The Portal of Geriatrics Online Education

University of California, San Francisco, School of Medicine

Is this a Reynold's grantee: 
Yes

"TMI"... (Too Many Interpretations): Mr. Moore's Medication Misadventures!

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

This two hour interprofessional curriculum brings together fourth year medical students and third year pharmacy students in a hands-on, interactive small group session. Learners are given a guide briefly describing the case and delineating five health care members and their roles and expertise in Mr. Moore's healthcare team (Mr. Moore's partner, the outpatient pharmacist, the inpatient intern, etc). A pair of interprofessional facilitators guide learners through the case, utilizing different healthcare team members' roles and expertise to explore methods of medication organization and systemic barriers to accurate and safe discharge medication reconciliation. Learners discover and discuss discrepancies in high-risk medications, gain an appreciation of systems hurdles for patients and healthcare providers during transitions of care, complete an exercise in writing discharge medication instructions, and brainstorm action items to personally employ to overcome systemic hurdles for safer discharge medication reconciliation.

Educational objectives: 

By the end of the two-hour session, learners will work collaboratively to:

  1. Describe the roles and expertise of three health professions that can collaborate to reconcile medications and enhance safety of medication orders at the time of hospital discharge. 
  2. List three potential communication barriers between health professionals involved in discharge planning that contribute to medication errors in vulnerable older adults.
  3. Identify key components of discharge medication lists and instructions to communicate information safely to patients, caregivers, primary care providers and others on the healthcare team.
Date posted: 
Tue, 08/30/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 08/30/2016
Contact Person/Corresponding Author:



Suggested Citation:
"TMI"... (Too Many Interpretations): Mr. Moore's Medication Misadventures!. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/1203

Interprofessional Standardized Patient Exercise (ISPE): The Case of “Elsie Smith”

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

Interprofessional education (IPE) occurs when students/trainees of two or more healthcare professions engage in learning with, from, and about each other, and is viewed as a primary mechanism through which to improve interprofessional teamwork and the quality and safety of patient care. This Interprofessional Standardized Patient Exercise (ISPE) was created to provide health professions students with a structured learning experience working within an interprofessional health care team. The case of “Elsie Smith” involves multiple complex chronic medical conditions in an older adult with many needs and limited resources. It highlights the need to address medical, functional status, and social domains, among others, and accordingly is designed to be relevant to many health professions. It can easily be adapted according to the types of health professions students available. At our University, participants were from seven schools or programs: dentistry, medicine, nursing, nutrition, pharmacy, physical therapy, and social work. All students were in their 3rd or 4th year, except for the nurse practitioner and social work students, who were in their 2nd year of training, and dieticians completing a one year internship. Students work in interprofessional teams to interview the standardized patient and create an integrated, comprehensive patient care plan. Faculty facilitators from participating schools/programs observe the students and lead debriefing sessions.

Educational objectives: 
  1. Students will demonstrate the ability to effectively communicate and collaborate with students from other health professions.
  2. Students will demonstrate the ability to efficiently interview and assess a patient with multiple chronic illnesses, showing sensitivity to a patient’s personal needs and resources.
  3. Students will develop a comprehensive care plan in collaboration with other health professions students to meet the patient’s healthcare needs.
  4. Students will describe the role of other healthcare professionals in caring for a patient with multiple chronic illnesses.
Additional information/Special implementation requirements or guidelines: 

This material was initally posted on MedEdPORTAL:

Rivera J, Yukawa M, Hyde S, Fitzsimmons A, Christman J, Gahbauer A, Scheid A, Wamsley M. Interprofessional Standardized Patient Exercise (ISPE): The Case of “Elsie Smith”. MedEdPORTAL; 2013. 

www.mededportal.org/publication/9507

Publications from, presentations from, and/or citations to this product: 
Date posted: 
Wed, 09/24/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 03/22/2018
Contact Person/Corresponding Author:



Suggested Citation:
Interprofessional Standardized Patient Exercise (ISPE): The Case of “Elsie Smith”. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/1203

ePrognosis: Cancer Screening decision support app

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

The free "ePrognosis: Cancer Screening" app aims to help trainees and practicing clinicians guide conversations with elderly patients of whether to start, stop, or continue breast cancer and/or colorectal cancer screening. The app is created around the idea that estimating prognosis is a critical aspect in the decision to recommend for or against cancer screening, as there is a long "lag-time to benefit" for these interventions.  The objective is to focus cancer screening on those most likely to benefit from these medical interventions, and conversely, avoid screening in those who are unlikely to live long enough to see a benefit but will be exposed to immediate harms.

Educational objectives: 

The objective is to educate providers in guiding conversations with elderly patients of whether to start, stop, or continue breast cancer and/or colorectal cancer screening. When a user starts the app they will see the start screen asking you whether you are interested in screening for colorectal cancer, breast cancer, or both. Once a selection has been made the app runs the user through 15 health related questions including age, gender, BMI, symptoms, and functional impairment to calculate a mortality risk to estimate life expectancy. Based on the response to these questions, the user will be shown a speedometer like image that can help inform whether cancer screening is more likely to help or harm a patient. The user can also click on the "harms" or "benefits" buttons to learn more about what these may include. Lastly, one can also click the learn more button, which will run the user through a series of pictographs (each pictograph is of 1,000 squares where each square represents one person). These pictographs visually display information on harms and mortality benefits from cancer screening, as well overall mortality risk at 10 years.

Additional information/Special implementation requirements or guidelines: 

Requires iOS 5.1 or later. Compatible with iPhone, iPad, and iPod touch. This app is optimized for iPhone 5.  It can be downloaded at the iTunes store via the following link https://itunes.apple.com/us/app/eprognosis-cancer-screening/id714539993?mt=8

Date posted: 
Tue, 10/29/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 10/29/2013
Product Viewing Instructions: 
This app is designed for both iPhone and iPad. Download on iTunes to install on your mobile device
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , , and . ePrognosis: Cancer Screening decision support app. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/1203

Oral Assessment for the Older Adult

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

The Oral Assessment For the Older Adult is a “Z” fold pocket card to be used as a quick reference or teaching tool for primary care providers working with older adults in outpatient clinics or inservice facilities. The card offers a sequence protocol for an oral and head/neck assessment, terms to help describe a lesion when referring to a dentist or another health specialist, and a comparison of normal to abnormal oral anatomy. In addition, on the back is a list of the top 13 lesions identified by medical providers, accompanied by a description of each lesion and of the first course of treatment.

Educational objectives: 

Learners who use the "Oral Assessment for the Older Adult "pocket card will be able to: 

  1. List a comparison of normal and abnormal clinical oral anatomy.
  2. Explain a sequenced approach to an oral and head/neck assessment.
  3. Recognize and describe abnormalities when referring any oral lesions for evaluation.
  4. Identify 13 common oral lesions and treatment in the older population.
  5. Use the quick reference for future clinical encounters.
Additional information/Special implementation requirements or guidelines: 

The Oral Assessment for the Older Adult pocket card is intented to be a quick reference and education tool for primary health care providers.

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

Presented to UCSF Geriatric Grand Rounds on March 23, 2013.

Date posted: 
Wed, 06/26/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 06/26/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , and . Oral Assessment for the Older Adult. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/1203

ePrognosis - Estimating Prognosis for Elders

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

Although many geriatric prognostic indices have been published, they may be difficult for busy clinicians to remember and use. The goal of ePrognosis (www.eprognosis.org) is to be a repository of validated geriatric prognostic indices for application in clinical and educational settings. The prognostic indices used in ePrognosis are derived from a systematic review of the literature, published by our group in JAMA January 11, 2011. ePrognosis offers a tutorial on how to use prognositic indicators in older adults. It also helps clinicians sort through quality issues of each index through it's use of a novel sorting algorithm. This algorithm uses set criteria to sort the indices by accuracy, generalizability, bias, usability, and clinical efficacy. 

Educational objectives: 
  1. Describe 4 steps needed to apply prognositic indices to an individual patient encounter.
  2. Identify the 5 factors that influence how one selects the best indices for an indivial patient (prediction accuracy, model generalizability, usability, clinical efficacy, and time-frame)
  3. Apply prognostic indices to at least one common clinical scenario for older adults in which the consideration of prognosis may improve decision making. 
Additional information/Special implementation requirements or guidelines: 

The indices in ePrognosis (www.ePrognosis.org) are designed for older adults who do not have a dominant terminal illness. For patients with a dominant terminal illness, such as advanced dementia, cancer, or heart failure, prognostic indices specifically designed for those purposes should be used (see the Links tab in ePrognosis).

The information on ePrognosis is intended as a rough guide to educate and inform clinicians about possible mortality outcomes. It is not intended to be the only basis for making care decisions, nor is it intended to be a definitive means of prognostication. Clinicians should keep in mind that every patient is an individual, and that many factors beyond those used in these indices may influence a patient's prognosis.

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

The content of ePrognosis is derived from a systematic review of the literature published in the Journal of the American Medical Association:

Lindsey C. Yourman, Sei J. Lee, Mara A. Schonberg, Eric W. Widera, Alexander K. Smith.  Clinical Review Prognostic Indices for Older Adults: A Systematic Review.  JAMA. 2012;307(2):182-192.  doi:10.1001/jama.2011.1966

Date posted: 
Thu, 05/17/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 05/17/2012
Contact Person/Corresponding Author:



Suggested Citation:
, , , , and . ePrognosis - Estimating Prognosis for Elders. POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/1203

Mad as a Hatter

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

Mad as a Hatter is an interactive educational game that reinforces principles of anticholinergic drug effects.  A single game set can be used with one to six learners.  Restating concepts in their own words to a teacher during and after the game allows students to assess their understanding of anticholinergic drugs and of normal cholinergic function.

Educational objectives: 

Understand pharmacology of anticholinergic drug effects

Recognize common durgs that have anticholinergic side effects

Review alterative treatments that do not cause anticholinergic effects

Recognize conditions for which all available medications have anticholinergic side effects

Additional information/Special implementation requirements or guidelines: 

Materials

The game is played with a game board and with accessory pieces that are printed and cut apart like cards.  The game board and the collection of accessory pieces are each PDF files formatted to be printed on 16 by 22 inch vinyl poster material. 

The game board is printed with

  • Two cartoon figures of patients
  • A list of 14 conditions (depression, nausea, incontinence, etc) needing treatment in these patients

Once cut apart, each accessory game piece fits onto one specific place on the board

  • Two sets each of six body organs (brain, eyes, mouth, heart, intestine, bladder), one set showing normal acetylcholine function and one set showing blocked acetylcholine function
  • 30 treatment options including drugs, non-pharmacologic treatment, or a disclaimer that no drug exists without anticholinergic effects

Methods

The game can be used with a single learner or with small groups of up to 20 learners.  If multiple game boards are available, each learner can work on an individual board.  If only one board is available, up to six learners can easily use one board.  For groups of more than six learners, the learners should be broken up into groups of two to six learners, each group working with a separate game board.

The teacher explains the two stages of the game.  In the first stage, learners place the 12 body organ pieces onto the board to review how body organ functions are affected by anticholinergic drugs.

In the second stage, learners place cards onto the board to indicate whether treatments have anticholinergic effects or not.  The teacher should state explicitly that while none of the treatements is explicitly cholinergic, several of the treatments at least do not block normal acetylcholine function.

When the game is used for a single learner,  then ask the learner after finishing the game to state concepts in their own words for the placement of each card. 

If two or more learners work on a single game board, they will usually talk out loud as they go to discuss placement of individual cards.  Nevertheless, once the game board is completed, the teacher should ask students to take turns explaining placement of one of the game cards.

An answer key can be printed on 8 ½ by 11 inch paper to hand out to learners after the game showing the correct placement of the cards.  (The game board and accessory pieces can also be printed on 8 ½ by 11 inch paper, but handling the accessory pieces is difficult when printed on paper this small.)

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

This product will be presented at the 2010 Reynolds Grantee 9th Annual Meeting

Date posted: 
Fri, 10/22/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 10/22/2010
Contact Person/Corresponding Author:



Suggested Citation:
Mad as a Hatter. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/1203

Geripardy - Geriatric Concepts

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

"Geripardy" is an educational tool with the goal of creating an interactive learning environment through a PowerPoint trivia game. We hope that this tool serves to facilitate discussion about geriatric syndromes and to act as a self-assessment tool for the learners. It requires at least one course leader knowledgeable in geriatrics to facilitate discussions in topics that may be brought up during the course of the game. It can also be used after a didactic session to lighten the mood and assess content knowledge.

Educational objectives: 

This interactive game is a fun way to introduce or solidify geriatric concepts with students, residents, or fellows. It can be modified to fit different levels of learners and learning environments. By the end of the session internal medicine and family practice interns will be able to: 1) List at least 5 geriatric syndromes including incontinence, falls, dementia, delirium, and osteoporosis 2) Describe 3 separate approaches for preventing falls in the elderly 3) List 5 different iatrogenic hazards of hospitalization in the elderly 4) Describe at least 3 different type of dementia and define how they differentiate from Alzheimer's dementia Educational Objectives can be easily modified to fit your learners' needs.

Additional information/Special implementation requirements or guidelines: 

This works best in a small group of 8-20 people. Before starting the game, breakup the group into 2 or 3 teams and assign a score keeper to track the money earned throughout the game. We have found that it is fun to have the teams choose their own names with some type of geriatric theme (some examples here have been failure to thrive, foley catheters, The Lewy Bodies, etc.) The game play follows similar rules to the well known "Jeopardy!" TV game show. o An initial 5 categories are brought up on screen, each with a column of five trivia questions written in answer form graded by difficulty. Each category is a topical category in geriatrics. o One team picks a category and dollar amount and the course facilitator will then reveal the question by clicking on the dollar amount. o The team that first "buzzes in" (either by slapping their hand on the desk or using more creative means such as Kazoos or rattlers) gets to answer by phrasing their response in question form ("What is Hip Protectors?"). o A correct response wins the dollar value of the question, which should be kept track of during the course of the game. If the team is incorrect, then the dollar value should be deducted and the opposing teams are given a chance to ring in and respond. After both teams respond the facilitator may want to add a couple comments about the specific question to help their understanding of the topic. This is education, after all! o After all the categories are answered you may either proceed to the second round, Double Geripardy, which works like the first round but with double dollar values, or jump directly to Final Geripardy. o Final Geripardy is the game's final round. Each team will secretly write down the dollar amount they would like to wager after the "category" is announced. After the teams are done writing down the amount wagered, the question is given and the teams then secretly write their responses which are then revealed. o The team with the most money in the end wins (we like to give out silly prizes or prizes such as geriatric assessment cards, Geriatrics At Your Fingertips, etc.) Button & Navigation Guide: The yellow home button on the lower right hand corner will always return you to the Main Menu Screen (to navigate to Single, Double, & Final Geripardy); The yellow arrow button on the answer slides will navigate you to the next slide or question slide; The blue home button on the question slide will take you back to the board for either Geripardy or Double Geripardy, depending on where you are in the game; The Blue arrows on the lower left hand of the slides allow you to navigate to any slide or end the show. Other Information: This is not a “read-only” program, so you can feel totally free to update the information or modify any of the categories to fit your educational learners.

Date posted: 
Fri, 12/01/2006
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/26/2009
Contact Person/Corresponding Author:



Suggested Citation:
, and . Geripardy - Geriatric Concepts. POGOe - Portal of Geriatrics Online Education; 2006 Available from: https://pogoe.org/taxonomy/term/1203

Exercise in Elders: PowerPoint and Small Group Exercise

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

This product contains two segments. The first is a power point presentation that provides basic information on exercise in elders (please contact Dr. Johnson at Bree.Johnston@ucsf.edu for updates). The second segment provides a small group exercise for writing exercise prescriptions.

Educational objectives: 

The goals of this product are: 1. To provide learners an overview of the benefits of exercise in elders, and 2. To provide learners with practical strategies for encouraging exercise among their patients. The learner will be able to: 1. Describe exercises that have been associated with improved outcomes for specific medical conditions. 2. Assess your patient’s interest and willingness to exercise, using the “stages of change?” model. 3. Describe approaches to increase your patient's self efficacy in exercising. 4. Develop an approach to writing an exercise prescription using the FITTS method (frequency, intensity, type, time, and specific modifications). 5. Use the 5 step method to write an exercise prescription.

Additional information/Special implementation requirements or guidelines: 

This was used in an SGIM workshop and among fellows and residents at UCSF, for a total of about 100 people. It was used as a lecture and small-group session (faculty development, primarily).

Date posted: 
Fri, 12/01/2006
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 11/23/2009
Contact Person/Corresponding Author:



Suggested Citation:
Exercise in Elders: PowerPoint and Small Group Exercise. POGOe - Portal of Geriatrics Online Education; 2006 Available from: https://pogoe.org/taxonomy/term/1203

An Unfolding Case of Delirium, Dementia, and Depression

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

This is an unfolding case of a man with depression (initially), dementia, and delirium. Issues of driving and dementia are explored. This has been used with students, residents, and interdisciplinary groups.

Educational objectives: 

Goal is to introduce learners to key issues in diagnosing and managing depression, dementia, and delirium. By the end of this session, participants will be able to: 1. Describe normal changes of cognition with aging. 2. Describe the risk factors, prevalence and clinical course of delirium, dementia, and depression. 3. Compare and contrast the clinical features of delirium, dementia, and depression. 4. List and describe common screening and diagnostic tools for delirium, dementia, and depression. 5. Describe management techniques for the above syndromes, with a focus on your own discipline.

Additional information/Special implementation requirements or guidelines: 

We have used this on 40+ learners, including practicing physicians, psychologists, pharmacists, nurses, social workers, residents, and medical students. We have used this in faculty development and residency teaching. This unfolding case takes about 1 and 1/2 hours; the material covered can be adapted to the sophistication level of the learners involved.

Date posted: 
Wed, 01/28/2009
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 11/23/2009
Contact Person/Corresponding Author:



Suggested Citation:
and . An Unfolding Case of Delirium, Dementia, and Depression. POGOe - Portal of Geriatrics Online Education; 2009 Available from: https://pogoe.org/taxonomy/term/1203

Ethics Small Group Discussion Cases

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

A series of three cases designed for second year medical students. They are best used in a 2 hour small group format. Facilitator notes are included. Format: Instructors Manual, Paper

Educational objectives: 

These three cases expose students to ethical dilemmas that are often seen in older patients. Learners should be able to: 1.) Discuss a framework for balancing confidentiality against public health and safety concerns, using the example of elders who are no longer able to provide food, clothing and shelter for themselves (self neglect). 2.) List elements of decision making capacity and discuss the difference between "competency" and decision making capacity. 3.) Discuss the issues surrounding the right of a patient to refuse potentially life-sustaining treatment. 4.) Discuss dilemmas that can arise when dealing with surrogate decision makers, and an approach to resolving them. 5.) Discuss a framework for balancing confidentiality against public health and safety concerns, using the examples of: - dementia and driving - elders who are no longer able to provide food, clothing and shelter for themselves. 6.) Discuss the physician's role in reporting elder abuse.

Additional information/Special implementation requirements or guidelines: 

600 second year medical students in small group case based teaching

Date posted: 
Wed, 11/15/2006
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 11/15/2006
Contact Person/Corresponding Author:



Suggested Citation:
Ethics Small Group Discussion Cases. POGOe - Portal of Geriatrics Online Education; 2006 Available from: https://pogoe.org/taxonomy/term/1203

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