirements that align with established geriatrics care principles (e.g., transitions of care, interprofessional teamwork, managing complex patients, patient / caregiver communication).  Our internal medicine residency program transformed an existing monthly, hour long educational case conference into an an interdisciplinary team-based educational forum emphasizing key geriatrics care and interprofessional principles.  This educational product includes all tools and information necessary for this session to be successfully implemented and evaluated in other institutions.  

Materials and information includes:

  1. Outline / identification of interdisciplinary participants
  2. Forum structure and format 
  3. Content area examples
  4. Learner and curriculum evaluation tool. 

This session provides tools for learners to reach these training goals and requirements while integrating core geriatrics principles through use of team teaching with interprofessional colleagues.  Learners consistently reported an increase in knowledge gained in all targeted milestones with the most dramatic increases in milestones specific to systems-based practice and professionalism.

Educational objectives: 
  1. Integrate interprofessional colleagues into internal medicine residency education in a meaningful forum.
  2. Demonstrate how interprofessional collaboration and communication leads to higyh quality patient care through the use of practical patient cases with evidence to support key points drawn from the literature.
  3. Emphasize core geriatric syndromes and principles that are often overlooked or missed.

 

Additional information/Special implementation requirements or guidelines: 

Please see the attached Instructor's Guide for full implementation details and guidelines for the session.

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

Abstract/Poster Presentation: Kuester J, Carnahan J, Duthie E, Rehm J, Denson S, Duthie E Jr, Integration of ACGME Milestones into Internal Medicine Residency Curriculum Through Teaching Care Geriatric Principles, American Geriatrics Society Annual Meeting, Orlando, FL, 05/2014.

Date posted: 
Thu, 10/01/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 10/01/2015
Contact Person/Corresponding Author:



Suggested Citation:
It Takes a Village: Interprofessional Geriatrics Case Conference. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/119

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/119

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/119

When Eating Problems Arise in Advanced Dementia: An Interdisciplinary Trigger Video

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

This is an interactive seminar centered on a trigger video depicting a family meeting with the treating physician, the speech and language pathologist and the family of a patient with advanced dementia who suffers from dysphagia/poor oral intake. The seminar can be provided to a small group of 4-10 healthcare trainees (medical residents or students, nursing students, speech and language pathology students, social work students). The seminar is designed to present the learners with an interdisciplinary approach to conducting a family meeting on this topic. It starts with reading a case presentation, which is meant to emphasize the need for a family meeting, followed by playing the video until a trigger question comes up. At that point the participants are asked to reflect on the question and share their answers with the group. The group then watches the video exemplifying a way the question can be discussed. The process is repeated for all the trigger questions. At the end of the seminar the trainees are encouraged to debrief on language that could be modeled for goals of care discussions as well as aspects of the discussion that could have been approached differently. They are also provided with all the references used in the video as a resource for future family meetings. Trainees are asked to complete a short retrospective pre/post self-assessment survey. 

Educational objectives: 
  1. Review importance of completing advance directives (applied to patients with dementia); define surrogate decision maker, substituted judgment, and best interest concepts and discuss advance care planning for the case presented.
  2. Describe the natural history of advanced dementia.
  3. Become familiar with potential treatment burdens associated with tube feeding in patients with advanced dementia.
  4. Appreciate various options for eating/feeding in advanced dementia and swallowing problems.
  5. Analyze aspects of difficult conversations with surrogate decision makers.

 

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

Some of the materials for this seminar were presented during the Marketplace at the Reynolds Meeting in Las Vegas, Oct 7, 2014.

 

 "When Eating Problems Arise in Patients with Advanced Dementia- An Interdisciplinary Approach to

Communicating with Caregivers" This interactive seminar was presentated at the Annual

Assembly of the American Association of Hospice and Palliative Medicine Annual Meeting, February 2015, Philadelphia.

 

 

Date posted: 
Fri, 06/17/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 06/17/2016
Contact Person/Corresponding Author:



Suggested Citation:
When Eating Problems Arise in Advanced Dementia: An Interdisciplinary Trigger Video. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/119

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/119

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/119

Palliative Care Lectures

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
999
Abstract: 

This educational series of lectures was designed with a focus to teach the medical professional training in palliative care medicine and can be used to teach advanced care nurses, medical students, residents and fellows.  The lectures cover a variety of topics in palliative medicine, ranging from the basics to specialty areas, and include case studies to supplement the teaching.

In addition to pain and symptom management, there are specific lectures to discuss common symptoms such as nausea, vomiting, constipation, diarrhea, and shortness of breath. The psychosocial care of the patient is addressed including depression, goals of care, ethics, and spiritual care.  Specialty lectures include palliative chemotherapy and palliative surgery as well as special cases at end of life in dementia patients. There are lectures covering the last hours of life, controlling terminal delirium and anorexia, as well as risk benefits of tube feeding at end of life.  In addition there is a lecture on terminal weaning and ventilator withdrawal.

References include relevant articles that were used to help create the lectures and should be accessed for further study. Topics seen on the palliative medicine board examination are covered and reviewed.

Educational objectives: 
  • To review the general principles of palliative care and hospice
  • To discuss the evaluation and management of pain and non-pain symptoms
  • To review the assessment and treatments of common symptoms in palliative medicine and hospice
  • To review special issues in palliative care including dementia, palliative chemotherapy, & palliative surgery
  • To discuss spirituality and psychosocial aspects of palliative medicine
  • To review ethical principles in medicine and important topics in end of life
  • To discuss patient interactions including goals of care, advance directives and legal issues in palliative care
  • To provide an overview for the palliative medicine and hospice board examination
Date posted: 
Mon, 04/13/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 04/13/2015
Contact Person/Corresponding Author:



Suggested Citation:
Palliative Care Lectures. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/119

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