In 2008 the Association of America Medical Colleges ( AAMC ) set the minimum competencies that every graduating US medical student must know and demonstrate to assure competent care to older patients by new interns. These competencies are endorsed by the American Geriatrics Society. USMLE and OSCE testing have questions and activities on these specific areas.
For more on this go to; http://www.pogoe.org/Minimum_Geriatric_Competencies
What are the competencies and where are they in University of Nebraska College of Medicine (UNCOM) curriculum?
| AAMC Minimum Geriatric Competencies | ||
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MEDICATION MANAGEMENT
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Location in curriculum. Coursesrequiredfor all students. | Location in curriculum available as elective only |
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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 |
-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 |
-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.
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-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
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| 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 |
-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 |
-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 |
-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 |
-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 rotation# |
| 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 rotation# -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
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-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 rotation# |
| 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 rotation# |
| 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
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| 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
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| 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 |
-M4 Geriatric Sub
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| 26) Conduct a surveillance examination of areas of the skin at high risk for pressure ulcers and describe existing ulcers. |
-M2 Geriatrics Lectures
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-M3 Ambulatory |
| * 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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