Longitudinal Encounters with Alzheimers Disease Standardized Patients (LEADS)

Longitudinal Encounters with Alzheimers Disease Standardized Patients (LEADS)
University of Cincinnati College of Medicine
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Product ID: 20246

Abstract: 

**** This is an assessment tool. The associated documents are available to faculty members only. To request materials, contact the POGOe Managing Editor at Editor@pogoe.org. **** UC LEADS CURRICULUM In 2004, faculty at the University of Cincinnati introduced a new geriatric medicine curriculum for residents from training programs in internal medicine, family practice, psychiatry, gynecology, and physical medicine and rehabilitation. The curriculum’s centerpiece is a three-part longitudinal unfolding Alzheimer’s Disease (AD) standardized patient case that introduces residents to “Tess Clermont”, a 78 year old woman, and her daughter Linda as the pair experiences her transition over 10 years through progressive stages of AD. The curriculum focuses on teaching and assessing geriatric medicine competencies among primary care and subspecialty residents. Teaching methods included lectures, videotaped longitudinal SP stations, written exercises, standardized patient feedback sessions, faculty-facilitated case discussion and video review exercises. Geriatrics, primary care, and subspecialty faculty were recruited and trained to lead the sessions. Standardized patients (SPs) were trained to evaluate learner performance using written checklists and rating forms, provide learners with constructive verbal feedback, and facilitate learners’ self-evaluations. The SP case was developed so as to portray progressive memory problems and functional impairments. The patient’s daughter accompanies her at each visit and portrays her experience as the eventual caregiver. The case is layered so that multiple topics in geriatrics are available for discussion. An accompanying mock patient chart was developed. Who? This training experience was developed especially for residents in internal medicine, family practice, psychiatry, gynecology, and physical medicine/rehabilitation. What? Through the use of standardized patients (SP), residents meet Tess Clermont, a 78 year old woman with memory problems and her daughter, Linda Stevens. During their first encounter with Mrs. Clermont they review her prior assessments and determine her primary diagnosis, explain the cause of her cognitive and functional impairments and make treatment recommendations. During 2 subsequent encounters they assist Mrs. Clermont and her daughter understand and cope with her progressive illness. Residents' standardized patient stations are videotaped for educational review. When? Three consecutive mornings during your assigned month, from 1-3:30pm. You will gain the most from this experience if you attend all three sessions! Where? Center for Competency Development and Assessment (CCDA) Why? Chronic illness is common among older adults. This new training experience will allow you to manage a progressive disease over a 10-year course of illness. You will learn strategies that will help you assist patients and families. The use of SP will provide you

Documents associated with this product:

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Educational objectives: 

See documents section for ACGME Core Competencies Session One Learning Goals and Objectives Goal: Develop resident physician’s clinical competency in the initial management of patients with cognitive impairment to improve well-being for these patients and their caregivers. Objectives: After completing session one, participants should be able to: •Gather essential and accurate historical information from patients and collateral historians to assess cognitive impairment and relevant psychological, functional, and social issues. •Clearly explain the terms age-related memory loss, dementia, and Alzheimer’s disease to a layperson. •Differentiate between vascular dementia and Alzheimer’s disease. •Explain essential information about the treatment of Alzheimer’s disease based on most recent clinical data. •Assess safety issues and make appropriate recommendations regarding driving safety and ability to live alone. Session Two Learning Goals and Objectives Goal: Prepare resident physician to counsel caregivers and facilitate decision-making regarding the appropriate level of care for community-dwelling demented patients. Objectives: After completing session two, participants should be able to: •Identify evidence of progressive functional decline. •Identify and assess caregiver stress in family members or other persons caring for an individual with dementia. •Assess and treat urinary incontinence in the context of a dementia. •Assess and treat restlessness and agitation in the context of dementia. •Discuss appropriate interventions to reduce caregiver stress arising in the home setting •Counsel caregivers of dementia patients to facilitate selection of an appropriate level of care for these patients Session Three Learning Goals and Objectives Goal: To develop resident’s competency to coordinate care for elderly patients with advanced chronic fatal illnesses, including establishment of an effective advance care plan, and facilitation of patients’ access to hospice services. Objectives: After completing session three, participants should be able to: •Communicate effectively with a patient’s family concerning that individual’s prognosis in the setting of a chronic fatal illness. •Assess and treat weight loss, swallowing difficulty, poor oral intake in the context of advanced dementia. •Assess patient preferences and values concerning longevity, quality of life, and medical care near the end of life. •Discuss and devise an advance care plan with a surrogate decision maker for a patient who lacks decision-making capacity. •Document an advance care and conservative treatment plan that addresses care goals and unwanted medical interventions •Explain hospice care to a layperson.

Additional information/Special implementation requirements or guidelines: 

To implement this program fully requires access to the equivalent of a clinical skills lab and standardized patient program. In preparation for program implementation, we provided twenty experienced standardized patients with 12 hours of formal on-site training. The standardized patients (SPs) were instructed about realistic dementia portrayal in training that involved review of documentary footage of real patients. The SPs were also trained in the use of open-ended questions to elicit learners’ formative self-evaluations of their performance during the SP encounters. The SP training also provided guidelines for disclosure of key case history information and assignment of credit on the SP checklists. The SPs also received a case script that specified the relevant clinical history (available on request) as well as structured questions and responses to interview questions or counseling that were constructed based on what a highly competent physician would be expected to do during each encounter. Prior to implementing the curriculum with residents, geriatrics, primary care, and subspecialty faculty instructors interviewed ten SP pairs in a videotaped pilot-test conducted in the Clinical Skills Lab. The pilot-test helped achieve the goals of providing first-hand experience to faculty with the curriculum they would be teaching and feedback to assist SPs learning new roles. A comprehensive instructor’s manual and a faculty training program were developed to insure a consistent instructional standard (included in documents). As part of faculty training, subspecialist and generalist faculty co-taught their first curriculum session paired with an experienced member of the geriatric medicine faculty. Instructors received written preparatory materials including the instructor’s manual, presentation slides, didactic handouts, and a summary of each session’s instructional agenda.

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

Curriculum was presented as a poster/abstract at the 2005 American Geriatrics Society Presidential Poster Session.

Date posted: 
Tue, 09/22/2009
Date last updated: 
Tue, 09/22/2009
CME credits available: 
No
Has this product been peer reviewed?: 
No
Intended learner audience: 
Authors: 
Timothy Lewis
E. Gordon Margolin
Irene Moore
Gregg Warshaw
Creative Commons License: 
CC BY-NC-SA
NLM Citation:
Lewis, T, Margolin, E, Moore, I and Warshaw, G. Longitudinal Encounters with Alzheimers Disease Standardized Patients (LEADS). POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/20246
APA Citation:
Lewis, T, Margolin, E, Moore, I and Warshaw, G. (2009). Longitudinal Encounters with Alzheimers Disease Standardized Patients (LEADS). POGOe - Portal of Geriatric Online Education. Retrieved February 10, 2012 from http://www.pogoe.org/productid/20246