The Portal of Geriatrics Online Education

Medical Ethics

Medical Ethics

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

This web-based module for third-year medical students reviews primary and ancillary principles of medical ethics and challenges the learner to apply these principles to patient care scenarios. Reading assignments include an ethics article (Lancet, 2009) regarding allocation of scarce medical resources. A small group discussion for this module immediately precedes an Ethical Analysis noon conference presented by a Geriatrics Fellow and is required for 3rd year medical students, but is open to anyone.

Educational objectives: 
  1. Discuss the principle of autonomy as an ethical standard, as it relates to medical decision making, and in contrast with the principle of beneficence.
  2. Define the medical ethics principle of justice.
  3. Relate examples of ambiguous distributive justice.
  4. Explain the principle of informed consent as an ethical standard, as it relates to medical decision making.
  5. Discuss the clinical situations in which life-sustaining treatment might alter one's choice of management.
  6. Describe the clinical situations in which medical futility might alter one's choice of management.
  7. Describe the important medical treatment options which must often be considered by older adults and their surrogate decision makers.
  8. Describe how one would assess a patient for decision making capacity (decisional capacity).
  9. Recommend appropriate courses of action for patients and family members as exemplified by the case studies.
Date posted: 
Sat, 10/16/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Sat, 10/16/2010
Contact Person/Corresponding Author:



Suggested Citation:
and . Medical Ethics. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/209

Advance Directives

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

This module is intended to assist in teaching undergraduate medical students about advance health care planning; including, the various documents available to the provider for discussion and documentation of the wishes of patients and their surrogate decision makers. This module also discusses the issues of determination of decisional capacity and competency, with an approach provided to assess decision-making capacity. Additionally, students are provided information on the advance directive discussion and communicating with patients, families and surrogate decision makers.

Educational objectives: 

Attitudes - Medical students should be able to:

  1. Realize the importance of establishing the wishes of the patient prior to their loss of decisional-capacity when surrogacy would be required.
  2. Realize the importance of the role of the health care provider in providing the patient and their family a realistic and clear understanding of the patient's clinical situation and likely prognosis.
  3. Acquire an ability to effectively engage patients and families in discussion of these issues.

Knowledge - Medical students should be able to:

  1. Discuss a Living Will, including the definition, acquisition, utility, and limitations.
  2. Discuss a Health Care Treatment Directive, including the definition, acquisition, utility, and limitations.
  3. Discuss a DNR, including the definition, acquisition, utility, and limitations.
  4. Discuss a Durable Power of Attorney for Health Care, including the definition, acquisition, utility, and limitations.
  5. Recognize the cognitive and emotional qualities which contribute to the assessment of competency and decision-making capacity.
  6. Recognize the scope and importance of the legal context of advance directives.
  7. Recognize the importance of selected issues relating to advance directives.
  8. Describe how to appropriately begin the advance directive discussion.
  9. Describe the importance of communicating with families and surrogates concerning advance directives.
  10. Describe the importance of clarifying unclear statements.
  11. Describe the best approach to documenting the discussion of advance directives.

Skills - Medical students should be able to:

  1. Define the following entities and discuss how one acquires such a document: Living Will, Health Care Treatment Directive, DNR, Durable Power of Attorney for Health Care.
  2. Participate in a family "discussion" about these entities and recommend appropriate interventions for the patients presented in the case that follows and the Standardized Patient Encounter.
  3. Create a framework for how one would initiate and/or discuss such issues with real patients and families.
Date posted: 
Sat, 10/16/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Sat, 10/16/2010
Product Viewing Instructions: 
N/A
Contact Person/Corresponding Author:



Suggested Citation:
and . Advance Directives. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/209

Conversations about Health and Aging

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

As a legacy of our geriatrics education project supported by the Donald W. Reynolds Foundation, we decided to make a short film about caring for elderly patients. We wanted real doctors and real old people. Recognizing we are all in this together, we also chose physicians from multiple medical and surgical subspecialties in addition to primary care physicians/geriatricians. None of it is scripted. Rather it is, as we intended, the good, the bad and the ugly, of caring for the aged. 

Educational objectives: 

To encourage learners  to see the value in caring for older adults;

To hear experienced geriatricians and physician specialists tell their stories of practicing medicine with older adults;

To impress upon learners the reality that almost all physicians will be caring for older adults regardless of their specialty.

Date posted: 
Wed, 10/20/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 10/20/2010
Contact Person/Corresponding Author:



Suggested Citation:
and . Conversations about Health and Aging. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/209

Health Literacy and Patient Safety: Help Patients Understand

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

This manual reviews the problem of health literacy, its consequences for the health care system, and the likelihood that a clinician’s practice includes patients with limited literacy. The manual then provides practical tips for clinicians to use in making their office practices more “user friendly” to patients with limited literacy, and gives suggestions for improving interpersonal communication between clinicians and patients. Finally, the manual concludes with several “case discussions” based on vignettes in the accompanying instructional video.

Educational objectives: 

MANUAL FOR PHYSICIANS
The enclosed materials will enable physicians to:

  • Define the scope of the health literacy problem.
  • Recognize health system barriers faced by patients with low literacy.
  • Implement improved methods of verbal and written communication.
  • Incorporate practical strategies to create a shame-free environment.

REDUCING THE RISK
The activity will enable physicians to:

  • Define the scope of patient safety problems caused by low health literacy and the need to manage the risk they present
  • Recognize the ethical and legal foundations for safe medical practices and patient-centered care
  • Explain patient safety concepts and approaches utilized in designing safer practice environments
  • Identify patient safety practices that reduce the risk of miscommunication and optimize the patient’s ability to safely manage their own care
  • Determine steps toward establishing a climate for change
  • Identify tools and resources for creating safer practice environments
  • Demonstrate how to utilize and implement these tools in a practice environment
Additional information/Special implementation requirements or guidelines: 

Communication is essential for the effective delivery of health care, and is one of the most powerful tools in a clinician’s arsenal. Unfortunately, there is often a mismatch between a clinician’s level of communication and a patient’s level of comprehension. In fact, evidence shows that patients often misinterpret or do not understand much of the information given to them by clinicians. This lack of understanding can lead to medication errors, missed appointments, adverse medical outcomes, and even malpractice lawsuits. Clinicians can most readily improve what patients know about their health care by confirming that patients understand what they need to know and by adopting a more patient-friendly communication style that encourages questions.

Date posted: 
Tue, 09/21/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 09/21/2010
Contact Person/Corresponding Author:



Suggested Citation:
, and . Health Literacy and Patient Safety: Help Patients Understand. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/209

The Physician's Role in Medication Reconciliation: Issues, Strategies, and Safety Principles

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

In “The physician’s role in medication reconciliation,” the panel aims to heighten physician awareness of the integral role of reconciliation in the safe use of medications and to provide a framework for physicians to understand their personal roles and responsibilities in this often difficult process of care.

The essence of medication reconciliation is making sense of a patient’s medications and resolving conflicts between different sources of information to minimize harm and to maximize therapeutic effects. It is an ongoing, dynamic, episodic and team-based process that should be led by and is the responsibility of the patient’s attending or personal physician in collaboration with other health care professionals. Medication reconciliation is essential to optimize the safe and effective use of medications.

Educational objectives: 

After completing this activity, participants should be able to:

  • Describe medication reconciliation principles and processes
  • Distinguish the physician's role in the medication reconciliation process
  • Integrate patient-centric aspects of medication reconciliation into practice
  • Create a medication management plan with your patients
  • Integrate principles and processes into practice in all settings of care
  • Identify appropriate medication reconciliation team in all settings of care
  • Identify proper delegation of clinical and nonclinical medication reconciliation responsibilities
  • Lead your organization's efforts to support medication reconciliation
Additional information/Special implementation requirements or guidelines: 

This monograph first provides background on medication issues, including: medication errors and adverse drug events, communication problems and medication reconciliation’s relationship to patient safety. It then presents an overview, including the steps of medication reconciliation, the underlying principles of medication reconciliation for deeper understanding of the physician’s leadership role and obligations, and guidance for effective achievement of medication reconciliation. This is followed by strategies for two particularly important areas of medication reconciliation: taking a medication history and promoting patient understanding of their medication regimen. Case study examples illustrate medication reconciliation failures and can be the basis for discussions physicians may have with their medical team and with their patients.

Recognizing that ultimately all health care safety and factors affecting medication reconciliation must be customized to the particular patient and practicing setting, this monograph does not offer rigid prescriptions, but rather general principles that physicians and their teams may adapt to their specific circumstances and needs. Because medication reconciliation represents an integral part of the patient safety effort, this monograph offers guidelines and information on developing support for medication reconciliation in the context of core safety principles. It provides useful information for physicians’ use in local improvement efforts and in advocacy for medication safety.

Finally, this monograph discusses important special topics critical to effective medication reconciliation: information technology, coordination of care and vulnerable populations. Information technology has tremendous potential, but it also poses significant challenges. This discussion highlights some of those issues. It also reviews a key issue in medication reconciliation—coordination of care—and sketches a directly related effort to address this concern (i.e., medical homes). In addition to enhancing coordination of care, medical homes may provide important benefits to older and minority populations—groups that are disproportionately affected by ineffective medication reconciliation. Lastly and significantly, the monograph discusses vulnerable patient populations, including older adults and minorities, and provides examples and potential strategies to improve medication reconciliation for these patients.

For information on receiving CME credit, go to http://www.ama-assn.org/ama/no-index/physician-resources/medication-reconciliation.shtml.

Date posted: 
Tue, 09/07/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 09/07/2010
Contact Person/Corresponding Author:



Suggested Citation:
, , and . The Physician's Role in Medication Reconciliation: Issues, Strategies, and Safety Principles. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/209

Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 140--To Feed or Not To Feed

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

The Step1 Test Prep Serices was created by second-year students at the Texas Tech School of Medicine in Lubbock as a project of the MS2 Aging Block of Systems Disorders II. It was developed as part of the REynolds Geriatrics Podcast series, which is supported in part by an Aging and Quality of Life grant from the D.W. Reynolds Foundation. The episodes in the series are based on questions that have geriatrics content and patient vignettes from the 2010 Step1 Sample Exam, available from http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri...

Educational objectives: 

The second-year medical student studying for the Step1 exam should be able to:

  • Discuss the appropriateness of paternalism in medicine
  • Describe the ethical implications of a physician practicing paternalism in their practice
  • Understand the importance of advanced directives in the case of end-of-life care and the ethical dilemmas faced by family when an advanced directive is non-existent.
Date posted: 
Thu, 10/07/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/22/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , , , , , and . Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 140--To Feed or Not To Feed. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/209

Geropsychiatric Nursing Competency Enhancements

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

Nurses care for older adults in health and illness across the full range of health care settings. Especially in late life, physical illness often precipitates and/or is accompanied by psychiatric symptoms. Therefore it is important that nursing education programs provide knowledge and skills that prepare nurses to care for older adults with mental health concerns and psychiatric/substance misuse disorders.

The Geropsychiatric Nursing Collaborative has developed the following resources to draw attention to the special needs of older adults.

  • Definition of Geropsychiatric Nursing. This definition serves to guide future discussions about preparing nurses to care for older adults with mental health concerns.
  • Key Concepts. These key concepts are foundational to the geropsychiatric nursing competency enhancements.
  • Geropsychiatric Nursing Competency Enhancements. These enhancements are not intended to ‘stand-alone,’ but rather to enhance existing or to-be-developed competencies by relevant professional nursing organizations. The competency enhancements are organized in four topic areas: entry level and advanced practice level for Gerontological, Psychiatric-Mental Health and Other Specialties Caring for Older Adults, i.e.  Adult, Family, Acute Care, and Women’s Health. The advanced level category is further categorized by role, either Nurse Practitioner or Clinical Nurse Specialist.
Educational objectives: 

Based on the competency enhancements, the Geropsychiatric Nursing Collaborative is identifying and evaluating the quality and suitability (appropriateness, evidence base, relevance, cultural sensitivity, and currency) of extant curricular and training materials for each level of curricula and identifying gaps at both the entry level, i.e., Associate and Bachelor of Science in Nursing, and the advanced level, i.e.,Master of Science in Nursing in Gerontological, Psychiatric-Mental Health and Adult/Family/Acute Care Women’s Health  Clinical Nurse Specialist and Nurse Practitioner Programs and the Doctor of Nursing Practice. The project will foster linkages of nursing education programs whose graduates will care for older adults to basic, graduate, post-graduate and continuing education geropsychiatric curricular offerings (courses, textbooks, journal articles, toolkits, training films, web-based courses and materials, course syllabi, and learning tools). All levels of nurses practicing in many different settings will require ‘retooling’ with current knowledge and skills in order to best provide mental health services to older adults.

Additional information/Special implementation requirements or guidelines: 

The competency enhancements are meant to inform the development of new and the updating of existing nursing competencies for the level and specialty indicated.

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

Buckwalter, K., Beck, C, Evans, L. (In press). Envisioning the Future of Geropsychiatric Nursing. In K.D. Melillo & S. C. Houde (Eds.). Geropsychiatric and Mental Health Nursing, 2nd Ed. Boston: Jones & Bartlett Publishers.

Date posted: 
Wed, 04/04/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 04/04/2012
Contact Person/Corresponding Author:



Suggested Citation:
, and . Geropsychiatric Nursing Competency Enhancements. POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/209

TEXAS Training Excellence in Aging Studies: Geriatric Gems and Palliative Pearls

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

"Geriatric Gems and Palliative Pearls" are a series of brief web modules, or "soundbytes", of geriatric medical topics developed by Texas Training Excellence in Aging Studies Program (TEXAS), funded by the D.W. Reynolds Foundation, and located at the University of Texas Medical School at Houston. UTH faculty developed the soundbytes using the AAMC and ACGME competencies germane to medical residents from a variety of speciality areas.   The "Gems and Pearls" are developed on andragogical principles employing brevity, repetition and an element of entertainment or compelling information to gain the learner's attention.  Each soundbyte takes about 3-5 minutes to review and is linked to videos, diagrams, text materials, and additional information on specific topics. Examples include Depression, Dementia, End-of-Life Issues and many others.

The rationale for using this form of educational methodology is based on research from the 70's and 80's showing that the spacing of education, repeated over time, results in more efficient learning and material retention than the massed presentation of educational materials.  This form of interactive spaced education (ISE) has been used by medical educators to teach physical diagnosis, effective feedback behaviors, and urology board review material.

Some of the topics covered include acute coronary syndrome, dementia, dying process, elder abuse, hazards of hospitalization, hospice, medical decision making, opioid toxicity, pain, self-neglect, urinary incontinence and executive function and capacity. 

Educational objectives: 

Learners will:

  1. Increase their knowledge, skills and attitudes in geriatric medicine
  2. Describe and differentiate variations in fundamental biomedical aspects of aging, geriatric assesment, and care coordination from younger adult populations; and
  3. Apply the knowledge and skills and demonstrate attitudes learned in caring fro geriatric patients in inpatient and outpatient clinical settings.
Date posted: 
Tue, 10/26/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 10/26/2010
Contact Person/Corresponding Author:



Suggested Citation:
, , , , and . TEXAS Training Excellence in Aging Studies: Geriatric Gems and Palliative Pearls. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/209

Preventive Ethics

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

This is an online, self-directed educational module describing and regarding the use of preventive ethics in medicine. It is a 2009 update by the director of the University of Oklahoma Bioethics Center, of a prior product completed in 1999.

Educational objectives: 

After completing this module, the learner will: 1. Be able to recognize the potential for ethical conflicts, especially in caring for patients with complex or difficult medical decisions to be made or patients whose decision-making capacity is likely to be affected. Ethical conflicts are especially likely in the following cases: (a) Patients with dementing illnesses or progressive neurological illnesses, (b) Patients with depression or other psychiatric disorders, (c) Patients with other chronic or progressive incurable illnesses, (d) Patients with a need for long-term care, (e) Patients/family members with unrealistic expectations or conflicting relationships, and (f) Patients with a terminal illness. 2. Be aware of different techniques to prevent ethical problems, including the following: Negotiation and mediation, Advance planning, and Appropriate referrals. 3. Be aware of methods to defuse ethical conflicts when they occur, including the following: Gathering facts, Agreeing on issues, Identifying alternatives/options, Negotiation, and Coercion.

Additional information/Special implementation requirements or guidelines: 

A computer with broadband Internet access is required.

Date posted: 
Tue, 01/12/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 10/10/2012
Contact Person/Corresponding Author:



Suggested Citation:
, and . Preventive Ethics. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/209

Student Senior Partners Program (SSPP)

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

SSPP is the cornerstone of the geriatrics education program for medical students at UCI. Each first year medical student is partnered with an older adult who lives in the local community. Each pair of students interacts with their senior partner for each module. These partnerships are designed to be maintained through the first three years of the students' predoctoral education. Three SSPP modules, each consisting of a preparatory didactic presentation, the student/senior encounter (at the senior partner's home), and a faculty-facilitated small-group discussion, are scheduled for each of the first three years of undergraduate medical education. They are incorporated into the times dedicated to geriatrics as a content theme in the required courses listed below. Scheduled student/senior interactions have both structured educational objectives and enough flexibility to make use of other learning opportunities as they arise.

Educational objectives: 

<p>
Basic training in healthy aging/history taking, transitions, functional assessment, cardiovascular/pulmonary issues, community resources, pharmacology issues, preventative health, advance directives, and closing a patient/physician relationship. Learners should be able to: 1. List at least three patient/doctor communication "tips" and identify personal goals for the students’ own healthy aging. 2. Discuss the role of loss and life transitions in working with older adults and identify your own coping mechanisms and those used by your senior partner. 3. Demonstrate the process of conducting a mini mental status exam (MMSE) and demonstrate an understanding of how to use the Tinettti Gait and Balance Exam. 4. Demonstrate proper techniques for physical examination, including vital signs and orthostatic blood pressures and discuss strategies to prevent cardiovascular and pulmonary disease in older adults. 5. Recognize older adults' needs for community resources. 6. Increase your knowledge about community resources that maintain or improve the health of older adults. 7. Discuss strategies to prescribe appropriately and to avoid polypharmacy, and discuss age-associated changes in pharmokinetics and pharmacodynamics. 8. Determine what screening tests are appropriate for patients 65 and older and research one recommendation relevant to your senior partner. 9. Determine the beliefs of your senior partner regarding aggressiveness of care and discuss and document an advance health care decision with your senior partner. 10. Discuss strategies to end a patient-physician relationship in a professional manner. 11. Participate in an evaluation and improvement process of the SSPP program.</p>

Additional information/Special implementation requirements or guidelines: 

Used with 500 1st-4th year undergrad and faculty in medical school classes. Faculty need to facilitate the small groups.

Date posted: 
Fri, 12/01/2006
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 12/18/2012
Contact Person/Corresponding Author:



Suggested Citation:
, , and . Student Senior Partners Program (SSPP). POGOe - Portal of Geriatrics Online Education; 2006 Available from: https://pogoe.org/taxonomy/term/209

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