UTHSCSA HARTFORD CENTER FOR EXCELLENCE IN GERIATRICS EDUCATION

Geriatrics Gynecology Rotation

image_elderlywomanpaintingWelcome to the Geriatrics Gynecology rotation! You will spend the month long block working with our geriatricians in our outpatient facility, the Nix Senior Health Care Center. During this rotation, you will have the opportunity to care for a variety of elder patients in both the ambulatory clinic an the cognitive disorders clinic. In these settings, you will perform comprehensive geriatric assessments and address quality of life issues with older adults.

OBJECTIVES

  • Discuss the general principles of aging, the changing demographics of the female population in the United States and the disease and chronic conditions prevalent among women older than 65.
  • Perform competently a history and physical examination, evaluate the functional status of a woman, and provide appropriate periodic screening, evaluation and preventative services at an ambulatory or inpatient visit.
  • Discuss the responses to medication and the effects of multiple medication use on the health and well being of elderly women.
  • Provide the appropriate preoperative evaluation and perform competently the operative procedure and postoperative management for gynecologic and urogynecologic operations required for older women.
  • Develop a positive attitude toward the provision of services to older women; understand the impact of socioeconomic status, lifestyle, and social support on the well being of older women; and understand the problems of chronic disability and the benefits and limitations of advanced directives in end-of-live care.
  • The resident should also understand and be able to explain the relevant information or demonstrate the clinical skills needed to perform geriatric care in the following areas:
    • General principles of aging in women
    • Functional assessment of the geriatric patient
    • Screening assessments
    • Preventive health services
    • Periodic evaluation, physical examination and tests, health education and other preventative care as recommended by ACOG
    • Surgical Care
    • Evaluation for surgery
    • Pre- and Postoperative management and evaluation
    • Communication skills and interpersonal interactions
    • Common diseases, disorders, and health concerns of aging women
    • Pharmacology, pharacokinetics and pharmacodynamics
    • Ethical and legal issues
    • Coding and reimbursement

RESIDENT EVALUATION

Resident evaluation will be weighed towards three (3) distinct areas: Attitude & Behavior, Problem list Completion and Knowledge Base. Comments on your evaluation will primarily be directed toward these three areas.


Attitude & Behavior

Absences - Residents will have no unexcused absences. Two or more unexcused absences may result in you needing to repeat the geriatrics portion of your rotation. Absences are only excused if they have been cleared by an attending at least 24 hours prior to the absence. Excused absences due to an illness must be accompanied by an practicing physician (not colleague) note.

 

Tardiness - Residents will not be chronically tardy. Clinic starts promptly at 8:15am and 1:00pm. Call if you anticipate that you are going to be tardy (568-5600). Tardiness of more than 30 minutes will be treated as an absence.

 

Dress - Dress appropriately. As our patients represent a unique cohort with preconceived notions of how physicians should interact with them it is requested that residents dress respectfully. Men should wear ties and women appropriate dress. We take this very seriously.

 

Problem List Completion

The resident is responsible for the completion of the new and follow up patients problem list in a responsible and complete manner. Three (3) resident-evaluated patient charts (electronic) will be reviewed at random. Outstanding residents will have be expected to have all elements of the problem list document complete or documented as being in progress on ALL three new patient charts reviewed. Residents who fail will have missed basic elements such as the medical problem list or the geriatrics instrumentation list on at least one of the charts.

Knowledge Base

You are expected before the rotation to have reviewed the geriatrics syllabus and be familiar with its content. Although, we appreciate hard work and it will be reflected under the attitude section of your evaluation, hard work is not a substitute for lack of knowledge. If you do not know the information, but are willing to look it up it still constitutes a lack of knowledge.

BEFORE YOU START

  • Familiarize yourself with basic geriatric care.
    The following website, Geriatrics at Your Fingertips, is good for a quick overview, http://www.geriatricsatyourfingertips.org/default.asp . Within the geriatrics syllabus, review the sections on Aging, Geriatrics Syndromes, and General Management principles in detail.
  • Review the geriatric assessment instruments listed on this site.
  • Review the Clinic and Sevocity EMR orientations, listed in the Orientation Info area on this page.

**ABSENCES: Please let the faculty and staff know your post call schedule and any additional absences so that we know when to expect you in clinic. The attending needs to be aware of any absences and absences need to be posted on the whiteboard. We do not suffer unexcused absences well, so be forewarned.

 

NIX SENIOR HEALTH CENTER INFORMATION

In the Nix Senior Health Center, older patients are seen both for consultative and ongoing primary care geriatrics services. The Center offers a multidisciplinary approach in the outpatient care of frail, older adults with onsite support from nursing and consultative support from social work, physical therapy, occupational therapy and speech therapy. Again, please review the clinic orientation listed in the left-hand tool bar on this page. The orientation walks you through how to use the ACIS electronic medical record system.

GETTING STARTED

Show up at 8am the first day for a brief orientation. If the attending is not available at 8am, review the orientation information again and then proceed to seeing the first patient.

Parking

The Nix Senior Health Center is located at 414 Navarro, STE. 1111 in downtown San Antonio. Please park at Mid-City Garage across the street from the Nix (see map). Have your parking ticket validated at the Nix garage on the first floor. Let them know that you a physician working with the Nix geriatrics group.