Geriatric Evaluation & Management

Educational Purpose:

The GEM rotation is designed to give Internal Medicine residents a basic overview of the evaluation and management of geriatric patients. As a core member of the multidisciplinary team, the resident will be exposed to the process of comprehensive geriatric assessment. The residents will be involved in providing continuous care to the cohort of GEM patients, in the inpatient and outpatient settings.

Goal:  Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Residents are expected to:

PGY 1

PGY 2 and 3

1. To recognize polypharmacy and understand the use of medications in the geriatric population.
2. To learn the appropriate evaluate of geriatric patients with mental status changes.

Medical Knowledge Goals and Objectives:

Goal:  Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. 

Residents are expected to:

PGY 1

PGY 2 and 3

1. To understand and learn the elements of comprehensive geriatric assessment.
2. To recognize and care for common syndromes in the geriatric patient population.

Practice-Based Learning and Improvement Goals and Objectives:

Goal: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.

Residents are expected to develop skills and habits to be able to:

PGY 1

PGY 2 and 3

Systems Based Practice Goals and Objectives:

Goal: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Residents are expected to:

PGY 1

PGY 2 and 3

1. To function as part of a multidisciplinary team in caring for geriatric patients.

Professionalism Goals and Objectives:

Goal: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

Residents are expected to demonstrate:

PGY 1

PGY 2 and 3

Interpersonal and Communication Skills Goals and Objectives:

Goal: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. 

Residents are expected to:

PGY 1

PGY 2 and 3

Teaching Methods:

The majority of teaching on the GEM service is case-based at the time of clinical encounters either in the inpatient or outpatient settings. Inpatient rounds and outpatient clinic visits provide the best opportunities for education. Additionally, the residents are given 5 to 7 didactic lectures on common geriatric problems/syndromes over the course of the month. Each resident is also required to make a 30 minute presentation to the multidisciplinary team.

Mix of Diseases and Pathological Material:

Residents care for patients with a wide variety of clinical syndromes including coronary artery disease, CVAs, CHF, diabetes mellitus, pneumonia, COPD, dementia, and peripheral vascular disease. Residents also assess patients with common geriatric problems such as polypharmacy, incontinence, altered mental status, etc.

Patient Characteristics:

Residents care for an elderly population diverse in ethnicity and gender.

Types of Clinical Encounters:

The GEM rotation takes place in the ten bed inpatient unit on ward 4A and in the outpatient facilities at the VAMC in Charleston. Residents perform all routine ward duties on the inpatient service including performing H and Ps, daily rounds, writing orders and progress notes. Residents present updates on all inpatients during weekly multidisciplinary meetings. Residents attend outpatient clinic 2 half-days per week and participate in developing a care plan for all new and return patients. Lastly, residents are involved in the initial evaluation of consults to the GEM service.

Procedures and Services:

Residents do not commonly perform procedures on this rotation, though they occasionally may perform arthrocentesis or central catheter placement under the supervision of the attending physician. Residents are expected to interpret all EKGs and other studies performed on their patients.

Supervision:

The GEM team consists of a PGY 2 or 3 resident, the attending Geriatrician, specialty nurses, clinical pharmacists, a psychologist and OT/PT. The upper level resident performs the H and P, writes progress notes, and writes orders. The upper level resident also leads rounds and helps formulate the care plan. All patient care encounters are directly supervised by the attending physician.

Educational Resources to be Used and Reading Lists:

The residents are given an in-depth syllabus at the outset of the rotation which consists of educational materials and approximately 25 journal articles. The residents are expected to read this syllabus and keep it as a reference resource.

Method of Evaluation of Resident Competence:

Residents are evaluated using the global evaluation form. Patient Care is assessed based on direct observation and complete review of all records. Medical Knowledge is assessed through direct questioning and observation. Interpersonal Skills and Communication is assessed by observation of interactions with patients and families. The attending physician evaluates Professionalism through direct interaction and observation of the resident. Systems-Based Practice is evaluated based on interactions with the multidisciplinary GEM team. Practice-Based Learning is evaluated based on the ability to consult the literature and incorporate the tenets of geriatric medicine throughout the rotation. Residents receive formative evaluation throughout the month. The residents evaluate the rotation and the attending physician through the E*Value system.