Geriatrics

Geriatric Competencies in COM Curriculum

AAMC Minimum Geriatric Competencies    

MEDICATION MANAGEMENT

Location in curriculum. Courses required for all students. Location in curriculum available as elective only

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

-M2 Pharmacology
-M2 Geriatric  
 Pharmacology              
-M2 Geriatric  Lectures 
 and Small Groups ,
-M4 Senior Seminars-
 EOL care, pain 
 management

-M3 Ambulatory 
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
-M4 Senior Seminars- Pain management
2) Identify medications, including anticholinergic, psychoactive, anticoagulant, analgesic, hypoglycemic, and cardiovascular drugs that should be avoided or used with caution in older adults and explain the potential problems associated with each.   -M2 Pharmacology
-M2 Geriatric
 Pharmacology 
-M2 Geriatric 
 Lectures 
 and Small Groups
-M4 Senior Seminars;
 EOL care 
-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub  Internship** -M4 Senior Seminars -
 Pain management
 
3) Document a patient’s complete medication list, including prescribed, herbal and over-the-counter medications, and for each medication provide the dose, frequency, indication, benefit, side effects, and an assessment of adherence. -M3 internal medicine 
 inpatient
-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
COGNITIVE AND BEHAVIORAL DISORDERS    
4) Define and distinguish among the clinical presentations of  delirium, dementia, and depression.

-M2 Geriatric  Lectures
 and  Small Groups
-M2 Neurology
 lectures
-M2  Simulated Patient
 exercise
-M2 Core 7 Psychiatry
 Course
-M3 IM case
 discussion

-M3 Ambulatory
 Medicine  Geriatrics*
-M4 Geriatric 
 Sub Internship**
5) Formulate a differential diagnosis and implement initial  evaluation in a patient who exhibits cognitive impairment. -M2 Geriatric  Lectures
 and Small Groups
-M2 Core 7 Psychiatry 
 Course
-M3 Ambulatory 
 Medicine-Geriatrics* -
 M4 Geriatric Sub
 Internship**
6) Urgently initiate a diagnostic work-up to determine the root cause (etiology) of delirium in an older patient.

-M2 Geriatric Lectures.
-M3 IM case discussion

 

 

-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
-M4 Senior Seminars -
 Emergency Problems 
 Inpatient Care
7) Perform and interpret a cognitive assessment in older patients  for whom there are concerns regarding memory or function. -M2 Geriatric Lectures
 and Small Groups
-M2 Psychiatric
 lectures
-M1 Geriatric Home Visit
 Primary Care Block

-M3 Ambulatory 
 Medicine-Geriatrics*

 

8) Develop an evaluation and non-pharmacologic management plan for agitated demented or delirious patients. -M2 Core 7 Psychiatry
 Course
-M2 Geriatrics Lectures
 and Small Groups
-M3 IM case discussion
-M3 Ambulatory
 Medicine Geriatrics*
-M4 Geriatric Sub
 Internship**
-M4 Senior Seminars -
 Emergency
 Problems Inpatient
 Care, Essential
 Psychiatric Skills
SELF-CARE CAPACITY    
9) Assess and describe baseline and current functional abilities  (instrumental activities of daily living, activities of daily living, 
and special senses) in an older patient by collecting historical data from multiple sources and performing a confirmatory 
physical examination.

-M1 Geriatrics Lecture
-M2 Geriatrics
 Lectures and Small
 Groups 
-M1 Primary Care
 Block-Geriatric Home
 Visit

-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
-M4 Senior Seminar-  
 Long Tem Care
10) Develop a preliminary management plan for patients presenting with functional deficits, including adaptive interventions and involvement of interdisciplinary team members from appropriate disciplines, such as social work, nursing, rehabilitation, nutrition, and pharmacy.

-M1 Primary Care
 Block-Geriatric Home
 Visit
-M2 Geriatrics
 Lectures and Small
 Groups

-M3 Ambulatory 
 Medicine-Geriatrics*
-M4 Geriatric Sub 
 Internship**
11) Identify and assess safety risks in the home environment, and make recommendations to mitigate these.

-M1 Primary Care
 Block-  Geriatric Home
 Visit
-M2 Geriatrics
 Lectures and Small
 Groups

-M3 Ambulatory 
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
FALLS, BALANCE, GAIT DISORDERS    
12) Ask all patients > 65 y.o., or their caregivers, about falls in the last  year, watch the patient rise from a chair and walk (or transfer), then record and interpret the findings. -M1 Primary Care 
 Block-Geriatric Home 
 Visit
-M2 Geriatrics Lectures and Small Groups
-M3 IM case discussion
-M2 OSCE prep book
-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
-M4 Senior Seminars-
 Adult Rehabilitation
13) In a patient who has fallen, construct a differential diagnosis  and evaluation plan that addresses the multiple etiologies identified by history, physical examination and functional assessment.

-M3 IM case
 discussion
-M2 Geriatrics Lectures
 and Small Groups

-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
HEALTH CARE PLANNING AND PROMOTION    
14) Define and differentiate among types of code status, health care proxies, and advanced directives in the state where one
is training.
-M2 ICE, (health care
 proxies &  advanced
 directives)
-M4 ICE Senior
 Seminar-End-Of-Life
 Care
-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
-M4 Hospice and
 Palliative Care
 rotation
-M4 Senior Seminars:
 Women’s Health,
 Preventative
 Medicine
15) Accurately identify clinical situations where life expectancy,  functional status, patient preference or goals of care should override standard recommendations for screening tests in older adults. -M4 ICE Senior
 Seminar-End-Of-Life
 Care
-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
-M4 Hospice and 
 Palliative Care 
 IMED 728
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. -M4 ICE Senior
 Seminar-End-Of-Life
 Care
-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
-M4 Hospice and
 Palliative Care 
 IMED 728
-M4 ICE Senior
 Seminar-Preventative
 Medicine
ATYPICAL PRESENTATION OF DISEASE      
17) Identify at least 3 physiologic changes of aging for each organ system and their impact on the patient, including their contribution to homeostenosis (the age-related narrowing of homeostatic reserve mechanisms).

-M2 Geriatrics Lectures
 and Small Groups

 

-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
18) Generate a differential diagnosis based on recognition of the unique presentations of common conditions in older adults, including acute coronary syndrome, dehydration, urinary tract infection, acute abdomen, and pneumonia. -M2 Geriatrics Lectures
 and Small Groups
-M3 IM case 
 discussion
-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
PALLIATIVE CARE    
19) Assess and provide initial management of pain and key non-pain symptoms based on patient’s goals of care. -M4 Senior Seminars; 
 EOL and Pain
 management
-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
-M4 Senior Seminars-
 Pain Management
-M4 Hospice and
 Palliative Care 
 IMED 728
20) Identify the psychological, social, and spiritual needs of patients with advanced illness and their family members, and link these identified needs with the appropriate interdisciplinary team members. -M2 ICE
-M4 ICE Senior
 Seminar (EOL)
-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**
-M4 Hospice and
 Palliative Care
 rotation
21) Present palliative care (including hospice) as a positive, active  treatment option for a patient with advanced disease. -M2 ICE
-M4 ICE Senior
 Seminar (EOL)
-M4 Geriatric Sub
 Internship**
-M4 Hospice and
 Palliative Care
IMED 728
HOSPITAL CARE FOR ELDERS    
22) Identify potential hazards of hospitalization for all older  adult patients (including immobility, delirium, medication side effects, malnutrition, pressure ulcers, procedures, peri and post operative periods, and hospital acquired infections) and identify potential prevention strategies.  -M3 IM case
 discussion-Dr. O’Dell
-M2 Geriatrics Lectures
 and Small Groups
-M4 Geriatric Sub
 Internship**
-M4 Senior
 Seminars-
 Emergency
 Problems Inpatient
 Care
23) Explain the risks, indications, alternatives, and contraindications for indwelling (Foley) catheter use in the older adult patient. -M3 IM case
 discussion-
 Dr. O’Dell
-M2 Geriatrics Lectures
 and Small Groups

-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**

24) Explain the risks, indications, alternatives, and contraindications for physical and pharmacological restraint use. -M3 IM case
 discussion-Dr. O’Dell
-M2 Geriatrics
 Lectures and Small
 Groups

-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**

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

-M2 Geriatrics Lectures
 and Small Groups 

-M4 Geriatric Sub
 Internship**

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

-M2 Geriatrics Lectures
 and Small Groups

 

-M3 Ambulatory
 Medicine-Geriatrics*
-M4 Geriatric Sub
 Internship**

  * M3 Ambulatory Medicine-Geriatrics*= Required Clerkship for Junior students (M3's) - IMED-705
** M4 Geriatric Sub Internship  = Geriatric Sub internship- IMED-709
 # M4 Hospice and Palliative Care rotation = End of Life Care - IMED-728

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