Rotation: Geriatrics
Site:
- Amarillo VAMC
Instructors:
- Dennis Zoller, M.D., Daksha Khandheria, M.D.
Days per week (night call):
- 5 days a week (One upper level ICU night call/month possible)
Course Description:
- further details will be given via Dr. Zoller's Internal Medicine Geriatrics Curriculum Guidelines, a hard copy to be sent from the Residency Program Office prior to the beginning of the month's rotation.
Educational goals/competencies:
Patient Care:
Residents will learn to use the history and physical exam to generate a limited number of diagnostic possibilities. The list should include the likeliest choice and those that, if missed, pose the greatest peril to the patient's life and health. Resident will then develop an efficient diagnostic strategy using the principles of epidemiology, risk/benefit analysis, and sensitivities/specificities of the selected test. Residents will choose therapy that is logical and appropriate, will pay attention to the risk and cost of the chosen therapy, and will be aware of drug-drug interactions and pharmacologic principles.
Medical Knowledge:
Residents will develop a working knowledge of the differential diagnosis of those presenting complaints which are specific and peculiar to geriatric patients. Residents will evaluate and treat disorders and diseases specific for geriatric patients.
Residents will learn symptom management, terminal care, how to care for the dying and their families, (including hospice care).
Interpersonal/Communication Skills:
Since history-taking is the physician's most important tool, residents will spend sufficient time with the patient to obtain a complete and coherent history. Resident will be aware of nonverbal cues (i.e. pain behavior), and in geriatrics the input of other caregivers (i.e. family members, nursing home staff), is invaluable. Residents will review old records and medication history on each patient.
The VMAC electronic medical record will be utilized. When nedded, written records will be complete and tidy. Residents will learn skills in reference to patients with dementia including those with aggressive behavior. Interaction with family members will be encouraged.
Professionalism:
The foundation of professionalism is respect, and the resident is expected to treat the patient as if he/she were a member of the resident's own family. Residents will have opportunity to deal with patients who do not share the resident's ethnic groups, religious beliefs, sexual orientation, and attitudes toward drug use, alcohol use, sexuality, etc. Residents will treat these diverse patients with respect.
Residents will treat other members of the health care team with respect. All are encouraged to listen to and obtain input from nurses, therapists, technicians, etc. in the decision-making process.
Practice-based learning and improvement:No one knows everything all the time. Residents will develop habits of life-long learning on this rotation. Residents will recognize when they are "in over their heads" and need to obtain help from the faculty member or consultants. Residents on this rotation will learn to use current journals and on-line resources to obtain up-to-date information. This will be especially important for the upper level resident. Mistakes will be honestly acknowledged, never "covered up". Errors will be analyzed so that the resident can learn from his/her mistakes. Residents will be open to input from nurses, respiratory therapists, etc. about how the residents' care may be more effective and more humane.
Systems-based practice:
Many different systems are involved in the nursing home patient. Residents will know the implications of coverage by Medicare, Medicaid, HMOs, and "self-pay". Residents will understand the implications of DRGs, formularies, skilled nursing facilities, and home health care agencies. Residents will become familiar with the language of cost-effective medicine (cost-benefit analysis, quality adjusted life years, etc). Residents will interact on a frequent basis with hospice systems (two are currently available) to provide humane and cost-effective end-of-life care. Residents will learn how to make the best use of this network of various systems to the maximum benefit for the patient.
Text/References to be consulted:
Geriatrics Review Syllabus (most current edition) will be available for the resident. SNU residents will be encouraged to obtain current journal articles and a presentation on a geriatric topic will be given toward the end of month to the noon conference.
Method of Evaluation:
Evaluation by the faculty on each resident will be provided to the program director at the end of the rotation on the standard department evaluation form. Promptness, dedication, eagerness to learn, and interpersonal skills will play an important role in the evaluation process.