The Portal of Geriatrics Online Education

Complex or Chronic Illness(es) in Older Adults

Frailty Interactive Cases and A Facilitator’s Guide

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

Introduction: Frailty is a diagnosable and treatable medical condition. It is a common syndrome in older adults, characterized by: physiological decline, marked vulnerability to adverse health outcomes, increased healthcare utilization, disability, high risk of falls, multiple comorbidities, and mortality. Our goal was to create a case-based educational resource in frailty for medical and other healthcare students.

Methods: A multidisciplinary team at the Miami VAHS, Geriatric Research Educational and Clinical Center, designed and implemented an 8-module educational resource on frailty: An Introduction and 7 cases covering screening, diagnosis, management, and comorbidities. This curriculum was used and evaluated by 4th-year medical students from the University of Miami Miller School of Medicine. Evaluation included a pre-/post-test and a curriculum evaluation with questions on content, learning objectives, value of the learning, and multimedia module usability. The Wilcoxon signed rank test was used with unilateral Monte Carlo significance to compare pre-/post-test performance, significant at p<.05.

Results: Fifty-one students completed 4 modules and the pre-/post-test from November 2020 to March 2021. Students’ post-test performance demonstrated significant improvement (p<.05) in knowledge of frailty. Fifty-five percent agreed the multimedia educational activity enhanced their knowledge of frailty and will include frailty assessment in their future practices. The combined “Good + Excellent” rating from evaluations of content linked to learning objectives ranged from 82.3-94.2%. Overall, written comments were positive regarding multimedia usability.

Conclusion: These case-based modules on frailty were highly rated and positively critiqued by students. Pre-/post-test evaluations demonstrated an increase in knowledge of frailty.

Keywords

Frailty, sarcopenia, comorbidities, multimedia, case-based learning

Educational objectives: 

There are twelve (12) learning objectives for the seven (7) cases; two learning objectives repeat for multiple cases. The number(s) in parentheses at the end of each learning objective below designates the cases in which the learning objective applies. All learning objectives start with the statement, “After viewing this module, learners will be able to describe.”

  1. Frailty can be diagnosed using accepted criteria and available tools (1)
  2. Frailty can be managed with literature-based interventions that include exercise nutritional support and optimized treatment of comorbid conditions (1)
  3. Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional (2 through 7)
  4. Frailty is often associated with a reduction in socialization that is often remediable with optimized care across all domains as well as care coordination (2)
  5. As is often the case in caring for patients with complex disease, it takes a team (2, 3, 6, 7)
  6. Frailty is often associated with cognitive deterioration that is often remediable with optimized care across all domains (3)
  7. Frailty is often associated with dependency and the need to recommend palliative care (4)
  8. Frailty is often associated with depression because both are common diseases (5)
  9. Depression can affect frailty by amplifying the symptoms of co-morbid conditions (5)
  10. Frailty coexisting with cognitive impairment need to be recognized early because of their mutual deleterious impact on function (6)
  11. The need to customized cancer care in frail patients based on comorbidities, function and prognosis (7)
  12. The importance of the social domain in care planning for patients with frailty and cancer (7)
Additional information/Special implementation requirements or guidelines: 

 

Facilitator’s Guide

Understanding Frailty: Screening, Diagnosis and Management

Authors

Lubna A. Nasr, MD

Department of Public Health, University of Miami Miller School of Medicine

Bruce W. Carter Miami VAMC, Miami, FL, USA

Raquel Aparicio-Ugarriza, PhD

ImFINE Research Group. Faculty of Physical Activity and Sport Science-INEF

Universidad Politécnica de Madrid, Madrid, Spain

Douglas Salguero, MD

Mount Sinai Medical Center, Miami, FL, USA.

Michael J. Mintzer, MD, AGSF

Director and Associate Director for Education & Evaluation

Miami Geriatric Research, Education and Clinical Center (GRECC), Miami, FL, USA

Acknowledgements

The authors would like to thank:

Rose van Zuilen, PhD, and Corinne B. Ferrari for their help in reviewing the modules and including this frailty training as a component of the MS4 geriatrics clerkship

 

Overview

Frailty is a term widely used in clinical medicine but often ill-defined. The primary purpose of these modules is to teach learners the definition, screening modalities and diagnostic methods for frailty. In addition, the secondary purpose to is display healthcare issues of older adults commonly associated with frailty. These include comorbid conditions, social disruptions, end-of-life care, etc.

This training is composed of eight PowerPoint narrated and animated presentations. PowerPoint was chosen because of its ubiquitous availability to virtually all learners. The introduction presents the basics of frailty definition, screening and diagnosis. The subsequent seven case-based modules ask students to apply their knowledge. We recommend that learners complete a minimum of four modules starting with the introduction and ending with Case 7; learners are free to choose two modules from cases 1 through 6 and are welcome to complete all these optional cases. Finally, case 7 is the most complicated and longest module; if a learner uses the fully narrated and animated features, it will run approximately 25-minutes. To meet individual needs, learners have the option to disable audio (narration and dialog) on some or all of the screens. (These PowerPoint-based modules do not provide the option of varying the speed of audio tracks as in some programs). Most students can complete the minimum of 4 modules in 60-75 minutes; all the modules can be completed in 2-2.5 hours. The list of module titles is included in Learning Objectives below.

All cases use a standardized template. Navigation instructions are included in the Introduction; all cases follow the same instructions. Learners must start with the Introduction followed by cases in numerical sequence; cases become more complex with progression. In evaluating this curriculum, we used: Introduction, followed by Case 1, Case 5 and Case 7. Students can return to the Introduction module at anytime to review terms and definitions.

Materials and Supplies

Access to a computer with Microsoft PowerPoint or other compatible software is required. Headphones or earbuds may be needed if learning is occurring in a congregate environment or because of learner preference. This training requires no other special instructions, materials or supplies. The PowerPoint presentations can be easily uploaded to the school’s learning management system for assignment to learners.

Learning Objectives

Learning objectives are included in each case. These objectives also act as a “preview” for the content within the animated and interactive modules. The introduction has no learning objectives because it is a “definition of terms” module for frailty, sarcopenia, and frailty screening, diagnosis and management. These topics are specifically addressed within the learning objectives of the cases. There are 12 unique learning objectives. Some of the learning objectives appear in more than one case. This is intentional. It allows learners to apply their learning to a new clinical circumstance or a new domain of care. The learning objectives follow the statement, “After viewing this module, learners will be able to describe:” and are listed here by case:

Case 1: Mild Frailty

  • Frailty can be diagnosed using accepted criteria and available tools
  • Frailty can be managed with literature-based interventions that include exercise, nutritional support and optimized treatment of comorbid conditions

Case 2: Moderate Frailty and Falling

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty is often associated with a reduction in socialization that is often remediable with optimized care across all domains as well as care coordination
  • As is often the case in caring for patients with complex disease, it takes a team

Case 3: Frailty and Cognitive Symptoms

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty is often associated with cognitive deterioration that is often remediable with optimized care across all domains
  • As is often the case in caring for patients with complex disease, it takes a team

Case 4: Severe Frailty, Dependency and Palliative Care

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty is often associated with dependency and the need to recommend palliative care

Case 5: Frailty and Depression

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty is often associated with depression because both are common diseases
  • Depression can affect frailty by amplifying the symptoms of co-morbid conditions

Case 6: Frailty and Major Neurocognitive Disorder

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • Frailty coexisting with cognitive impairment need to be recognized early because of their mutual deleterious impact on function
  • As is often the case in caring for patients with complex disease, it takes a team

Case 7: Frailty and Cancer

  • Frailty is a multifactorial illness with contributions from many domains of well-being: medical, psychological, social and functional
  • The need to customized cancer care in frail patients based on comorbidities, function and prognosis
  • The importance of the social domain in care planning for patients with frailty and cancer
  • As is often the case in caring for patients with complex disease, it takes a team

Evaluation

During this curriculum evaluation, we used identical pre- and post-tests, containing seven questions with twenty correct answers, to measure learning. This pre-/post-test is available upon request. All questions were effective in discriminating an increase in learning. Learner comments on content, presentation and usability of the modules were overwhelmingly positive.

Use of These Modules

These modules are free for use for all teachers, instructors and trainers. They can be used as produced and be incorporated into an existing curriculum, in part or in full. When these frailty modules are used or included in another curriculum, questions from the pre-/post-test may be adapted for assessments of students’ learning. As with all student assessments, these questions would likely require revision after several years of use. If adapted versions of this curriculum, or parts of this curriculum, are published, attribution to original authors must be included and these new materials must be equally accessible to teachers, instructors and trainers as are the original materials. These materials may not be used or adapted for commercial purposes. (See Creative Commons criteria: CC BY-NC-SA [Attribution-NonCommercial-ShareAlike]).

Date posted: 
Wed, 08/11/2021
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 06/09/2021
Contact Person/Corresponding Author:



Suggested Citation:
Frailty Interactive Cases and A Facilitator’s Guide. POGOe - Portal of Geriatrics Online Education; 2021 Available from: https://pogoe.org/taxonomy/term/4827

Office - Based Geriatrics Assessment

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

The geriatric assessment is a multidimensional, multidisciplinary assessment designed to evaluate an older person’s functional ability, physical health, cognition and mental health, and socioenvironmental circumstances. It is usually performed when the medical provider identifies a potential problem with the older adult patient. This holistic evaluation includes nutrition, vision, hearing, fecal and urinary continence, and balance. The geriatric assessment model has been studied in the home, inpatient and ambulatory care settings and there is evidence that it aids in the diagnosis of medical conditions; development of treatment and follow-up plans; coordination of management of care; and evaluation of long-term care needs and optimal placement.

Educational objectives: 
›Understand how to assess a new complex older patient in the office
›Understand the importance of overall function, including activities of daily living (ADL and IADL)
›Discuss validated tools for depression and cognitive assessment
›Discuss medication review
Date posted: 
Wed, 08/11/2021
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 05/07/2021
Contact Person/Corresponding Author:



Suggested Citation:
Office - Based Geriatrics Assessment. POGOe - Portal of Geriatrics Online Education; 2021 Available from: https://pogoe.org/taxonomy/term/4827

Palliative Care of a Patient with End-Stage Liver Disease: An Unfolding Case Study

:  
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 case study was developed for use in academic coursework and as a standalone training for health care providers (MDs, ARNP, Pharmacists, Social Workers, Nurses). This unfolding case study about the management of an adult in the midst of a health crisis. This case is a composite of many actual cases seen in clinical practice. During the course of this case study, learners are presented with information as the providers learn of the patient’s emergent and ongoing health concerns – from his Emergency Department admission through the development of his palliative care plan. Learners are asked to make decisions and use their best judgment about how to care for this patient and family.

Educational objectives: 

By the end of this case study, the learner will be better able to:

  1. Understand the natural history and disease management of end stage liver disease (ESLD).
  2. Use evidence-based practice to collaboratively develop and refine goals of care for patients with chronic, progressive conditions.
  3. Work interprofessionally to ensure the best quality of care for the patient and family.
Date posted: 
Fri, 09/14/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 08/15/2018
Contact Person/Corresponding Author:



Suggested Citation:
Palliative Care of a Patient with End-Stage Liver Disease: An Unfolding Case Study. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/4827

Simulation Curriculum for Geriatric Medicine Fellows

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

This material consists of a suite of nine simulated clinical cases, divided into three separate sessions of three cases each, intended to be conducted in a simulation center with simulated patients.  Cases are designed to teach geriatric medicine fellows and other appropriate learners basic geriatric assessment skills (Session one), how to navigate difficult situations in long-term care (Session two), and high-level communication skills in palliative and end-of-life care (Session three).  Each case consists of a multi-page document outlining scripts for the learner as well as the roles (patient, family member, facility staff, etc) portrayed by actors, necessary props and supporting materials, and instructions for evaluating and debriefing the learner.  Also contained in each document are Entrustable Professional Activities (EPA), Curricular Milestones (CM), and Reporting Milestones (RM) relevant to the case.

Educational objectives: 

- Efficiently and effectively assess and manage common geriatric syndromes in a variety of clinical settings.

- Demonstrate the ability to navigate difficult communication scenarios in a long-term care environment, while providing leadership, mediating conflict between interdisciplinary team members and/or family members, and providing high quality care.

- Provide compassionsate, patient-centered care at the end of life, using high-level communication strategies.

Additional information/Special implementation requirements or guidelines: 

n/a

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

None, though plans to present this at AGS/ADGAP in 2019.

Date posted: 
Mon, 11/12/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 08/08/2018
Contact Person/Corresponding Author:



Suggested Citation:
Simulation Curriculum for Geriatric Medicine Fellows. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/4827

Where's the Fall Risk?

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

One in four older adults have a fall or fall-related injury every year. “Where’s the Fall Risk?” is an interactive educational game that allows learners to discuss falls prevention in the home environment and think of potential solutions. Learners will be in groups of 2-6 people and use the provided picture to circle the fall risk areas in the given amount of time. The teams will then present the total number of areas by room and propose solutions for each fall risk area. A point will be given for each circled area and solution. The discussion portion of the game provides learners the ability to identify and fix high fall risk areas in the home. 

 

Educational objectives: 
  1. Understand what aspects of the home environment are considered fall risks
  2. Think of creative solutions to fix these fall risk areas
  3. At the end of the game, be able to have an active discussion with patients regarding falls prevention in the home environment
Additional information/Special implementation requirements or guidelines: 
Materials:
The game is best played in a group setting with teams composed of about 2-6 people.
  • Diagram of the home environment (PowerPoint provided)
  • Pen/Marker to circle fall risk areas
  • Timer
  • White board to keep track of points
Instructions:
Please print the provided diagram of the home environment. Groups of 2-6 people with a minimum of 2 groups.
Identification Phase:
  1. Set timer for 2 minutes and provide groups with the home diagram
  2. Start timer and have groups circle areas in the home that are considered fall risks. Suggestion to groups: it is easier to go room by room
  3. Once time is up, set pens to the side.
Solution Phase:
  1. Set timer for 2 minutes and provide groups with a sheet of paper.
  2. Start timer and have groups discuss why they circled the area as a fall risk and think of a solution for the fall risk area (of note, groups may not use “get rid of the item” as a solution).
  3. Once time is up, set pens to the side.
Discussion Phase:
  1. On white board, create a grid with group names at the top and rooms on the side (“Outside”, “Living Room”, “Kitchen”, “Dining”, “Bedroom”, “Bathroom”)
    1. Depending on how much time you have, it may be faster to discuss some rooms together: Outside & Living Room, Kitchen & Dining, Bedroom & Bathroom
  2. Start the discussion by going from room to room. Each team will get 1 point if they can identify a fall risk area and provide a solution. Of note, this is a key opportunity to discuss and talk about these high fall risk areas. You may propose other solutions and open it up to discussion with other groups as well.
  3. The winning team has the most points at the end of the game. 
Date posted: 
Wed, 07/25/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Sat, 05/26/2018
Contact Person/Corresponding Author:



Suggested Citation:
Where's the Fall Risk?. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/4827

ACUTE MANAGEMENT OF OLDER ADULT FOUND DOWN WITH ALTERED MENTAL STATUS

:  
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 case study was developed for use in academic coursework and as a standalone training for health care providers (MDs, ARNP, Pharmacists, Social Workers, Nurses). This unfolding case study about the management of an older adult in the midst of a health crisis. This case is a composite of many actual cases seen in Emergency Departments. During the course of this case study, learners are presented with information as the providers learn of the patient’s emergent and ongoing health concerns – from her Emergency Department admission through her Intensive Care Unit stay. Learners are asked to make decisions and use their best judgment about how to care for this patient.

Educational objectives: 

 

  • Apply knowledge of evidence-based care provision to an older adult found with altered mental status after a ground level fall
  • Describe the contributions of the interprofessional team to care management
  • Demonstrate effective communication during handoffs in care
Publications from, presentations from, and/or citations to this product: 

Citations are listed at the bottom of the screen throughout the case study.

Date posted: 
Fri, 07/27/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 05/22/2018
Contact Person/Corresponding Author:



Suggested Citation:
ACUTE MANAGEMENT OF OLDER ADULT FOUND DOWN WITH ALTERED MENTAL STATUS. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/4827

Compendium of Five Case Studies: Lessons for Interprofessional Teamwork in Education and Workplace Learning Environments

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

The VA Centers of Excellence in Primary Care Education began educational activities in Academic Year 2011-2012 to improve primary care education, particularly to harmonize the education of clinician trainees with the emerging and future practice of primary care exemplified by patient centered care such as VA’s Patient Aligned Care Team model for primary care delivery. This volume shares examples of educational strategies that have
emerged from the first four academic years of the project, with each chapter being a case study from a participating site. Each case study reports on the implementation of a curricular element within their unique Center of Excellence. These case studies are intended to be of use to those interested in introducing curricular activities in accredited programs for health profession trainees that will lead to
the advancement of interprofessional, Veteran/patient-centered primary care. These case studies also represent one component of the project’s evaluation plan, designed by Annette Gardner, Ph.D. We have attempted to inform readers about the context of the institutions and readiness for change, the steps each program completed to design and develop strategies, gain leadership commitments,
implement, and evaluate these interventions in the spirit of continuous improvement. Additional reports about the project have been published, are in press, or are in the pipeline. Further, many of the references in this document have full-text available online. We have provided live links for ease of access to these additional resources.

Educational objectives: 

Shared Decision-Making: Care is aligned with the values, preferences and cultural perspectives of the patient. Curricula focus is on communication skills necessary to promote patient’s self-efficacy.


Sustained Relationships: Care is designated to promote continuity of care; curricula focus on longitudinal learning relationships.


Interprofessional Collaboration: Care is team based, efficient and coordinated, curricula focus is on developing trustful, collaborative relationships.


Performance Improvement: Care is designed to optimize the health of populations; curricula focus on using the methodology of continuous improvement in redesigning care to achieve quality outcomes.

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

Centers of Excellence in Primary Care Education (2017). Compendium of Five Case Studies: Lessons for Interprofessional Teamwork in Education and Workplace Learning Environments 2011-2016 (S. Gilman & L. Traylor Eds.): United States Department of Veterans Affairs, Office of Academic Affiliations. ISBN: 978-0-16-094202-0

Date posted: 
Wed, 05/16/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 05/16/2018
Product Viewing Instructions: 
Download Adobe pfd file
Contact Person/Corresponding Author:



Suggested Citation:
Compendium of Five Case Studies: Lessons for Interprofessional Teamwork in Education and Workplace Learning Environments. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/4827

Mobility Clinical Evaluation Exercise (Mini-CEX)

:  
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 mobility Clinical Evaluation Exercise (Mini-CEX) is designed to use with a learner during an actual patient encounter. The leaner first views the Center for Disease Control and Prevention (CDC) videos on the Timed Up and Go Test, 30 Second Chair Stand and 4 Stage Balance tests and handouts prior to the administration of the Mini-CEX. The teacher observes the learner during the patient encounter and completes the Mini-CEX. The teacher reviews the form with the learner and provides feedback of what skill was observed, partially observed, not observed, not applicable and comments about the encounter.

Educational objectives: 

Learners who are administered this mobility Mini-CEX will:

1)acquire knowedgle about various tests for mobiilty, strength and balance.

2)be observed assessing mobility during a patient encounter.

3)receive feedback about their communcation and professionalism skills in assessing mobility.

Date posted: 
Mon, 01/23/2017
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 01/23/2017
Product Viewing Instructions: 
Learner views videos prior to Mini-CEX
Contact Person/Corresponding Author:



Suggested Citation:
Mobility Clinical Evaluation Exercise (Mini-CEX). POGOe - Portal of Geriatrics Online Education; 2017 Available from: https://pogoe.org/taxonomy/term/4827

Geriatrics Self Learning Tools For Residents

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

The enclosed materials are learning tools developed to help medical residents on the geriatrics rotation at Montefiore Medical Center master delirium screening, dementia screening and falls risk evaluation. Each tool consists of a short description of the definition and epidemiology of the respective syndrome followed by a screening instrument for the syndrome. Residents are given the tools at the start of the rotation and are asked to practice each of the assessments on at least two patients. To ensure that they receive feedback on their performance of the assessment, the residents are given a log sheet for preceptors to fill out after each assessment. Logs are reviewed at the end of the rotation. Residents are also given a reading packet at the start of the rotation with more in depth information on the above topics as well as other geriatrics topics.  

Educational objectives: 

Learners will review knowledge of dementia, falls and delirium.

Learners will gain the ability to perform assessments for dementia, falls and delirium 

Additional information/Special implementation requirements or guidelines: 

Permission pending for use of the 3DCAM

Date posted: 
Tue, 10/18/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 10/19/2016
Contact Person/Corresponding Author:



Suggested Citation:
Geriatrics Self Learning Tools For Residents. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4827

Family Medicine Resident and Geriatric Fellow Longitudinal Home Visit Curriculum

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

With an aging population, the need to train primary care residents and geriatric fellows in home-based care continues to grow. A needs assessment of family medicine residents and geriatric fellows' attitudes and knowledge was performed to guide a novel, longitudinal home care curriculum based out of a Home-Based Primary Care practice within the Family Medicine Center.

Fellows are assigned a panel of two home visit patients from the Family Medicine Center's Home-Based Primary Care practice. Fellows follow these patients monthly and manage their care between visits.  In today’s rapidly changing clinical environment, primary care physicains and geriatricians must be adapt at analyzing systems and processes they work under and making changes to improve patient care. A new home visit program is a natural venue for a specific, achievable quality improvement intervention with support from faculty, the Home Based Primary Care practice team and the Family Medicine Center Patient and Family Advisory Council. 

The longitudinal family medicine resident curriculum is based on graded autonomy and focused objectives for each level with the ultimate goal of residents feeling empowered to include home visits in their future practice. After home visit sessions, residents complete personal, written reflections after each visit to optimize learning and retention, as well as for giving a venue for processing potentially challenging situations. Sample reflections are included. Third-year residents facilitate an interdisciplinary case conference to address various social determinants of health, home safety issues and medication concerns. By residency graduation, residents will complete 10-14 home visits. 

 
Educational objectives: 
  1. Describe challenges and opportunities unique to patient care in the home environment.  
  2. Review medication use and adherence while identifying medications that are no longer effective, are duplicative or carry greater burden than benefit.  Identify medications that you would recommend stopping and create a schedule for stopping these medications.
  3. Develop and implement a safety plan to make the patient’s home environment safer.
  4. Develop a personal plan to integrate home visits into your future practice.

Fellow-specific objectives:

  1. Develop, document and manage patient- and family-centered care plans related to patient’s health conditions and expected trajectory with emphasis on personal goals of care in collaboration with an interprofessional health care team and community service providers.
  2. Implement a process improvement as part of the Home Based Primary Care team.  

 

Date posted: 
Wed, 10/19/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 10/19/2016
Contact Person/Corresponding Author:



Suggested Citation:
Family Medicine Resident and Geriatric Fellow Longitudinal Home Visit Curriculum. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4827

Pages

Subscribe to RSS - Complex or Chronic Illness(es) in Older Adults