The Portal of Geriatrics Online Education

Intro to Clinical Medicine/Clinical Skills/Doctoring

Elder Care: A Resource for Interprofessional Providers: Communicating with People who have Hearing Loss

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

Communicating with People who have Hearing Loss is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings.

Educational objectives: 
After reading this issue of Elder Care, you should be able to…
  1. State the approximate percentage of older adults who have hearing impairment
  2. List the aspects of speech perception that are impaired in older adults with hearing impairment
  3. Explain how you can improve oral communication with older adults who have hearing impairment
Additional information/Special implementation requirements or guidelines: 

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as

  1. content is not changed,
  2. no one is charged a fee to use or read the publication,
  3. authors and their affiliated institutions are noted without change, and
  4. the reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatric Education Center."

Elder Care Provider Sheets can also be accessed at http://www.reynolds.med.arizona.edu/EduProducts/ElderCareProviderSheets.cfm.

Publications from, presentations from, and/or citations to this product: 
The Elder Care provider sheets are occasionally published in the Arizona Geriatrics Society Journal, which is published twice yearly.
Date posted: 
Mon, 11/12/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 10/16/2018
Contact Person/Corresponding Author:



Suggested Citation:
and . Elder Care: A Resource for Interprofessional Providers: Communicating with People who have Hearing Loss. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/208

KBIT (Delirium Module): Knowledge Based Inference Tool

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Abstract: 

Learners using the KBIT Delirium Module will pick from 12 differential diagnoses of delirium based on histories, physical exam findings, and laboratory studies given in each clinical case.  Feedback will then be given on which clinical findings are more commonly found in the differential diagnosis selected and which clinical findings are more commonly found in other causes of delirium. KBIT is an advanced, instructional sciences derived, artificial intelligence based approach to DDX training and assessment.  It was developed to aid undergraduate medical students in development and assessment of diagnostic competence. KBIT utilizes learning science principles and instructional methods to support the development of problem-specific DDX competencies.  

Educational objectives: 
  • Aid medical students in the active transformation of problem-specific declarative knowledge of delirium into procedural knowledge of delirium.
  • Aid medical students acquisition, comprehension and application of medical knowledge and differential diagnosis of delirium.
  • Provide medical school students with the development of diagnostic competency of delirium by providing exposure to multiple case portrayals of delirium which vary in difficulty from prototypical to atypical.
Additional information/Special implementation requirements or guidelines: 

The University of North Texas Health Science Center’s Reynolds Geriatric Education and Training in Texas (GET-IT) Program has partnered with Frank Pappa DO, PhD, and Michael Oglesby PhD developers of a web based differential diagnosis (DDX) tutor KBIT (Knowledge Based Inference Tool).  

The development of DDX competence is based on seven cognitive and instructional sciences based research findings:

  1. Diagnostic competence is “Problem Specific”
  2. Diagnostic competence is “Disease-Specific”
  3. Diagnostic competence is a function of “Case Typicality.”
  4. Differential diagnosis involves “Pattern Recognition”
  5. The development of diagnostic competence requires “Deliberate Practice.”
  6. The development of diagnostic competence requires “Immediate, Individually-Tailored Formative Feedback.”
  7. Evidence of the attainment of diagnostic competence requires the establishment of “Performance Criteria” defining a minimal level of acceptable performance.

KBIT creates multiple practice cases that:

  • Are problem and disease specific.
  • Support the development and refinement of pattern matching and pattern discrimination capabilities.
  • Expose students to multiple case portrayals which vary in difficulty from prototypical to atypical.
  • Provide students with pattern recognition oriented feedback.
  • And allows the institution to set the performance criteria to help assess competence.

KBIT is used with UNTHSC Texas College of Osteopathic Medicine second year medical students to aid in DDX training in support of the medical school’s curriculum.  Second year medical students also participate in a Capstone course to aid in the student’s acquisition, comprehension and application of medical knowledge skills, including differential diagnosis, scientific explanation of findings, and selection of treatments for common and important presentations of Geriatric problems.  The GET-IT Program and Drs. Papa and Oglebsy are working together to develop several Geriatrics differential diagnosis tutorial KBIT modules.  Drs. Pappa, Oglesby, and Jennifer Heffernan MD of the UNTHSC GET-IT Program have developed the first of these geriatrics diagnosis tutorials, the Delirium KBIT.

The Delirium differential diagnosis tutorial is accessible on the ACDET web site at www.acdet.com under the demo tab, and is available for use free of charge.  The Delirium KBIT module is the first to be completed and will be followed by Dementia and Incontinence modules which will be available for use upon completion. Drs. Pappa and Oglesby market their other differential diagnosis modules which are available for charge through their company ACDET. 

Date posted: 
Wed, 08/17/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 08/17/2011
Contact Person/Corresponding Author:



Suggested Citation:
, and . KBIT (Delirium Module): Knowledge Based Inference Tool. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/208

Medical Student Introduction to Acute Care for Elders (ACE) Interdisciplinary Consult Team

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

3rd year medical student curriculum for ACE rotation

Educational objectives: 
  1. To increase exposure of 3rd year medical students (MS3) to inpatient acute care of the elderly during their inpatient ward medicine clerkship, using the ACE unit as the platform
  2. To enable the MS3 on his/her clerkship to understand and integrate the recommendations of the ACE team on his/her patient receiving the consult
  3. To provide MS3 students an opportunity to be an active participant in the ACE interdisciplinary team rounds
  4. To increase the MS3’s depth of understanding and appreciation of the broad variety of functional, physical, and psychiatric problems an elder faces when admitted to the hospital with an acute medical issue
Additional information/Special implementation requirements or guidelines: 

The protocol for 3rd year Medical Students invites them to attend the Acute Care for Elders Interdisciplinary Consult Team when a patient of theirs is receiving an ACE consult. It provides them a unique experience to participate in an interdisciplinary team discussion focusing around the functional needs of a frail hospitalized elder. Also included is a letter that was distributed to all of the teaching faculty for the inpatient medicine rotation at Wishard Hospital. This letter was sent not only as a notification, but also as a hope of obtaining their support and buy-in of the process. This can be used as a template for any other institutions that might want to develop a similar process.

Date posted: 
Fri, 05/25/2007
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 03/06/2018
Contact Person/Corresponding Author:



Suggested Citation:
Medical Student Introduction to Acute Care for Elders (ACE) Interdisciplinary Consult Team. POGOe - Portal of Geriatrics Online Education; 2007 Available from: https://pogoe.org/taxonomy/term/208

SAGE (Seniors Assisting in Geriatric Education)

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

The SAGE (Senior Mentoring Program) is a competency-based learning activity that offers the unique opportunity for community seniors to receive in home visits with medical school & physician assistant students from UNT Health Science Center. The program pairs two 1st or 2nd year medical school and physician assistant students with a senior client that either receives home delivered meals through the Meals on Wheels Program Inc. of Tarrant County or a senior in the community who has volunteered to participate in the program.

Educational objectives: 

Strengthen the healthcare professional students’ medical education through increased development of competency in attitudes, knowledge, and skills in their care of older adults. In this experience with their senior client medical students will:

  1. Obtain a medical history and mental status exam
  2. Practice history and physical examination skills
  3. Perform evaluations, assessments, advance care planning
  4. Complete other assignments assigned in medical school

Allow an opportunity for seniors to assist in students’ development of competency in attitudes, knowledge, and skills in their care of older adults. To ultimately impact the way future doctors care for older adults. By participation in the SAGE program, senior clients will assist in the geriatric education of healthcare professional students by participating in:

  1. Providing evaluative feedback on their experience with their assigned students
  2. Participating in research related to geriatric education; care-giver attitudes, knowledge, and skills; attitudes about medical professionals; demographic and biopsychosocial factors and life-transition issues related to aging
  3. Participate in scheduled SAGE visits and assignments with their assigned medical students
  4. Provide demographic, biopsychosocial, and life-transition information through written questionnaires, interviews, surveys, and or evaluations
Additional information/Special implementation requirements or guidelines: 

The SAGE program was started in the fall of 2009 with the TCOM class of 2013, and is currently in its third year involving 520 medical school & physician assistant students and over 280 community seniors. It is a mandatory part of the Clinical Medicine Course for all year 1 and 2 medical students and is part of the Clinical Medicine Course grade. The program is also mandatory for the physician assistant student program within the School of Health Professions. The University of South Carolina School of Medicine/ Palmetto Health Senior Mentor Program, led by Paul Eleazer MD was a program partner in the original curriculum design of the SAGE Program assignments. The SAGE Program is an incredibly important component of a healthcare student’s education. All healthcare students and Fort Worth Metroplex senior adults benefit from this innovative senior mentoring program.

Students are paired and assigned to a community senior client. Students make eight home visits to their senior client and complete eight assignments over two years. Assignments allow students a real life opportunity to practice their clinical medicine skills and address recommended minimum geriatric competencies. This dynamic real world experience exposes students to a diverse population of older adults, helping prepare them to care for the growing and diverse geriatric population. This relationship allows students to know the senior as a person who is more than just medical conditions or diseases, and to observe how their quality of life and coping mechanisms are impacted.

SAGE senior clients receive free blood pressure checks, a limited physical exam, a nutritional assessment, a home safety assessment, discussions on available community resources and advanced care planning, as well as benefit from the students’ companionship and have an opportunity to contribute to the students’ medical school training. Senior clients are given the opportunity to evaluate their student doctors to aid in feedback on the attitudes and skills demonstrated by the students during the SAGE visits. Students submit their SAGE visit assignments electronically through the UNTHSC Blackboard Learning System to an assigned faculty mentor. SAGE faculty mentors are assigned a SAGE POD, which consists of 10-14 senior clients and approximately 20-28 students. Mentors grade the assignments and provide the students with feedback.

Student policies and procedures have been developed to support student and senior client safety. Each semester students are oriented to SAGE for that semester by the Geriatric Education and Training in Texas (GET-IT) Program faculty and staff. Prior to making the first home visit all students participate in mandatory IRB training, and in a criminal background check. Campus Department of Public Safety officers speak to the students on safety measures in making their home visits. Student feedback is gained through student focus groups, larger student feedback sessions, program surveys, feedback to faculty mentors through the assignment submissions and senior client evaluations on their student doctors.

Date posted: 
Tue, 11/01/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 01/05/2012
Contact Person/Corresponding Author:



Suggested Citation:
, , and . SAGE (Seniors Assisting in Geriatric Education). POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/208

Carolina Opinions on Care of Older Adults (COCOA)

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

The Carolina Opinions on Care of Older Adults (COCOA) is an instrument that was developed to gather more detailed information regarding medical and health professional students' perceived attitudes and opinions on working with the elderly, and to assess the compatibility of a career choice in geriatrics.

Additional information/Special implementation requirements or guidelines: 

This instrument is usually used to assess the students in Year 1 and again in year 4.

Each COCOA item is scored on a 1-5 Likert-type agreement scale (see attached COCOA items with wording for 1-5 response choices).
 
Single item responses can be compared across survey respondents over time with multiple administrations using a pretest-posttest format. Comparisons across comparison or alternative treatment/intervention groups can be conducted on single items as well.
 
The COCOA items can be summed to produce a composite score for the entire instrument or for subscale combinations of items. However, if this procedure is taken, the following items must be reverse-scored to preserve common orientation of attitudes across items:
 
Items 1, 5, 7, 8, 9, 11, 12, 13, 18, 24, 25, 26, 27, 29, 30, 32, 33, 34, 36, 37, 39, 40, and 42 are reverse-scored (see attached table of COCOA items).
 
Potential subscales (for the reduced 24-item COCOA instrument) are as follows:
 

  1. Geriatrics as a Career (Items 2, 4, 10, 16, 21, 31, 38, 41 in Factor 1 on Table 1)
  2. Cost Effectiveness of Caring for Older Adults (Items 11, 13, 24, 25, 27, 32, 33 in Factor 2 on Table 1)
  3. Value of Older Adults (Items 15, 17, and 20 in Factor 4 on Table 1)
  4. Experience in Caring for Older Adults (Items 6 and 19 in Factor 5 on Table 1)
  5. Perception of Older Adults being Helpless (Items 1, 5, 18, and 39 in Factor 6 on Table 1)

 A study was performed on the effectiveness of this instrument. The objective of this study was to test the reliability and validity of the Carolina Opinions on Care of Older Adults (COCOA) survey compared with the Geriatric Assessment Survey (GAS). Participants were first year medical students (n=160). A Linear Structural Relations (LISREL) measurement model for COCOA had a moderately strong fit that was significantly better than the null model (GFI = 0.81, TLI = 0.90) and the GAS (GFI = 0.76). A reduced, 24-item COCOA performed well (GFI = 0.90, TLI = 1.00) with R = 0.595 on five factors. The COCOA and GAS represent complementary instruments for assessing attitudes toward older adults.

The Factor Loadings for all 42 items are included in the attached table.

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

Hollar, D; Roberts, E; Busby-Whitehead, J. “COCOA: A New Validated Instrument to Assess Medical Students’ Attitudes towards Older Adults”. Educational Gerontology. In Press.

Date posted: 
Tue, 12/07/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 12/07/2010
Contact Person/Corresponding Author:



Suggested Citation:
, and . Carolina Opinions on Care of Older Adults (COCOA). POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/208

SMILE: Senior Mentor Independent Living Education Program with Meals-on-Wheels

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

This is a one-morning community experience pairing a medical student with a volunteer driver (age 65+) for the local Meals-on-Wheels program.  The student accompanies the driver on the delivery route and en route conducts a life history of the driver and delivers a prevention message on an aspect of healthy aging.  Afterwards, the student writes a reflection paper on the experience with this high-functioning senior.  Students evaluate the experience and are evaluated by the driver and a faculty member on professionalism and communications. Evaluation forms are included.

Educational objectives: 
  • Successful aging
  • Self-care capacity
  • Professionalism
  • Communication
  • Interviewing skills
  • Prevention counseling
  • Attitudes toward older adults
Date posted: 
Wed, 12/08/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 12/08/2010
Contact Person/Corresponding Author:



Suggested Citation:
and . SMILE: Senior Mentor Independent Living Education Program with Meals-on-Wheels. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/208

Clinical Evaluation Exercise (Mini-CEX) Mini-Cog

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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 mini-CEX is designed to observe a trainee performing a Mini-Cog on a patient. The trainees are then given direct feedback on their performance.

Educational objectives: 

Learning Objectives:

  1. Demonstrate competence in introducing the subject of memory testing with a patient.
  2. Demonstrate competence in completing the mechanics of a Mini-Cog.
Date posted: 
Wed, 04/06/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 04/06/2011
Contact Person/Corresponding Author:



Suggested Citation:
and . Clinical Evaluation Exercise (Mini-CEX) Mini-Cog. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/208

Clinical Applications of Latino Ethnogeriatrics

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

This lecture presentation focuses on delivering health care for older Latino patients.

Educational objectives: 
  1. Understand what is meant by the term "Latino",
  2. Discuss most recent U.S. Latino demographics,
  3. Discuss health-related Latino elderly population characteristics,
  4. Understand clinically important relative health risks of Latino elderly,
  5. Expand history and physical exam skills to assess significant, culturally relevant findings, and
  6. Introduce targeted methods for delivering culturally appropriate geriatric care.
Date posted: 
Wed, 01/19/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 01/19/2011
Contact Person/Corresponding Author:



Suggested Citation:
Clinical Applications of Latino Ethnogeriatrics. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/208

A Guide to Developing A Medical Readers' Theater (MRT) Program

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

This step-by-step guide offers a roadmap for developing and starting a medical readers' theater (MRT) program.  MRT at UC Irvine School of Medicine is presented as a model for bringing together older adults and third-year medical students in order to share their perspectives on various health-related topics. 

Educational objectives: 
  1. To provide an overview of a medical readers' theater (MRT) program;
  2. To identify and describe the components of an MRT experience; and
  3. To recognize the value of MRT and its impact on the medical education of future physicians.
Date posted: 
Mon, 01/23/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 01/23/2012
Contact Person/Corresponding Author:



Suggested Citation:
A Guide to Developing A Medical Readers' Theater (MRT) Program. POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/208

Medical Ethics

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

This web-based module for third-year medical students reviews primary and ancillary principles of medical ethics and challenges the learner to apply these principles to patient care scenarios. Reading assignments include an ethics article (Lancet, 2009) regarding allocation of scarce medical resources. A small group discussion for this module immediately precedes an Ethical Analysis noon conference presented by a Geriatrics Fellow and is required for 3rd year medical students, but is open to anyone.

Educational objectives: 
  1. Discuss the principle of autonomy as an ethical standard, as it relates to medical decision making, and in contrast with the principle of beneficence.
  2. Define the medical ethics principle of justice.
  3. Relate examples of ambiguous distributive justice.
  4. Explain the principle of informed consent as an ethical standard, as it relates to medical decision making.
  5. Discuss the clinical situations in which life-sustaining treatment might alter one's choice of management.
  6. Describe the clinical situations in which medical futility might alter one's choice of management.
  7. Describe the important medical treatment options which must often be considered by older adults and their surrogate decision makers.
  8. Describe how one would assess a patient for decision making capacity (decisional capacity).
  9. Recommend appropriate courses of action for patients and family members as exemplified by the case studies.
Date posted: 
Sat, 10/16/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Sat, 10/16/2010
Contact Person/Corresponding Author:



Suggested Citation:
and . Medical Ethics. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/208

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