The Portal of Geriatrics Online Education

Intro to Clinical Medicine/Clinical Skills/Doctoring

Advance Care Planning with Surrogate of Older Adult with Dementia

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Abstract: 

Medical students are given the opportunity in small groups to practice communication skills with a standardized patient.  Students assume the role of attending physician, who is in charge of this patient’s care while attending on the Acute Care for the Elderly (ACE) Unit, and speak to the patient’s adult child. The objective is to have the student discuss the patient’s clinical condition and what the goals of care should be during this hospitalization, i.e., whether the patient should be transferred to the ICU if she worsens and, if so, whether she should be intubated and resuscitated.

Educational objectives: 
  1. To discuss clinical condition of older adult with surrogate.
  2. To discuss goals of care for a hospitalized older adult with surrogate; specific to CPR, ventilation, and ICU level of care.
Date posted: 
Mon, 10/04/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/04/2010
Contact Person/Corresponding Author:



Suggested Citation:
and . Advance Care Planning with Surrogate of Older Adult with Dementia. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/208

Conversations about Health and Aging

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

As a legacy of our geriatrics education project supported by the Donald W. Reynolds Foundation, we decided to make a short film about caring for elderly patients. We wanted real doctors and real old people. Recognizing we are all in this together, we also chose physicians from multiple medical and surgical subspecialties in addition to primary care physicians/geriatricians. None of it is scripted. Rather it is, as we intended, the good, the bad and the ugly, of caring for the aged. 

Educational objectives: 

To encourage learners  to see the value in caring for older adults;

To hear experienced geriatricians and physician specialists tell their stories of practicing medicine with older adults;

To impress upon learners the reality that almost all physicians will be caring for older adults regardless of their specialty.

Date posted: 
Wed, 10/20/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 10/20/2010
Contact Person/Corresponding Author:



Suggested Citation:
and . Conversations about Health and Aging. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/208

Geriatric Health Literacy Workshop for Medical Students and Residents

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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: 
3
Abstract: 

This 2.5 Hour Health Literacy Workshop provides a hands-on opportunity for learners to improve communication skills and teaches problem based learning and improvement skills.  Designed for internal medicine residents and medical students, it has been piloted at the University of Chicago for all PGY-1 Internal Medicine residents rotating on the Geriatrics Rotation. This workshop is suitable to physicians-in-training at any level and across medicine subspecialties and interdisciplinary health care professions. 

During the health literacy workshop, learners view a brief lecture, role-play using “teach-back” cases, and critique patient education materials utilizing the Suitability of Assessment of Materials (SAM) (Doak and Doak) available at http://www.guidesforbeginnings.com/pdfs/SAM-for-Beginnings.pdf

Educational objectives: 

After completing this workshop, learners should be able to:

  1. Describe the anticipated demographic changes in the US over the next 50 years.
  2. Recognize the impact of low health literacy on geriatric patients.
  3. Explain the relationship between health literacy and health care disparities.
  4. Demonstrate the “teach-back” method.
  5. Edit patient handout materials for low health literacy patients.
Additional information/Special implementation requirements or guidelines: 

Course director or learners need to bring patient handout materials from their clinic or the web to analyze and revise.

The University of Arizona's Health Literacy online module (POGOe product #20029) is recommended for pre-workshop study.  The author would like to acknowledge and thank the University of Arizona for creating and publicly distributing this excellent work. 

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

Farrell, T. W. (2011), Review of a Geriatric Health Literacy Workshop for Medical Students and Residents. Journal of the American Geriatrics Society, 59: 2347–2349. doi: 10.1111/j.1532-5415.2011.03720.x

Date posted: 
Fri, 04/22/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 08/17/2012
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Health Literacy Workshop for Medical Students and Residents. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/208

Health Literacy and Patient Safety: Help Patients Understand

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

This manual reviews the problem of health literacy, its consequences for the health care system, and the likelihood that a clinician’s practice includes patients with limited literacy. The manual then provides practical tips for clinicians to use in making their office practices more “user friendly” to patients with limited literacy, and gives suggestions for improving interpersonal communication between clinicians and patients. Finally, the manual concludes with several “case discussions” based on vignettes in the accompanying instructional video.

Educational objectives: 

MANUAL FOR PHYSICIANS
The enclosed materials will enable physicians to:

  • Define the scope of the health literacy problem.
  • Recognize health system barriers faced by patients with low literacy.
  • Implement improved methods of verbal and written communication.
  • Incorporate practical strategies to create a shame-free environment.

REDUCING THE RISK
The activity will enable physicians to:

  • Define the scope of patient safety problems caused by low health literacy and the need to manage the risk they present
  • Recognize the ethical and legal foundations for safe medical practices and patient-centered care
  • Explain patient safety concepts and approaches utilized in designing safer practice environments
  • Identify patient safety practices that reduce the risk of miscommunication and optimize the patient’s ability to safely manage their own care
  • Determine steps toward establishing a climate for change
  • Identify tools and resources for creating safer practice environments
  • Demonstrate how to utilize and implement these tools in a practice environment
Additional information/Special implementation requirements or guidelines: 

Communication is essential for the effective delivery of health care, and is one of the most powerful tools in a clinician’s arsenal. Unfortunately, there is often a mismatch between a clinician’s level of communication and a patient’s level of comprehension. In fact, evidence shows that patients often misinterpret or do not understand much of the information given to them by clinicians. This lack of understanding can lead to medication errors, missed appointments, adverse medical outcomes, and even malpractice lawsuits. Clinicians can most readily improve what patients know about their health care by confirming that patients understand what they need to know and by adopting a more patient-friendly communication style that encourages questions.

Date posted: 
Tue, 09/21/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 09/21/2010
Contact Person/Corresponding Author:



Suggested Citation:
, and . Health Literacy and Patient Safety: Help Patients Understand. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/208

The Physician's Role in Medication Reconciliation: Issues, Strategies, and Safety Principles

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

In “The physician’s role in medication reconciliation,” the panel aims to heighten physician awareness of the integral role of reconciliation in the safe use of medications and to provide a framework for physicians to understand their personal roles and responsibilities in this often difficult process of care.

The essence of medication reconciliation is making sense of a patient’s medications and resolving conflicts between different sources of information to minimize harm and to maximize therapeutic effects. It is an ongoing, dynamic, episodic and team-based process that should be led by and is the responsibility of the patient’s attending or personal physician in collaboration with other health care professionals. Medication reconciliation is essential to optimize the safe and effective use of medications.

Educational objectives: 

After completing this activity, participants should be able to:

  • Describe medication reconciliation principles and processes
  • Distinguish the physician's role in the medication reconciliation process
  • Integrate patient-centric aspects of medication reconciliation into practice
  • Create a medication management plan with your patients
  • Integrate principles and processes into practice in all settings of care
  • Identify appropriate medication reconciliation team in all settings of care
  • Identify proper delegation of clinical and nonclinical medication reconciliation responsibilities
  • Lead your organization's efforts to support medication reconciliation
Additional information/Special implementation requirements or guidelines: 

This monograph first provides background on medication issues, including: medication errors and adverse drug events, communication problems and medication reconciliation’s relationship to patient safety. It then presents an overview, including the steps of medication reconciliation, the underlying principles of medication reconciliation for deeper understanding of the physician’s leadership role and obligations, and guidance for effective achievement of medication reconciliation. This is followed by strategies for two particularly important areas of medication reconciliation: taking a medication history and promoting patient understanding of their medication regimen. Case study examples illustrate medication reconciliation failures and can be the basis for discussions physicians may have with their medical team and with their patients.

Recognizing that ultimately all health care safety and factors affecting medication reconciliation must be customized to the particular patient and practicing setting, this monograph does not offer rigid prescriptions, but rather general principles that physicians and their teams may adapt to their specific circumstances and needs. Because medication reconciliation represents an integral part of the patient safety effort, this monograph offers guidelines and information on developing support for medication reconciliation in the context of core safety principles. It provides useful information for physicians’ use in local improvement efforts and in advocacy for medication safety.

Finally, this monograph discusses important special topics critical to effective medication reconciliation: information technology, coordination of care and vulnerable populations. Information technology has tremendous potential, but it also poses significant challenges. This discussion highlights some of those issues. It also reviews a key issue in medication reconciliation—coordination of care—and sketches a directly related effort to address this concern (i.e., medical homes). In addition to enhancing coordination of care, medical homes may provide important benefits to older and minority populations—groups that are disproportionately affected by ineffective medication reconciliation. Lastly and significantly, the monograph discusses vulnerable patient populations, including older adults and minorities, and provides examples and potential strategies to improve medication reconciliation for these patients.

For information on receiving CME credit, go to http://www.ama-assn.org/ama/no-index/physician-resources/medication-reconciliation.shtml.

Date posted: 
Tue, 09/07/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 09/07/2010
Contact Person/Corresponding Author:



Suggested Citation:
, , and . The Physician's Role in Medication Reconciliation: Issues, Strategies, and Safety Principles. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/208

Effective Clinical Partnerships between Primary Care Medical Practices and Public Health Agencies

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

The purposes of the study reported in this monograph were:

  • To identify partnerships between public health and medicine that increase the effectiveness and efficiency of clinical care, with a particular emphasis on the aging population; and
  • Through a careful examination of current models, to identify themes and lessons that would be useful in the expansion, replication, and broader application of such partnerships.
Additional information/Special implementation requirements or guidelines: 

The monograph is divided into four sections. The introduction reviews the literature on primary care/public health partnerships. The methods used in our research are described in the second section. The third section describes the 48 programs we identified and profiled, thereby providing an inventory of the wide range of partnerships currently in operation. The fourth section presents the results of qualitative analyses of in-depth interviews we conducted with key participants in a selection of 16 programs. The final section presents our conclusions and recommendations.

Our research methods included conducting a national scan to identify successful ongoing programs, gathering detailed information from a sample of the identified programs, and analyzing the data to identify themes and lessons that could be drawn from the experiences of these pioneers.

We believe that the U.S. health care system would benefit greatly from more integration between population-oriented and individual patient care systems. This monograph is intended to foster movement in that direction.

Date posted: 
Tue, 09/07/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 09/07/2010
Contact Person/Corresponding Author:



Suggested Citation:
and . Effective Clinical Partnerships between Primary Care Medical Practices and Public Health Agencies. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/208

Fall Risk Assessment Experience

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

The recent AAMC/Hartford Foundation Minimum Geriatrics Competencies for medical students (MSs) recommended that all graduating students ask about falls and conduct a brief fall risk assessment on a patient. The goal of this resource is to improve MSs´ understanding of the impact of falls on the lives of older adults, fall risk factors, and evidence based interventions to reduce fall risk, by performing a Fall Risk Assessment on an older adult patient. At Mount Sinai School of Medicine, the Fall Risk Assessment occurs during the third year Integrated Internal Medicine-Geriatrics Clerkship.

Educational objectives: 
  1. To be able to recognize the impact of falls on the lives of older adults.
  2. To be able to identify risk factors for falls in the elderly.
  3. To be able to perform the 3 Chair Rise and Timed Up and Go tests to assess functional status.
  4. To be able to describe interventions to reduce an older patient's risk of falling.
Additional information/Special implementation requirements or guidelines: 

The Fall Risk Assessment Experience Student Guide provides background information about falls, fall risk factors, interventions to prevent falls, and patient education material. The Guide directs the student to read a comprehensive fall assessment and management article, obtain relevant information from the patient´s medical record (documented fall risk factors, medications, etc.) and then conduct a fall risk assessment (including questions about fall risk factors, orthostatic vital signs, observed gait and balance, 3 chair rise and the timed up and go test) on their patient. Findings are then reviewed with the patient´s doctor and recommendations offered to the patient. This hands-on student directed approach activates learning, as the student plays a primary role in the patient's care by identifying risk factors, recommending treatment, and providing counseling.

Falls are common in older adults and result in significant morbidity, including injury, pain, disability, and even death. Risk factors for falling have been identified and interventions to improve these risk factors have been found to reduce fall rates by more than 30%. However, medical students (MSs) are frequently not instructed on fall risk assessment and management.

During the 2007-2008 academic year third year MSs performed the Fall Risk Assessment Experience with 19 of 27 (70%) of eligible senior mentors. Falls were common even among this highly functional community dwelling population as 79% of the mentors reported previously falls on the Fall Risk Assessment Questionnaire. In spite of this, at the start of the assessment, 11/19 (61%) did not think they were at risk of having another fall. Patients reported low rates of being asked about falls and of feeling they were at risk of falling. 36% of senior mentors said they were "almost never" asked about falls by their doctor while only 29% noted that their physician "almost always" asked them about falls.

The student-directed fall risk assessment module identified multiple fall risk factors and students were able to make important recommendations to reduce their senior mentors´ risk of future falls. All mentors had at least one risk factor for falling in addition to age. The mean number of fall risk reduction strategies recommended was 3.3 (range 0-8).

73% of the older adults found the intervention to be helpful in recognizing their own fall risks. The assessment changed the mentors' perceptions of their own risk of having a fall from 39% thinking they were at risk to 50% thinking they were at risk afterwards. 
53% said there are things that they are going to do differently after the assessment to reduce their risk of falling. These included "being more careful", doing exercises, taking tai chi, taking their time when first getting up, and using a walker.

Our resource is student driven and this makes it very easy to incorporate into any clerkship or rotation. In addition, highlighting the importance of chart review as a method for health care providers to evaluate the quality of their care and make important practice changes is helpful when incorporating this resource into a curriculum. This cueing facilitates an appreciation for reflection and self assessment in the student.

Scheduling time for the assessment is imperative as the actual assessment takes between 20 to 30 minutes to complete. Informing the patient about the assessment before the visit is also very useful. Patients can then bring questions they have to the assesment and many misconceptions can be clarified during the visit.

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

1. Bradley S, Atanous A, Karani R. Impact of a Student-directed Fall Risk Module in Ambulatory Geriatrics, Innovations in Medical Education Poster Session, Society of General Internal Medicine Annual Meeting, Miami, Fl, May 14, 2009.

2. Bradley S, Atanous A, Karani R. A Fall Risk Module in Ambulatory Geriatrics, accepted for Poster Session, The Association for Medical Education in Europe Annual Conference, Malaga, Spain, August, 2009.

3. Bradley S , Karani R, Fall Risk Assessment Experience. MedEdPORTAL; 2010. Available from: http://services.aamc.org/30/mededportal/servlet/s/...

Date posted: 
Mon, 06/14/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 10/12/2012
Contact Person/Corresponding Author:



Suggested Citation:
and . Fall Risk Assessment Experience. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/208

Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 143--You Are What You Eat

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

The Step 1 Test Prep Series was created by second-year students at the Texas Tech School of Medicine in Lubbock as a project of the MS2 Aging Block of Systems Disorders II. It was developed as part of the Reynolds Geriatrics Podcast series, which is supported in part by an Aging and Quality of Life grant from the D.W. Reynolds Foundation. The episodes in this series are based on questions that have geriatrics content and patient vignettes from the 2010 Step 1 Sample Exam, available from http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri...

Educational objectives: 

The second-year medical student studying for the Step 1 exam should be able to:

  • Identify the clinical presentation of vitamin C deficiency
  • Understand the physiologic function of vitamin C
  • Understand how the clinical presentation of vitamin C deficiency correlates with its physiologic function
  • Identify the causes of vitamin C deficiency
Date posted: 
Thu, 10/07/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/22/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , , , , , and . Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 143--You Are What You Eat. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/208

Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 30--The Gasping Geriatric

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

The Step 1 Test Prep Series was created by second-year students at the Texas Tech School of Medicine in Lubbock as a project of the MS2 Aging Block of Systems Disorders II. It was developed as part of the Reynolds Geriatrics Podcast series, which is supported in part by an Aging and Quality of Life grant from the D.W. Reynolds Foundation. The episodes in this series are based on questions that have geriatrics content and patient vignettes from the 2010 Step 1 Sample Exam, available from http://www.ttuhsc.edu/som/fammed/ttmedcast/gerseri...

Educational objectives: 

The second-year medical student studying for the Step 1 exam should be able to:

  • Describe physical findings associated with lobar pneumonia
  • Describe the clinical presentation in patients with lobar pneumonia
  • Differentiate diseases of the lung based on clinical presentation, onset of symptoms, and physical findings
Date posted: 
Thu, 10/07/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 01/22/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , , and . Texas Tech Medcast Reynolds Geriatrics Step 1 Prep Series: No. 30--The Gasping Geriatric. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/208

Focused Neuro Exam for a Patient with Falls

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

This video will instruct medical students and post graduate trainees on how to perform a thorough neurological examination when assessing an older adult with falls. It stresses examination technique as well as tools used in the assessment as a demonstration using a simulated patient encounter in a clinical setting.

Educational objectives: 

Objective of the neurologic exam in assessing falls: 1. Develop an understanding of the terminology and tools used to assess neurologic function in older adults 2. Recognize symptoms which suggest neurologic dysfunction in relation to falls in older adults

Date posted: 
Tue, 02/23/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 11/26/2012
Contact Person/Corresponding Author:



Suggested Citation:
Focused Neuro Exam for a Patient with Falls. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/208

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