The Portal of Geriatrics Online Education

16 HCP: When to override recommendations for 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.

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/119

Advance Care Planning

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
2
Abstract: 

The Advance Care Planning Module uses a team approach to reduce errors and improve the quality of health care for older adults. This interdisciplinary formative assessment tool for Elder Safety can be utilized by fourth-year medical students, residents in training and practicing physicians. Learners will take a pre-test, review learning objectives, exemplar and video demonstrations, have access to reference materials and links to websites for Advance Care Planning. Content experts share their professional experience on the sensitive topic of addressing patient goals of care in preparation for death and dying.  Information on Advance Directives, legal considerations, clinician resources, cultural and gender differences, patient competency and capacity concerns are presented in a straight forward way to aid the medical professional in their ability to facilitate end-of-life care.  

Educational objectives: 

1. Healthcare professionals working with the 65 years and older population will develop knowledge and skills needed to formulate a health policy and educate patients about an Advance Care Plan.

2. Healthcare professionals working with the 65 year and older population will gain an advanced understanding of the options available to patients when planning end-of-life care.

Additional information/Special implementation requirements or guidelines: 

To access the material, go to the Learning Center at ilearn.nbome.org to access the Elder Safety Modules:

  • Select your learning activity (Advance Care Plan) and add it to your cart.
  • In the cart, click Proceed to Checkout. This will prompt you to either create a new account or login to your existing one.
  • Create your free account by entering the required information.
  • Once completed you will be directed back to the catalog to complete your course registration.
  • There is No Charge for viewing the Advance Care Plan Module.
Publications from, presentations from, and/or citations to this product: 

Presentation:

Marquez-Hall, S., Horber, D. (2017) Web-based formative assessment: An innovative way to assess and improve physician/patient care using an interprofessional team approach. Joint presentation with the National Board of Osteopathic Medical Examiners at the American Association of Osteopathic Medicine and Association of Osteopathic Directors and Medical Educators Annual Conference, Baltimore, MD

Date posted: 
Fri, 01/12/2018
Product Viewing Instructions: 
See Additional information/Special implementation requirements or guidelines under the Additional Details Section.
Contact Person/Corresponding Author:



Suggested Citation:
Advance Care Planning. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/119

Establishing goals of care- Standardized caregiver interview

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

This Observed Standardized Caregiver (SCG) interview is designed to be used with geriatric fellows. The goal is to assess the fellow's competence in establishing goals of care with patient’s families in the ambulatory setting. 

Educational objectives: 

The case is designed to evaluate geriatric fellow’s ability to elicit the following core competencies in geriatrics assessment during a Standardized Patient Interview:
1. Establish that the caregiver is the appropriate health care designee
2. Introduce the need to have a discussion about overall goals of care
3. Establish what would be an acceptable quality of life for the patient
4. Assist the family with completing a written health care directive ( for this exercise a Practitioner Order of Life Sustaining Treatment  form - POLST )
 

Additional information/Special implementation requirements or guidelines: 


This exercise can be integrated into an ongoing geriatrics curriculum for geriatric fellows.
• An overview of the educational goals and patient characteristics is discussed with the fellow(s) prior to the session (15 minutes)
• Training of SCG (30 minutes)
• The fellow(s) are videotaped performing a caregiver interview (30 minutes)
• The fellow(s)complete a self-assessment tool (3 minutes)
• The SCG completes a fellow(s) assessment tool (3 minutes)
• The videotape is reviewed by the faculty with a standardized assessment tool (20 minutes)
• A group session to provide formative feedback is conducted with geriatrics faculty
 

Date posted: 
Thu, 11/16/2017
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 11/01/2017
Contact Person/Corresponding Author:



Suggested Citation:
Establishing goals of care- Standardized caregiver interview. POGOe - Portal of Geriatrics Online Education; 2017 Available from: https://pogoe.org/taxonomy/term/119

Goals of Care/Medication Management Clinical Evaluation Exercise (Mini-CEX)

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

This goals of care and/or medication management Clinical Evaluation Exercise (Mini-CEX) is designed to use with a learner during a patient encounter. The teacher observes the learner with a patient discussing goals of care and/or medication managment and completes the form. The teacher then reviews the form with the learner and provides feedback of what skills were observed, partially observed, not observed, not applicable and comments about the encounter.

Educational objectives: 

Learners who are administered this Goals of Care/Medication Management Mini-CEX will:
1)be observed discussing goals of care and medication management with their patients and families.
2)receive feedback about their communication skills with patients and families.
3)obtain record of their goals of care and/or medication managment assessment skills using a Mini-CEX.

Date posted: 
Mon, 01/23/2017
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 01/23/2017
Contact Person/Corresponding Author:



Suggested Citation:
Goals of Care/Medication Management Clinical Evaluation Exercise (Mini-CEX). POGOe - Portal of Geriatrics Online Education; 2017 Available from: https://pogoe.org/taxonomy/term/119

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/119

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/119

VirginiaGeriatrics.Org

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Estimated time to complete: 
2
Abstract: 

The VirginiaGeriatrics.Org website consists of 6 primary resources and a secondary list of resources for further research. These primary resources include a video archive of the geriatric grand round lecture series, interactive pre-clinical basic science geriatric case studies for medical students, more advanced geriatric case studies for clinical residents, a quick consult guide for geriatric consults, an "ask the expert" discussion resource, and various educational materials related to the Virginia Geriatrics Society Conference. Additionally, spread through the website are external educational resources to complement the core material. Finally, there are some resources for patients and families that may be interested in contacting clinics and/or geriatricians.

Educational objectives: 

Listed through 6 primary education sections (Grand Rounds, Med Student Materials, Resident Materials, Quick Consults, Ask the Expert, etc)

Date posted: 
Thu, 09/22/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 09/22/2016
Contact Person/Corresponding Author:



Suggested Citation:
VirginiaGeriatrics.Org. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/119

Geriatric Interprofessional Teaching Clinic (GITC)

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Estimated time to complete: 
1
Abstract: 
•Collaborative interprofessional practice and care are essential to the complex healthcare needs of a rapidly growing older adult population.
•Interprofessional collaboration (IPC) occurs when various health care practitioners, clients and/or caregivers work together to improve a client’s overall health.
•Teaching an IPC model continues to be a major gap in every health professionals’ education.
•To address this gap, the Geriatrics Interprofessional Teaching Clinic (GITC) at the University of Kansas Medical Center's Landon Center on Aging was created. It incorporates six professions: Students and faculty from  Physical Therapy, Medicine, Pharmacy, Social Welfare, Dietitics/Nutrition and Occupational Therapy.
•It is scheduled one half day a week with four patients scheduled on a "rolling" basis allowing for interprofessional teams of three to see patients in a staggered fashion. On average, each visit takes approximately 60-90 minutes.
•Logistically, students from 3 professions review the medical record together, discuss what they want to accomplish in the room, and how they will approach the patient encounter as a team. The students then see the patient and report back to the attending physician and other health professions faculty as a team. The assessment and plan for the patient is developed by the team.
•Team members are asked to define their roles by what the patient needs at that particular visit, starting with their own professional training and scope of practice, but then encouraged to allow themselves to participate in new ways. The interprofessional clinic faculty assist the learners by facilitating reflection on their clinical performance as individuals and as a team at the time of the clinic visit, incorporating their reflections into their next clinical encounter and through debriefing.
•To quantify interprofessional collaboration, evaluation tools are being piloted to assess for team dynamics, and surveys are sent out to each individual learner to assess for behavior and attitude changes. These are both done at the "beginning" and "end" of their GITC experience.
 
 
Educational objectives: 
•Create an interprofessional (IP) clinic involving multiple learners, emphasizing the national interprofessional competencies (values/ethics, roles/responsibilities, interprofessional communication and teams/teamwork).
•Train students in IP teams to evaluate their communication with the patient and with other team members following a patient encounter in GITC using a validated rubric. 
•Monitor changes in IP team behavior through individual learner evaluations.
Date posted: 
Mon, 10/10/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/10/2016
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Interprofessional Teaching Clinic (GITC). POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/119

The Geriatric Experience Multimedia Menu for Residents and Medical Students on Geriatrics Rotation

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
3
Abstract: 

This multimedia menu was created to add variety to a geriatrics rotation for third- and fourth-year medical students and family medicine residents while exposing learners to different aspects of the social and ethical issues integral to the care for older adults. The menu includes multiple books, movies, online videos and podcasts that learners may choose from during an assigned half-day of the rotation. Afterward, learners complete a written, personal reflection that is submitted to the course director. Reflective ability is an important skill for practicing physicians that is rarely taught in a formal curriculum. This simple menu broadens the breadth of the geriatric rotation and creates an opportunity to practice reflection. 

Educational objectives: 

After completing this experience, learners will:

1. Critically reflect on clinical experiences through the lens of multimedia portrayals of issues related to older adults. 

2. Discuss ethical issues related to the care of older adults. 

3. Describe new insights from a variety of media types and apply these insights to future practice. 

Date posted: 
Wed, 10/05/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 10/05/2016
Contact Person/Corresponding Author:



Suggested Citation:
The Geriatric Experience Multimedia Menu for Residents and Medical Students on Geriatrics Rotation. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/119

Building Caregiver Partnerships Through Interprofessional Education

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

Family caregivers are on the frontlines managing complicated chronic illnesses, assisting with day-to-day functioning, and providing direct care to manage symptoms and improve the quality of life of their loved ones. Yet, health professions students, medical/surgical residents, and care providers receive little, if any, training on the vital role that caregivers play on the healthcare team and how, effective partnering optimizes patient care throughout the illness trajectory and at end-of life.

The goal of Building Caregiver Partnerships through Innovative Interprofessional Education is to create effective partnerships between healthcare providers and family caregivers to reduce the burdens, ease suffering, and enhance the meaning of the caregiving experience for the patient, family and health care providers.  The project centers on a 20-minute film, No Roadmap: Caregiver Journeys, which features the compelling stories of four caregiving families. The film and companion discussion guides as well as resources for case-based learning and structured clinical encounters are freely accessible on the website. http://www.neomed.edu/medicine/palliativecare/building-caregiver-partnerships/

The website is designed so that faculty can easily select the materials that best fit their learners’ needs and the time constraints within their programs. The curricula is appropriate for medical, pharmacy, nursing, and other health professions educational programs at both undergraduate and graduate levels. Additionally, tools have been developed for interdisciplinary team-based forums and health provider training.  For medical/surgical residency programs, relevant ACGME milestones are identified. 

Educational objectives: 

The objectives of the educational tools are to prepare learners to:
• Describe home-based eldercare as a shared experience and the importance of building a relationship with family caregivers and care recipients based on trust, compassion and open communication; 
• Describe the vital role of family caregivers as important, but under recognized, members of the health care team;
• Discuss the meaning and challenges of family caregiving;
• Engage caregivers in meaningful discussions to identify the needs, values and goals of their caregiving family;
• Identify resources to address caregiver concerns and provide ongoing support; and
• Provide holistic team-based care to family caregivers that improves the quality of life for the care recipient and the caregivers. 

 

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

~~Date/Location Meeting/Forum Presentation Title Presenter(s)
Jan 28-31, 2016, Phoenix, Arizona; Society of Teachers of Family Medicine; 45 min presentation;  Exploring Caregiver Journeys: A Curricular Tool for Family Medicine Clerks;  D. Sperling; J.T. Thomas

March 10-13, 2016; Chicago, Ill;  American Academy of Hospice and Palliative Medicine;  60-min workshop; Using Film to Foster Empathetic Partnerships between Care Providers and Family Caregivers;  J. Drost; E. Scott; M. Scott; D. Damore; S. Radwany

May 19-21, 2016; Long Beach, Ca; American Geriatrics Society; Poster; Building Caregiver Partnerships Through Innovative Health Professions Education; E. Scott, S. Radwany, D. Drost, K. Baughman, B. Palmisano, M. Sanders

May 19-21, 2016; Long Beach, Ca; American Geriatrics Society; Educational Product Session; Building Caregiver Partnership Through Innovative Health Professions Education; J. Drost; B. Palmisano

May 25, 2016; NEOMED Department of Family and Community Medicine Resident Scholarship Day; 15 min presentation; Exploring Caregiver Journeys: A Curricular Tool for Family Medicine Residents; D. Sperling; J.T. Thomas
 

Date posted: 
Mon, 12/12/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 05/19/2017
Contact Person/Corresponding Author:



Suggested Citation:
Building Caregiver Partnerships Through Interprofessional Education. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/119

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