The Portal of Geriatrics Online Education

Transitions of Care

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/4830

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/4830

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/4830

Interprofessional Didactic on Medication Reconciliation for Medical and Pharmacy Students

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

Introduction
Medical schools are now required to include interprofessional training in which students collaborate with other healthcare professionals. This interprofessional didactic session was created by a pharmacist and physicians to teach a group of medical and pharmacy students about medication reconciliation.
Methods
A physician and pharmacist collaborated to deliver this 50-minute PowerPoint didactic during second-year medical students’ clinical skills course. Participating students included second-year medical students at the author’s institution, plus all pharmacy students rotating at the institution on the day of the didactic, since the author’s institution does not have its own pharmacy school. The didactic consists of lecturing, interprofessional small group work on cases, and large group discussion. Students were surveyed after the didactic to assess their attitudes about the session.
Results
A total of 63 students (54 medical and 9 pharmacy students) attended this didactic. Survey response rate was 58/63 (92%). On a 5-point Likert scale (1=Strongly Disagree, 5=Strongly Agree), students generally agreed that the lecture was valuable (mean +/- SD 4.7 +/- 0.5), provided new information (4.4 +/- 0.7), and should be continued for future students (4.7 +/- 0.5). Students also agreed that their school should have more interprofessional didactics (4.6 +/- 0.6).
Discussion
This 50-minute interprofessional didactic for medical and pharmacy students was highly valued by students, and provides a valuable setting for interprofessional education. This interprofessional didactic can be replicated at other institutions, including medical schools that do not have an on-site pharmacy school.

Educational objectives: 

By the end of this activity, learners will be able to:
1. Appreciate the difficulties many patients have with taking medications appropriately.
2. Describe how to approach patients in a collaborative, nonthreatening manner about their medications.
3. Identify how to appropriately obtain and document a patient’s complete medication list.
4. Appreciate the importance of maintaining an accurate medication list during times of transitions of care.
5. Appreciate the value of interprofessional learning.

Date posted: 
Thu, 02/15/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 02/15/2018
Contact Person/Corresponding Author:



Suggested Citation:
Interprofessional Didactic on Medication Reconciliation for Medical and Pharmacy Students. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/4830

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/4830

Advance Directives

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

Advance Care Planning (ACP) is more than documenting life-sustaining treatment choices or identifying a surrogate decision-maker; it is a comprehensive, continuing communication and ‘shared decision-making’ process between the patient, family, and medical providers designed to document patient values and goals for treatment.

This interactive self- learning module is designed for undergraduate medical students with the goal of introducing learners to ACP while building their confidence in facilitating difficult conversations with patients. At the beginning of the module, we provide background on ACP including the challenges and benefits associated with the process. We showcase an elderly couple discussing how important it is to have advance directives in place. The second portion of the module reviews the common forms that are used to document advance directives and two patient case scenarios where the students can interact and reflect on the acquired content.

Educational objectives: 
  • Recognize the relevance in conducting and documenting advance directive discussions with patients.
  • List commonly used advance directives documents.
  • Develop the skills necessary to engage patients in a discussion about advance directives through the use of realistic patient case scenarios.
     
Date posted: 
Wed, 07/19/2017
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Sun, 07/19/2020
Product Viewing Instructions: 
Interactive self learning module
Contact Person/Corresponding Author:



Suggested Citation:
Advance Directives. POGOe - Portal of Geriatrics Online Education; 2017 Available from: https://pogoe.org/taxonomy/term/4830

Hacking Geriatrics: The World 2 Challenge

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

The World 2 Challenge is an innovative quality improvement competition designed by our Reynolds Next Steps team, based on the concept of a healthcare hackathon.  We partnered with institutional leadership in our health system, graduate medical education leadership, nursing, physical therapy, pharmacy, and other interprofessional representatives to design a platform to promote friendly competition led by specialty faculty, fellows, and residents to improve the quality of care for older adults. In the process, they learn key principles of geriatrics and how to apply them at a broader level across the institution. Our first competition in April 2016 focused on improving communication at transitions of care for older patients.  At a retreat, 9 QI project "pitches" were delivered to a broad interprofessional audience, 5 were chosen by a voting process and developed their ideas further through interprofessional team collaboration. Ultimately, 2 project ideas were selected to go forward, and the ultimate winner of the QI competition will be the project with the most successful implementation and the broadest impact for the care of older patients institution-wide. This has been an energizing initial effort, and we look forward to its continuing for years to come because of several unique aspects that promote its success. The most important are the interprofessional focus, teamwork, contextual learning, and alignment with institutional priorities to make actual change in the way that patients are cared for at our institution.  We provide a timeline that illustrates the key inputs and steps to promote such a QI competition to enhance geriatric education and care.  We also provide the event agenda, pitch template, judging template, list of pitch topics, and follow-up inhouse publicity from our institution to give our geriatrics colleagues at other institutions sample materials which could be adapted to their specific needs.

Educational objectives: 
  1. To demonstrate how geriatrics can lead and facilitate improvements in care across the broader institution through interprofessional focus, teamwork, contextual learning, and alignment with institutional priorities, grounded in geriatrics principles.
Date posted: 
Mon, 10/17/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/17/2016
Contact Person/Corresponding Author:



Suggested Citation:
Hacking Geriatrics: The World 2 Challenge. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4830

The Hospitalized Older Adult

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

Older adults are exposed to multiple hazards during hospitalization resulting in multiple complications that limit their return to their functional and cognitive baseline. It is critical that healthcare providers are trained on best practices in the care of hospitalized older adults. This product is a monthlong module for M4 students during their Sub I rotation, that focuses on educating them on the hazards of hospitalization, best practices in the care of hospitalized older adults, issues that occur during transitions of care and best practices to ensure optimal transitions across care settings. The module starts with an initial lecture on hazards of hospitalization and best practices in the care of older adults. This is followed by assignments in which students are assigned older aduts to care for. Using a checklist, they evaluate the care that these patients have received and also implement best practices in the care of their patient. They also participate in an interdisciplinary team meeting that focuses on these aspects of care.  This is followed by another assignment in which they are involved in deciding on the most appropriate discharge care setting their patient. They subsequently place a post discharge call to their patient to identify any issues thay may have encountered post discharge and assist them in resolving some of these issues. Through the month, students share their experiences on blackboard, outlining hazards they identified in their patients,  challenges in implementing best practices, choice of discharge care setting and reasons for their choices along with care transitions issues identified in their patients. Additionally they are required to review educational materials and published articles posted on blackboard, focused on hazards of hospitalization, best practices in care, settings of care and transitions of care.  A final class is held with the students at the end of the month discussing the rotation and their experiences, with a focus on settings of care and best practices in transitions of care.

Educational objectives: 

At the end of this course, each participant will be able to:

1. Describe the hazards of hospitalization of older adults.

2. Evaluate the care and implement best practices in the management of a hospitalized older adult.

3. Enumerate the discharge options available in a particular case scenario.

4. Compare and contrast the problematic elements of care transition with those of an ideal care transition.

Date posted: 
Tue, 10/25/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 10/25/2016
Contact Person/Corresponding Author:



Suggested Citation:
The Hospitalized Older Adult. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4830

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/4830

Interdisciplinary Health Profession Module Videos

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

Care teams often don't know how to effectively and efficiently collaborate when addressing a patient’s health. Depending on a patient’s needs, team leadership can shift at any given moment from one person to another. Because of this constant jockeying and adaptation, educating learners about their own interprofessional relationships is becoming incredibly important. These videos and the corresponding text supplements provide a context for interprofessional team members to discover more about what it takes to become a member of another profession. This knowledge, combined with their own experiences and clinical practice, will assist in preparing learners for the next-generation of team-based healthcare.

Educational objectives: 

After watching these short 2-3 minute videos, interprofessional teams will be able to contextualize their own relationship within the group dynamic, understand the educational requirements that go into other disciplines, and formulate an effective team-based learning approach for future activities.

Date posted: 
Tue, 09/27/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 09/27/2016
Contact Person/Corresponding Author:



Suggested Citation:
Interdisciplinary Health Profession Module Videos. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/4830

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