The Portal of Geriatrics Online Education

5 CBD: Formulate a diagnosis and evaluate the 3D's

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

ACUTE MANAGEMENT OF OLDER ADULT FOUND DOWN WITH ALTERED MENTAL STATUS

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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: 
2
Abstract: 

This case study was developed for use in academic coursework and as a standalone training for health care providers (MDs, ARNP, Pharmacists, Social Workers, Nurses). This unfolding case study about the management of an older adult in the midst of a health crisis. This case is a composite of many actual cases seen in Emergency Departments. During the course of this case study, learners are presented with information as the providers learn of the patient’s emergent and ongoing health concerns – from her Emergency Department admission through her Intensive Care Unit stay. Learners are asked to make decisions and use their best judgment about how to care for this patient.

Educational objectives: 

 

  • Apply knowledge of evidence-based care provision to an older adult found with altered mental status after a ground level fall
  • Describe the contributions of the interprofessional team to care management
  • Demonstrate effective communication during handoffs in care
Publications from, presentations from, and/or citations to this product: 

Citations are listed at the bottom of the screen throughout the case study.

Date posted: 
Fri, 07/27/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 05/22/2018
Contact Person/Corresponding Author:



Suggested Citation:
ACUTE MANAGEMENT OF OLDER ADULT FOUND DOWN WITH ALTERED MENTAL STATUS. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/82

Geriatric Medicine Consult Curriculum for Orthopedic Surgery

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

Geriatrics/medicine curriculum developed for Orthopedic residents to complete during a required Internal Medicine consult rotation.  Topics include: preoperative assessment, medication reconcilliation and adverse drug events, post-operative complications including delirium, care transitions, and common inpatient medical problems.   Curriculum also includes references to relevant high-yield literature for additional information.

Educational objectives: 

Provide learners (specifically orthopedic surgery interns) with an introduction to common inpatient medical problems and post-operative complications.  At the end of this curriculum, learners should be able to demonstrate an understanding of the work-up and management of  common inpatient problems and post-operative complications, and apply this knowledge to the direct care of patients.  Learners should be able to identify common adverse events in older patients.

Date posted: 
Mon, 10/17/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/17/2016
Contact Person/Corresponding Author:



Suggested Citation:
Geriatric Medicine Consult Curriculum for Orthopedic Surgery. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/82

Barney Smith - A Progressive Palliative Care Standardized Patient

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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: 

This six part progressive standardized patent serves re train medical students to care for an older adult with a life limiting condition, including making the diagnosis of multiple myeloma, breaking bad news, transitions of care from the hospital to home and curative care to palliation, through advance directiive discussions, and eventually into hospice and his death. The six encounters occur from Year 2 through Year 4 of the medical school curriculum , with a scripted five year span of patient care. Educational modalities include standandized patients, simulation, web-based modules, and small group discussions. 

Educational objectives: 

1) Provide medical care for an older adult with a life limiting condition from their diagnosis through their death

2) Understand the roles of the medical provider and other health care disciplines, as individual providers and as a team, in caring for an older adult with a life limiting diagnosis as they transition from the hospital to home and from curative care to palliation

3) Assist family caregivers in identifying caregiver responsibilities and potential caregiver burden

Date posted: 
Mon, 10/17/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/17/2016
Contact Person/Corresponding Author:



Suggested Citation:
Barney Smith - A Progressive Palliative Care Standardized Patient. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/82

Barney Smith 3 - A Transitions of Care Interprofessional Education Standardized Patient

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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: 

This transitions of care Interprofessional education standardized patient serves to train Year 3 medical students and graduate students from physical, occupational and speech therapy in the transition of care of a frail older adult from the hospital to home. It is the third of a six part progressive standarized patient encounter on palliative care. This clinical simulation is an encounter with Barney as a hospitalized patient with newly acquired functional decline. Learners gain experience in the interprofessional team assessment of a hopsitalized older adult's functional status and the team management of that patient's transition of care from the hospital to home. Educational modalities include web-based instruction , the simulation, and a small group discussion of the interprofessional set of learners immediately following the encounter facilitated by interprofessional faculty.  

Educational objectives: 

1) Perform an interprofessional, comprehensive team assessment of a hospitalized older adult's functional assessment and the team mangement of that patient's transition of care from the hospital to home. 

2) Understand the role that individual discpliness play in conducting  a comprehesive assessment of an older adult's functinal status 

3) Assess specific risks and barriers to older adult safety as they transition from the hospital to home 

4) Assist family caregivers in identfying caregiver responsibilities and potential caregiver burden 

Date posted: 
Mon, 10/17/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/17/2016
Contact Person/Corresponding Author:



Suggested Citation:
Barney Smith 3 - A Transitions of Care Interprofessional Education Standardized Patient. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/82

Interdisciplinary Health Profession Module Videos

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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: 

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/82

VirginiaGeriatrics.Org

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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: 
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/82

Interprofessional Geriatric Education and Training in Texas: Elder Mistreatment

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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: 

Although estimates vary, it is generally believed that 11% of the elderly are abused. According to the National Incidence Study on Elder Abuse, approximately 450,000 elderly experienced abuse each year. If self-neglect is included, the number increases to 551,000. Elder mistreatment is too large of a problem for any one person or one discipline to resolve. Incorporating the expertise of all the members of the interprofessional healthcare team is critical to determine the facts in the situation and the motives of the people involved. Healthcare providers can only see what is presented in the clinical setting. There is so much of the story that may not be manifested in a routine exam and encounter. Having all team members knowledgeable about the sometimes subtle signs of elder mistreatment is helpful for eliciting information and devising a holistic intervention plan.

The University of North Texas Health Science Center (UNTSHC) Reynolds Interprofessional Geriatric Education and Training in Texas (IGET-IT) Program has developed an Elder Mistreatment module as part of the Interprofessional Communication Improvement Modules (ICIM) Elder Safety series. The ICIM Elder Safety modules were created in collaboration with the National Board of Osteopathic Medical Examiners (NBOME) and are supported, in part, by a grant from the Donald W. Reynolds Foundation. The goal of the Elder Safety ICIMs is to provide innovative and sustainable programs to improve the ability of physicians to work with other health disciplines in teams to provide better care for geriatric patients. The care of older adults can be very complex and studies have shown that a team approach can be most effective in leading to quality outcomes.

 

Educational objectives: 

Upon completion of this activity, participants will be able to:

  • Define “elder mistreatment”
  • Describe the prevalence of elder mistreatment in the US
  • Define the multiple forms of elder mistreatment
  • Identify risk factors for elder mistreatment
  • List indicators of elder mistreatment
  • Prioritize the steps of elder mistreatment assessment
  • Determine the approach for including an elder mistreatment assessment in an IP team model of geriatric assessment
Publications from, presentations from, and/or citations to this product: 

Marquez Hall, S. (2016, May). Assessment Tool for Elder Safety on the Topics of Falls Risk and Elder Mistreatment. Presented at American Geriatrics Society Annual Scientific Meeting Education Product Showcase, Long Beach, CA.

Date posted: 
Wed, 10/05/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 10/05/2016
Product Viewing Instructions: 
Select your activities and add them to your cart. In the cart, click Proceed to Checkout. You will be prompted to create a new account or log in to your existing one. Once your account is created, you will be directed back to complete your registration.
Contact Person/Corresponding Author:



Suggested Citation:
Interprofessional Geriatric Education and Training in Texas: Elder Mistreatment. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/82

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/82

Transitions of Care Workshop- Preparing 4th year Medical Students for Internship

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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: 

Care Transitions are complicated and ineffective transitions result in poor patient outcomes and readmissions. The Association for American Medical Colleges (AAMC) has recently developed Entrustable Professional Activities (EPA) required for graduating medical students and two of the thirteen focus on transition of care issues. Residency programs are formalizing curricula around this topic as it is one of six focus areas within the Clinical Learning Environment Review (CLER) program, however graduating medical students have no formalized training in Care Transitions as of this time. This product provides a framework for practical training for graduating medical students and interns. A case based workshop on care transitions was created and utilized to instruct 4th yeard medical students and  Interns.  This included a small group didactic and a team based problem-solving session focused on a discharge case of a geriatric patient with multimorbidity. This curriculum was initially designed for medical students and interns on Internal Medicine, but can also be utilized to instruct learners in other fields and interprofessional learners.

Educational objectives: 
Define a care transition
Identify those at high risk for a complicated care transition
Apply specific risk assessment tools including the 8P’s, to estimate risk
Appraise the consequences resulting from ineffective transitions of care
Formulate a  safe care transition and discharge plan
Identify the important components of  successful transitional care
Additional information/Special implementation requirements or guidelines: 
Transitions of Care curriculum for 4th year medical students and Medical Interns
Interactive case based workshop to provide practical training on Transitions of Care
Small group classroom session with power point presentation and with a team based problem-solving component focusing on a discharge case of a geriatric patient with multimorbidit
Faculty Guide designed to guide active learning while students worked through the case in their teams
Publications from, presentations from, and/or citations to this product: 

Kranz, Kimberly, Strano-Paul, Lisa.  Preparing Graduating 4th year Medical Students for Internship- Implementing a Transitions of Care Workshop. Model Geriatric Programs: Geriatric Education Materials and Methods Swap. Presented at American Geriatric Society Annual Meeting Long Beach CA May 2016   

Kranz, K, Strano-Paul L, Go, R. Preparing graduating 4th year medical students for internship: Implementing a Transitions of Care Workshop. American Geriatric Society Annual Meeting, Long Beach CA, May 2016.

Kranz, K, Strano-Paul L, Go, R. Preparing graduating 4th year medical students for internship: Implementing a Transitions of Care Workshop. Women in Medicine Research Day. Stony Brook School of Medicine, Stony Brook, NY March 2016.

Kranz, K, Strano-Paul L, Go, R. Preparing graduating 4th year medical students for internship: Implementing a Transitions of Care Workshop. Clerkship Directors of Internal Medicine, Academic Internal Medicine Week, Atlanta, GA. October 2015.

                               

Date posted: 
Mon, 06/20/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 06/20/2016
Contact Person/Corresponding Author:



Suggested Citation:
Transitions of Care Workshop- Preparing 4th year Medical Students for Internship. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/82

3D (dementia, depression, delirium) Flipped Classroom Didactic for Medical Students

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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: 

Background: Dementia, delirium, and depression are core minimum competencies outlined by the AAMC (Association of American Medical Colleges) for medical students by graduation. Focus groups with Hopkins’ medical students found that they had variable clinical experiences with 3Ds during neurology and psychiatry rotations and found it challenging to take a history from a patient with cognitive impairment.
Methods: A joint curriculum was established with psychiatry and neurology core clerkship directors for third and fourth year medical students. Pre-session: PowerPoint with information on 3Ds, mini-cog, 4AT, and PHQ-9. Using pre-recorded simulated videos, students completed worksheets and discussed in class. Additionally we incorporated an in person caregiver interview. We assessed students’ knowledge with in-class audience response questions, pre and post evaluations on how well learning objectives were addressed, and three month post didactic to assess behavior change. This curriculum will be repeated 4 more times during 2015-2016 academic year.
Results: In the first 3 quarters, 64 students completed didactic. Students scored 44-78% correct on 3/6 knowledge test questions (other 3 questions scored >90% correct). Students demonstrated most improvement in use and interpret mini-cog for dementia screen and 4AT for delirium screen as well as communication skills with patients and caregivers. No self-reported change pre and post didactic for students’ ability to differentiating between dementia and depression, or between dementia and delirium. Most importantly, a majority of students identified the importance of communicating with caregivers and providing support not only for the patient, but also for the caregiver. At three months follow up survey (75% completion rate), students identified communication techniques and understanding caregiver’s challenges as the most useful “take home” points from didactic.
Conclusions: Overall the 3D didactic was well received by medical students. They improved in identifying when to use screening tools for 3Ds, which may translate from knowledge to behavior at their next rotations. They also overwhelmingly identified the importance of communicating and assessing caregivers’ needs. More data will be collected during additional sessions this academic year. This curriculum could be easily disseminated without much additional resources.

Educational objectives: 

Knowledge & Skills objectives:
1. Recognize, compare and contrast  delirium, dementia, and depression in various clinical presentations.
2. Formulate a differential diagnosis and implement initial evaluation in a patient who exhibits delirium, dementia, or depression by evaluating video interviews among patient, caregiver, and provider triad communication skills.
3.  Assess an older patient with delirium, initiate a diagnostic work-up to determine the root cause (etiology), by identifying predisposing factors and differential diagnosis of delirium, by utilizing  non pharmacologic strategies for delirium.
4. Perform and interpret a cognitive assessment in older patients for whom there are concerns regarding memory or function by demonstrating the ability to differentiate the result of 4AT (rapid assessment test of delirium) based on video interview of delirious patient.  Proficiency to use Mini-Mental Status Exam (MMSE)and mini-cog to determine cognitive impairment.

Program/process Objectives:
• ≥ 95% of medical students in neurology and psychiatry rotation will attend the dementia day.
• Of students who attended didactic in person, 100% of the medical students will have demonstrated the ability to distinguish dementia, delirium, and depression using worksheets based on video interviews.

 

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

AGS poster presentation 2016

AGS Educational Showcase 2016

Date posted: 
Tue, 07/26/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 07/26/2016
Contact Person/Corresponding Author:



Suggested Citation:
3D (dementia, depression, delirium) Flipped Classroom Didactic for Medical Students. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/82

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