Minimum Geriatric Competencies - Medical Students, Emergency Medicine Residents and IM-FM Residents | POGOe

Minimum Geriatric Competencies - Medical Students, Emergency Medicine Residents and IM-FM Residents

Product ID: 20480

Abstract:

“Competency-based education prepares trainees to perform tasks occurring within the context of practice. Teaching to competency differs from traditional instruction. It begins by stating the performance we expect of our graduates in the workplace and then designing the medical school curriculum to prepare our learners to achieve that performance through deliberate practice in applying the underlying knowledge, skills, and attitudes.” As the elderly population in America "booms," medical education must address the issue at hand and modify their curriculum and teaching practices to give credence to geriatric principles within medical care. It is imperative for many reasons (socially, financially, etc.) that we ensure competency in the care of older adults for every physician.

To help achieve this lofty goal, the Minimum Geriatric Competencies have been developed for Medical Students and are being developed for multiple residency disciplines. The files within this product showcase the Medical Student Minimum Geriatric Competencies (published in Academic Medicine, May 2009), Internal Medicine – Family Medicine Resident Minimum Geriatric Competencies (published in Journal of Graduate Medical Education, Sept 2010), and Emergency Medicine Resident Minimum Geriatric Competencies (published in Academic Emergency Medicine, 2010).

Documents associated with this product:

You must log in to view documents and videos.

Additional information/Special implementation requirements or guidelines:

The "Side-by-Side" document shows the progression from Medical Student Competencies into resident education.

The documents included with this product are:

Emergency Medicine Resident Competencies
Medical Student Competencies
IM-FM Resident Competencies
Side-by-Side Competencies Comparison

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

Leipzig R M, Granville L, Simpson D, Brownell Anderson M, Sauvigne K, and Soriano R P. (2009). Keeping granny safe on July 1: Consensus on minimum geriatric competencies for graduating medical students. Academic Medicine, 84, 604–610. Also available at http://journals.lww.com/academicmedicine/Fulltext/2009/05000/Keeping_Granny_Safe_on_July_1__A_Consensus_on.17.aspx

Hogan T M, Losman E D, Carpenter C R, Sauvigne K, Irmiter C, Emanuel L, and Leipzig R M. (2010). Development of geriatric competencies for emergency medicine residents using an expert consensus process. Academic Emergency Medicine, 17(3), 316-324. Also available at http://dx.doi.org/10.1111/j.1553-2712.2010.00684.x

Williams B, et al. (2010). Medicine in the 21st century: Recommended essential geriatrics competencies for Internal Medicine and Family Medicine residents. Journal of Graduate Medical Education, 2(3), 373-383. Also available at http://www.jgme.org/doi/abs/10.4300/JGME-D-10-00065.1

Date posted:

Thu, 01/01/2009

Date last updated:

Wed, 06/08/2011

CME credits available:

Has this product been peer reviewed?:

Geriatrics topic areas:

Aging Principles

Geriatric Psychiatry

Approach to the Geriatric Patient

Geriatric Syndromes

Chronic Illness

Models of Care

Communication

Geriatric Assessment

Transitions of Care

Geriatric Conditions, Diseases and Disorders

Discipline/specialty:

Emergency Medicine

Family Medicine

Internal Medicine

ACGME competency checklist:

Interpersonal and Communication Skills

Practice-Based Learning and Improvement

Medical Knowledge

Professionalism

Patient Care

Systems-Based Practice

Learning resource types:

Quick Reference/Pocket Card

Intended learner audience:

Medical Student Pre-Clerkship

Medical Student Clinical

Resident

Minimum geriatric competencies:

1. Explain impact of age-related changes on drug selection and dose based on knowledge of age-related changes in renal and hepatic function, body composition, and Central Nervous System sensitivity.

2. Identify medications, including anticholinergic, psychoactive, anticoagulant, analgesic, hypoglycemic, and cardiovascular drugs that should be avoided or used with caution in older adults and explain the potential problems associated with each.

3. Document a patient’s complete medication list, including prescribed, herbal and over-the-counter medications, and for each medication provide the dose, frequency, indication, benefit, side effects, and an assessment of adherence.

4. Recognize, compare and contrast among the clinical presentations of delirium, dementia, and depression.

5. Formulate a differential diagnosis and implement initial evaluation in a patient who exhibits delirium, dementia, or depression.

6. In an older patient with delirium, urgently initiate a diagnostic work-up to determine the root cause (etiology).

7. Perform and interpret a cognitive assessment in older patients for whom there are concerns regarding memory or function.

8. Develop an evaluation and non-pharmacologic management plan for agitated demented or delirious patients.

9. Assess and describe baseline and current functional abilities in an older patient by collecting historical data from multiple sources, making sure to include instrumental activities of daily living, activities of daily living, and capacity/competence assessment, and performing a confirmatory hearing and vision examination.

10. Develop a preliminary management plan for patients presenting with functional deficits, including adaptive interventions and involvement of interdisciplinary team members from appropriate disciplines, such as social work, nursing, rehabilitation, nutrition, and pharmacy.

11. Identify and assess safety risks in the home environment, and make recommendations to mitigate these.

12. Ask all patients > 65 y.o., or their caregivers, about falls in the last year, watch the patient rise from a chair and walk (or transfer), then record and interpret the findings.

13. In a patient who has fallen, conduct a gait assessment and construct a differential diagnosis and evaluation plan that addresses the multiple etiologies identified by history, physical examination and functional assessment.

14. Define and differentiate among types of code status, health care proxies, and advance directives in the state where one is training.

15. Accurately identify clinical situations where life expectancy, functional status, patient preference or goals of care should override standard recommendations for screening tests in older adults, noting that risk/benefit, not age alone is not a basis for withholding standard screening or treatment.

16. Accurately identify clinical situations where life expectancy, functional status, patient preference or goals of care should override standard recommendations for treatment in older adults.

17. For each organ system identify at least 3 changes of normal aging (e.g., normal labs for older adults) and their impact on the patient, including their contribution to homeostenosis (the age-related narrowing of homeostatic reserve mechanisms). Know when clinical signs and presentations are normal aging and not disease.

18. Generate a differential diagnosis based on recognition of the unique presentations of common conditions in older adults, including acute coronary syndrome, dehydration, urinary tract infection, acute abdomen, and pneumonia.

19. Assess and provide initial management of pain and key non-pain symptoms based on patient’s goals of care.

20. Identify the psychological, social, and spiritual needs of patients with advanced illness and their family members, and link these identified needs with the appropriate interdisciplinary team members.

21. Present palliative care (including hospice) as a positive, active treatment option for a patient with advanced disease.

22. Identify potential hazards of hospitalization for all older adult patients (including immobility, delirium, medication side effects, malnutrition, pressure ulcers, procedures, peri and post operative periods, transient urinary incontinence, and hospital acquired infections) and identify potential prevention strategies.

23. Explain the risks, indications, alternatives, and contraindications for indwelling (Foley) catheter use in older adult patients.

24. Explain the risks, indications, alternatives, and contraindications for physical and pharmacological restraint use.

25. Communicate the key components of a safe discharge plan (e.g., accurate medication list, plan for follow-up), including comparing/contrasting potential sites for discharge.

26. Conduct a surveillance examination of areas of the skin at high risk for pressure ulcers and describe existing ulcers.

Authors:

Multiple Authors

Creative Commons License:

NLM Citation:

Multiple Authors, . Minimum Geriatric Competencies - Medical Students, Emergency Medicine Residents and IM-FM Residents. POGOe - Portal of Geriatric Online Education; 2009 Available from: http://www.pogoe.org/productid/20480

APA Citation:

Multiple Authors, . (2009). Minimum Geriatric Competencies - Medical Students, Emergency Medicine Residents and IM-FM Residents. POGOe - Portal of Geriatric Online Education. Retrieved May 17, 2012 from http://www.pogoe.org/productid/20480

7929 reads

Home

Minimum Geriatric Competencies - Medical Students, Emergency Medicine Residents and IM-FM Residents

Secondary links