POGOe - Portal of Geriatric Online Education - Geriatric Syndromes

Geri-ConsultWiz
- 1.04 MB

Estimated time to complete:

1 hour

Authors: Dr. Carmel Dyer, Dr. Sharon Ostwald, Jennifer Larson, Dr. Grace Varas

POGOe Id:

21279

No CME credits available

Not peer reviewed

None Selected

Contact person/corresponding author:

Jennifer Larson, [email protected]">[email protected]

Geri-ConsultWiz 2.0: An Educational Intervention Using “Just-in-Time Learning” in Computer Orders

LSolberg — Fri, 19 Oct 2012 16:45:20 +0000

Attachments

Vanderbilt University School of Medicine

Abstract:

Geri-ConsultWiz 2.0 is an educational intervention project based in the Wiz Order Computerized Provider Order Entry program. Geri-ConsultWiz 2.0 introduces an educational intervention providing new “just-in-time” clinical education modules that allow medical learners at all levels to easily access and review consultation-relevant content for common geriatric syndromes. Geriatric syndromes covered include: Delirium, Dementia, Depression, Falls, Failure to Thrive, Fractures/Osteoporosis, and Polypharmacy. The “just-in-time” learning consists of summarized information from the medical literature and from online authoritative guideline sources describing a brief background of the syndrome, pharmacologic treatments, non-pharmacologic treatments, and laboratory tests to order. This will extend the personal teaching in geriatrics that is provided to trainees and to consult referring providers through the Consultation Service.

Educational objectives:

1. Offer "just-in-time learning" to providers requesting a geriatrics consult using an automated order program.

2. Learning offered covers several geriatric syndromes including Delirium, Dementia, Depression, Falls, Failure to Thrive, Fractures/Osteoporosis, and Polypharmacy.

3. Provides learners with appropriate laboratory tests related to each syndrome.

Additional information/Special implementation requirements or guidelines:

May be programmable in several different computer ordering platforms.

Intended learner audience:

Advanced Practice Nursing Student

APRN

Fellow

Physician Assistant

Practicing Physician/CME

22 HOSP: Identify hazards of hospitalizations

Minimum geriatric competencies:

6 CBD: Determine etiology of delirium

8 CBD: Evaluate and manage agitated patients

Learning resource types:

Demonstration

Discipline/specialty:

MedTEC Program Summary
- 35 KB

Estimated time to complete:

15 minutes

Authors: Dr. Laurence Solberg

POGOe Id:

21278

Date last updated:

Fri, 10/19/2012

No CME credits available

Not peer reviewed

None Selected

Medical Students as Teachers in Extended Care (MedTEC)

lathiaa — Tue, 16 Oct 2012 16:07:36 +0000

Attachments

MedTEC Pre-Program Survey-Test
- 49 KB

MedTEC Post-Program Survey-Test
- 44.5 KB

MedTEC Pocket Card
- 68 KB

MedTEC Information Sheet for Patients
- 42 KB

MedTEC Information Sheet for Students
- 24 KB

Cleveland Clinic Lerner College of Medicine

Abstract:

Medical Students as Teachers in Extended Care (MedTEC) is a program that was designed to train medical students on the different sites and levels of care in the community after discharge from the hospital. Students who participate in this program spend a day at a community facility that includes skilled nursing, assisted living, and long term care. The program consists of educational sessions on levels of care and transitions of care, a tour of the facilities, and opportunities to talk to patients. In addition, students lead, under the guidance of the program preceptor, an in-service for facility staff on topics relating to the care of older adults. Students are asked to complete pre and post program surveys/tests for program assessment.

Educational objectives:

By the end of the program, the learner will be able to:

List the levels of post-acute and extended care
Differentiate specific levels of care
Define transitions of care
Articulate ways to improve transitions of care
Differentiate
1. Inpatient (acute) rehab vs. skilled rehab
2. Long term acute care vs. inpatient rehab
3. Subacute vs. skilled nursing
4. Assisted living vs. long term care
Teach geriatric principles and other topics relevant to the care of older adults in post-acute and extended care to interdisciplinary facility staff members.
Identify a learning need of a patient and utilize a patient-centered teaching approach to address that need.

Intended learner audience:

Advanced Practice Nursing Student

Fellow

10 SCC: Develop management plan for patients with functional deficits

Minimum geriatric competencies:

25 HOSP: Communicate a discharge plan

Learning resource types:

Learner Assessment

Quick Reference/Pocket Card

Curriculum/Syllabus

Discipline/specialty:

Physical Medicine and Rehabilitation

Preventive Medicine

Estimated time to complete:

More than 3 hours

POGOe Id:

21263

Date last updated:

Tue, 10/16/2012

No CME credits available

Not peer reviewed

None Selected

Contact person/corresponding author:

Amanda Lathia, [email protected]">[email protected]

SAFE: The Safe Admissions For Elders App

jlawlor — Fri, 12 Oct 2012 17:19:40 +0000

Attachments

SAFE App content.pdf
- 4.15 MB

Wake Forest University School of Medicine

Abstract:

The SAFE App is an educational app intended for use by medical students and residents on their inpatient rotations. SAFE App addresses the processes of hospital admission and effective discharge planning for optimal transitions of care for older adult patients. The app also provides practical, just-in-time instruction in recognizing and managing common geriatric syndromes, symptoms and hazards of hospitalization.

Educational objectives:

1) Learners will access and use diagnostic and treatment recommendations for common geriatric symptoms and syndromes

2) Learners will identify and implement critical components of admission and discharge processes for hospitalized older adults

Intended learner audience:

4 CBD: Compare and contrast presentations of the 3D's

Minimum geriatric competencies:

9 SCC: Assess and describe functional abilities

14 HCP: Define and differentiate code status, proxies, and advance directives

22 HOSP: Identify hazards of hospitalizations

2 MM: Identify medications that should be avoided

10 SCC: Develop management plan for patients with functional deficits

23 HOSP: Explain risks, indications, alternatives, and contrainidictions for Foley catheter use

3 MM: Document a patient’s medication list

6 CBD: Determine etiology of delirium

16 HCP: When to override recommendations for treatment

24 HOSP: Explain risks, indications, alternatives, and contraindictaions for restraint

7 CBD: Perform and interpret a cognitive assessment

25 HOSP: Communicate a discharge plan

8 CBD: Evaluate and manage agitated patients

26 HOSP: Exam areas at risk for pressure ulcers

Learning resource types:

Other Resource Type

Quick Reference/Pocket Card

Software Program

Independent/Self-Directed Learning

Other Learning Resource Type:

iPhone app

Discipline/specialty:

Geriatric Competency-based Curriculum Cognition Module
- 32.5 KB

Estimated time to complete:

15 minutes

Authors: Franklin Watkins, Julie Williams

POGOe Id:

21257

Date posted:

Sun, 01/01/2012

Date last updated:

Fri, 10/12/2012

No CME credits available

Not peer reviewed

None Selected

Contact person/corresponding author:

Franklin Watkins, [email protected]">[email protected]

Competency-based Outpatient Skills Modules for Internal Medicine Residents

abaron — Mon, 08 Oct 2012 14:45:33 +0000

Attachments

Geriatric Comptency-based Curriculum Falls Module
- 43 KB

Geriatric Competency-based Curriculum Health Literacy Module
- 29 KB

Geriatric Competency-based Curriculum Med Review Module
- 44 KB

Geriatric Competency-based Curriculum RLE Module
- 79.5 KB

Geriatric Competency-based Curriculum Urinary Incontinence Module
- 15.66 KB

University of Chicago Division of the Biological Sciences The Pritzker School of Medicine

Abstract:

This is a collection of brief structured clinical evaluation exercises based on geriatric competencies for internal medicine residents. They are designed to be used as direct observation tools in the ambulatory clinic setting, for faculty to give structured feedback on specific geriatric competencies, including: falls screening and assessment, cognitive assessment, estimating remaining life expectancy, patient education incorporating health literacy, medication review, and urinary incontinence assessment.

Educational objectives:

The objective for each exercise is for a faculty member to observe and give formative feedback to a resident on a specific geriatric competency area.

Intended learner audience:

12 FBG: Ask about falls and intrepret tests

Minimum geriatric competencies:

2 MM: Identify medications that should be avoided

5 CBD: Formulate a diagnosis and evaluate the 3D's

13 FBG: Construct diagnosis and evaluation plan for fallen patient

15 HCP: When to override standard recommendations for screening tests

3 MM: Document a patient’s medication list

16 HCP: When to override recommendations for treatment

7 CBD: Perform and interpret a cognitive assessment

Learning resource types:

Study Guide/Lab Guide

Discipline/specialty:

Appendix 1 Background Content Information
- 100.5 KB

Estimated time to complete:

30 minutes

Authors: Dr. Katherine Thompson

POGOe Id:

21253

Date last updated:

Mon, 10/08/2012

No CME credits available

Not peer reviewed

What’s Wrong with Mom (Dad)? Chronic Care Evaluation and Management of the Older Adult (and their Caregivers) with Alzheimer’s Dementia

mandims — Tue, 25 Sep 2012 19:21:38 +0000

Attachments

Appendix 3 Quiz on Background Material
- 32.5 KB

Appendix 4 MOCA-Scoring Instructions
- 188.01 KB

Appendix 4.1 MOCA-Scored
- 606.61 KB

Appendix 4.1 MOCA-Unscored With Drawings
- 631.13 KB

Appendix 5 Overview of Geriatrics Curriculum Sesssion 1
- 27.5 KB

Appendix 5.1 Goals and Objectives for Session 1
- 29 KB

Appendix 6 Standard Patient Dyad Script
- 134 KB

Appendix 7.1 Standardized Patient Chart for Father-Son Dyad
- 2.01 MB

Appendix 7.2 Standardized Patient Chart for Father-Daughter Dyad
- 2 MB

Appendix 7.3 Standardized Patient Chart for Mother-Daughter Dyad
- 2 MB

Appendix 7.4 Standardized Patient Chart for Mother-Son Dyad
- 2.21 MB

Appendix 8 Standardized Patient Assessment and Plan
- 29.5 KB

Appendix 9 Standardized Patient Feedback Form and Checklist
- 61.5 KB

Appendix 10 Virtual 12-Month Follow Up
- 29 KB

Appendix 10.1 Unique 12-Month Email Vignettes
- 31 KB

Appendix 10.2 Expert Answers for 12-Month Follow Up Emails
- 38 KB

Appendix 10.3 Sample Student Email Responses
- 47 KB

Appendix 11 36-Month Follow Up
- 28 KB

Appendix 11.1 Unique 36-Month follow Up Vignettes
- 28.5 KB

Appendix 11.2 Expert Answers for 36-Month Follow Up Emails
- 14.9 KB

Appendix 12 Grading Rubric for Email Vignettes 12 and 36 Months
- 38.5 KB

Appendix 14 Student Self Assessment Post Assessment
- 37.5 KB

Appendix 15 Overall Grading Scale for Geriatrics Curriculum
- 10.43 KB

University of Cincinnati College of Medicine

Abstract:

Students learn the evaluation and management of the older adult and caregiver with a focus on Alzheimer’s Disease. This module consists of two large group sessions (week 1 & 4) and individualized assignments (weeks 2 & 3). In the first session, students interview a standardized patient and caregiver dyad and discuss initial diagnosis and management of Alzheimer’s Disease. Students receive real time feedback from the standardized dyad and observing faculty. In weeks 2 & 3, students individually receive questions from the caregiver of the patient they interviewed. These questions reflect real life challenges commonly faced by families of patients with Alzheimer’s as the disease progresses. During week 4, the monthly cohort of medical students participating in the Family Medicine clerkship, spends the final Friday morning of their clerkship month rounding on individual patients with physician providers and interdisciplinary team members, at a long term care facility that cares for patients in the latter stages of Alzheimer’s Disease. Evaluative components consist of: online post test assessment, Standardized Patient Student Feedback (verbal and written), student email responses to caregivers, final student self assessment.

Educational objectives:

Biopsychosocial Model (Patient Centered Communication Skills, Psychosocial Awareness, Patient Education, Comprehensive Care, Contextual Care, Coordination/Complexity of Care)

Demonstrate active listening skills and empathy for patients.
Demonstrate setting a collaborative agenda with the patient for an office visit.
Demonstrate the ability to elicit and attend to patients’ specific concerns.
Explain history, physical examination, and test results in a manner that the patient can understand.
Clarify information obtained by a patient from such sources as popular media, friends and family, or the Internet.
Demonstrate validation of the patient’s feelings by naming emotions and expressing empathy.
Reflect on personal frustrations, and transform this response into a deeper understanding of the patient’s and one’s own situation, when patients do not adhere to offered recommendations or plans.
Discuss the influence of psychosocial factors on a patient’s ability to provide a history and carry out a treatment plan.
Provide patient education tools taking into account literacy and cultural factors.
Describe the patient education protocols and programs for core chronic illnesses at their assigned clerkship sites.
Identify resources in a local practice community that support positive health outcomes for diverse patients and families.
Promote the use of support groups and other community resources in the area of mental health.
Find and use high-quality Internet sites as resources for use in caring for patients with core conditions.
Conduct an encounter that includes patients and families in the development of screening and treatment plans.
Demonstrate caring and respect when interacting with patients and their families even when confronted with atypical or emotionally charged behaviors.
Demonstrate interpersonal and communication skills that result in effective information exchange between patients of all ages and their families.
Demonstrate interpersonal and communication skills that result in effective information exchange between patients of all ages and professionals from other disciplines and other specialties.
Describe the value of teamwork in the care of primary care patients.
Discuss the roles of multiple members of a health care team (e.g., pharmacy, nursing, social work, and allied health).
Participate as an effective member of a clinical care team.
Differentiate among common etiologies based on the presenting symptom.
Recognize “don’t miss” conditions that may present with a particular symptom.
Elicit a focused history and perform a focused physical examination.
Discuss the importance of a cost-effective approach to the diagnostic work-up.

Acute Care, Dementia

Perform a screening test for cognitive decline (e.g., the clock drawing test or the Mini-Mental Status Examination).
Select appropriate initial diagnostic tests for a patient presenting with memory loss, focusing on tests that identify treatable causes.
Find and apply diagnostic criteria.
Find and apply surveillance strategies.
Elicit a focused history that includes information about adherence, self-management, and barriers to care.
Perform a focused physical examination that includes identification of complications.
Assess improvement or progression of the chronic disease.
Describe major treatment modalities.
Propose an evidence-based management plan that includes pharmacologic and non-pharmacologic treatments and appropriate surveillance and tertiary prevention.
Communicate appropriately with other health professionals (eg, physical therapists, nutritionists, counselors).
Communicate respectfully with patients who do not fully adhere to their treatment plan.
Educate a patient about an aspect of his/her disease respectfully, using language that the patient understands. When appropriate, ask the patient to explain any new understanding gained during the discussion.

Additional information/Special implementation requirements or guidelines:

Structure of clerkship in which curriculum has been used:
This innovative longitudinal teaching curriculum is used in the third year Family Medicine Clerkship. This is a 4-week, required rotation. Approximately 160 students complete this clerkship each year with 12-15 students on the clerkship at a time. While on the clerkship, the students rotate at either a residency, faculty, or community based family medicine site. All students come back to the medical school for Family Medicine didactic sessions every Friday during the clerkship. This geriatrics based curriculum is taught during these weekly sessions.

VIII: Program Content and Instructional Strategies
Week 1:

Background content information is reviewed by medical students using asynchronous learning with students reading material and watching and scoring a video of a geriatrics faculty member giving the Montreal Cognitive Assessment (MoCA) to a patient.
Students take an online quiz (utilizing Blackboard) on the background material by Thursday morning of the first week. This is a graded assignment.
Standardized patient session take place on the first Friday of the Clerkship.
1. Overview of the geriatrics curriculum and associated assigned tasks that are due throughout the clerkship month, done in a large group.
2. Discussion with clerkship students (done in a large group) of their review of the background content information. Students submit their questions about this content via Blackboard prior to the first geriatrics curriculum session. These questions are reviewed by both the Family Medicine and Geriatrics faculty who moderate this session.
3. Review of the standardized patient (SP) chart as a large group.
4. Dyads of students interview the SPs (a dyad consisting of a mother/father as a patient and daughter/son as the caregiver) and give the diagnosis of Alzheimer’s disease.
5. After interviewing the SPs, students, in their dyads, formulate a problem list and write out an assessment and plan for this patient encounter.
6. Each student dyad then meets with their SPs to get feedback on their interaction.
7. In a large group, students collectively discuss their SP feedback and review their assessment and plan. This session is moderated by faculty from Family Medicine and Geriatrics.

Week 2

Following the SP session, students receive a unique, 12 month follow up vignette on their patient and are emailed a question from the family regarding a problem. Students must research the answer to the question and email their response to the family by the second Thursday of the rotation. This assignment is graded and the students receive written feedback on content and writing style.
On the second Friday of the clerkship, the students receive a unique, 36 month follow up vignette and again receive another question emailed from the family. Once again the student researches the answer to the question and writes another emailed response back to the family. This is due by the third Thursday of the rotation. This assignment is graded and the students receive written feedback on content and writing style.

Week 3

On the third Friday of the clerkship, we have a panel discussion to review the answers to the emailed questions. Panel members include clerkship faculty, members of the Alzheimer’s Association, geriatrics faculty, and a geriatric pharmacist.

Week 4

The monthly cohort of medical students participating in the Family Medicine clerkship, spends the final Friday morning of their clerkship month rounding on individual patients with physician providers and interdisciplinary team members, at a long term care facility that cares for patients in the latter stages of Alzheimer’s Disease.
Students complete a post self assessment following this session.

“What’s wrong with Mom?” is an innovative Family Medicine Clerkship longitudinal teaching module developed by the University of Cincinnati (UC) Department of Family and Community Medicine in collaboration with the UC Division of Geriatrics, UC College of Pharmacy and the Alzheimer’s Association of Southwestern Ohio.

Intended learner audience:

4 CBD: Compare and contrast presentations of the 3D's

Minimum geriatric competencies:

9 SCC: Assess and describe functional abilities

19 PC: Assess and manage pain and non-pain symptoms

2 MM: Identify medications that should be avoided

5 CBD: Formulate a diagnosis and evaluate the 3D's

10 SCC: Develop management plan for patients with functional deficits

15 HCP: When to override standard recommendations for screening tests

3 MM: Document a patient’s medication list

11 SCC: Identify safety risks in home

16 HCP: When to override recommendations for treatment

21 PC: Present palliative care as a positive option

24 HOSP: Explain risks, indications, alternatives, and contraindictaions for restraint

7 CBD: Perform and interpret a cognitive assessment

8 CBD: Evaluate and manage agitated patients

Learning resource types:

Standardized Patient

Video

Curriculum/Syllabus

Discipline/specialty:

http://www.reynolds.med.arizona.edu/EduProducts/ElderCareProviderSheets.cfm

Authors: Dr. Mandi Sehgal, Dr. Robert Ellis, Barbara Tobias

POGOe Id:

21245

Date posted:

Sun, 01/01/2012

Date last updated:

Tue, 09/25/2012

No CME credits available

Peer reviewed

Contact person/corresponding author:

Dr. Mandi Sehgal, [email protected]">[email protected]

Elder Care: A Resource for Interprofessional Providers: Nocturia in Older Adults

loneill — Fri, 21 Sep 2012 20:51:12 +0000

Attachments

Nocturia.pdf
- 303.55 KB

University of Arizona College of Medicine

Abstract:

Nocturia in Older Adults is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings.

Educational objectives:

After reading this issue of Elder Care, you should be able to…

State how many episodes of voiding per night are considered abnormal (ie, diagnostic of nocturia).
Describe the non-pharmacologic approaches to treatment that are recommended for patients with nocturia.
List medications that can be used for treating nocturia.

Additional information/Special implementation requirements or guidelines:

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as

content is not changed,
no one is charged a fee to use or read the publication,
authors and their affiliated institutions are noted without change, and
the reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatric Education Center."

Elder Care Provider Sheets can also be accessed at http://www.reynolds.med.arizona.edu/EduProducts/ElderCareProviderSheets.cfm.

Intended learner audience:

Advanced Practice Nursing Student

Medical Student Pre-Clerkship

Entry Level Nursing Student

Patient

Physician Assistant

Practicing Physician/CME

Quick Reference/Pocket Card

Therapist

Learning resource types:

Discipline/specialty:

Obstetrics and Gynecology

Urology

Estimated time to complete:

30 minutes

Authors: Dr. Jerry Ciocon, Dr. Jorge Camilo Mora

POGOe Id:

21241

Date posted:

Fri, 09/21/2012

Date last updated:

Fri, 09/21/2012

No CME credits available

Not peer reviewed

None Selected

Contact person/corresponding author:

Dr. Barry Weiss, [email protected]">[email protected]

Peripheral Neuropathies

eotoole — Wed, 19 Sep 2012 21:57:05 +0000

Attachments

Peripheral Neuropathies
- 262.5 KB

University of California, Irvine, School of Medicine

Abstract:

This presentation will familiarize learners to the symptoms and signs of peripheral neuropathy, review common causes and outline the approach to evaluation and treatment. Information about autonomic neuropathies and review evaluation and treatment of these disorders is also included.

Intended learner audience:

Fellow