Geriatric Selective Rotation
Welcome to the Geriatric PGY2 Selective rotation! You will spend the month long block working with our geriatricians in a combination of ambulatory, inpatient and long term care experiences based on your selective choice. In these settings, you will perform comprehensive geriatric assessments and address quality of life issues with older adults.
PLEASE NOTE: PGY2 Family Medicine Residents must submit a completed Geri Selective Request Form at least 2 months prior to starting the rotation. Download request form.
SELECTIVE OPTIONS:
Skilled Nursing Selective (SNIFF, A-1, A-2)
The SNIFF selective will give you additional experience in caring for patients who are short term admissions for rehabilitative care. Emphasis will be on rehabilitation and management of complex medical problems and the communication with involved family. Patients are elders recently discharged from the hospital. This rotation will include training in wound care, extended medical management of subacute and chronic diseases, as well as emotional and mental conditions.
Schedule Template (subject to change, based on faculty availability)
| Rotation A-1 (Dr. Espino) | |||||
| MON | TUES | WED | TH | FRI | |
| AM | Parklane + | FHC | FHC | FHC | Parklane + |
| PM | Nix Clinic + | Nix Clinic * | Conference | Parklane West Clinic + |
FHC |
| Rotation A-2 (Dr. Ye) | |||||
| MON | TUES | WED | TH | FRI | |
| AM | Airforce Village + | Airforce Village Clinic + |
Nix Clinic | FHC | FHC |
| PM | Nix Clinic | Airforce Village | Conference | FHC | Nix Clinic + |
* = one day per month during continuity nursing home rounds.
+ = resident with assessing geriatrician
Objectives:
- demonstrate appropriate interdisciplinary coordination of the actions of multiple health professionals, including physicians, nurses, social workers, dieticians, and rehabilitation experts, in the assessment and implementation of treatment.
- provide postoperative assessment and involvement in management of elders admitted to skilled nursing facility environments.
- demonstrate greater awareness of and familiarity with skilled nursing are physical medicine and rehabilitation.
- demonstrate an understanding of psychosocial aspects of aging, including interpersonal and family relationships, living situations, adjustment disorders, depression, bereavement and anxiety.
Hospice/Palliative Selective (HOSPICE, B)
The HOSPICE selective will focus on care at the end of life. Emphasis will highlight the transition of curative medicine into palliative and hospice medicine. Individuals will be able to identify core and disease-specific end-stage indicators in the predicting of 6-month mortality. They will also become familiar with the roles of the hospice interdisciplinary team (physician, nurse, social worker, and chaplain) during this transition and in providing informed consent to patients and families. The process of completing advance directives and reviewing legal and ethical landmark cases involving life sustaining measures and pain management will be included. Specific tools and techniques for effective communication will be modeled in the context of providing end of life care. Best practices in assessing and managing pain and non-pain symptoms at the end of life will be provided. Administrative and regulatory coordination of hospice services within the LTC setting will be included.
Schedule Template (subject to change, based on faculty availability)
| Rotation B (Dr. Finley) | |||||
| MON | TUES | WED | TH | FRI | |
| AM | Hospice + | Nix Clinic * | FHC | FHC | FHC |
| PM | Nix Clinic | Nix Clinic * | Conference | FHC | Morningside Manor + |
* = one day per month during continuity nursing home rounds.
+ = resident with assessing geriatrician
Objectives:
- gain knowledge and understanding of the roles of palliative and hospice care including the hospice interdisciplinary team (physician, nurse, social worker, and chaplain) in end-of-life care for older patients and their families.
- become familiar with predicting 6-month mortality via core and disease-specific end-stage indicators.
- know and utilize tools and techniques for communicating effectively when delivering bad news, working with difficult cases, patients and/or families.
- know bet practices recommendations for assessing and managing pain.
- know best practice methods for managing non-pain symptoms at the end of life.
Geriatric Psychology/Psychiatry Selective (GEROPSYCH, C)
The GEROPSYCH selective will focus on caring for elders with dementia or related disorders. Emphasis will be on behavior management and prevention of iatrogenic effects in this frail elder population. This rotation will enhance training in interdisciplinary approach to improved care in long term care by providing psychotropic meetings in 2 different facilities. A rehab component will also be offered.
Schedule Template (subject to change, based on faculty availability)
| Rotation C (Dr. Oakes) | |||||
| MON | TUES | WED | TH | FRI | |
| AM | Nix Clinic | Buena Vida + | Nix Clinic | FHC | FHC |
| PM | Nix Clinic | Buena Vida * | Conference | FHC | FHC |
* = one day per month during continuity nursing home rounds.
+ = resident with assessing geriatrician
Objectives:
- demonstrate knowledge of the major etiologies of dementia and their clinical, historical and pathological correlates and risk factors.
- demonstrate a working knowledge of the epidemiology, common etiologies, associated clinical symptoms, treatment options and prognosis for delirium and the reversible causes of dementia.
- demonstrate knowledge of the available treatment options for Alzheimer's and associated dementia, both the primary cognitive process and associated psychiatric symptoms.
- demonstrate an appreciation of caregiver issues related to dementia, such as end of live care, education concerning dementia, resources available and the stress of caring for a demented loved one.
All selectives will have some element of ambulatory geriatrics experience and long term care (nursing home) experience.
Ambulatory Geriatric Experience - You will spend time at the Nix Senior Health Care Center (or the Airforce Village or Parklane West clinics) working under the supervision of one of the department geriatricians in evaluating new patients and seeing follow up patients. There are no more than 5 patients assigned per provider which allows you the extra time you need to work through the unique problems of the frail older patient.
Objectives:
- diagnose and treat the ambulatory, frail elderly with a goal of evaluating one (1) new geriatric patient and four (4) follow up geriatric patients each week.
- complete one geriatric assessment, including medical, affective, cognitive, functional status, social support, economic, and environmental aspects related to health; activities of daily living (ADL); and the instrumental activities of daily living (IADL).
- gain skills and experience with the unique aspects of geriatric preventive medicine, including nutrition, oral health, exercise, screening, immunization, chemoprophylaxis against disease, and advanced directives, and durable power of attorney fro medical affairs.
- gain awareness of the cultural aspects of aging, including knowledge about demographics, health care status of older persons of diverse ethnicities, access to health care, cross-cultural assessment, and use of an interpreter in clinical care.
- experience family meetings; gain awareness of the pivotal role of the family in caring for elderly members and the community resources (formal support systems) required to support both the elder patient and family.
Nursing Home Objectives - This experience is complementary to your longitudinal experience and will focus on handling acute issues that come up in the care of nursing home patients. This includes common problems such as change in behaviors, skin problems and rehabilitation issues.
Objectives:
- diagnose and treat the acutely ill, frail elderly in the less technologically sophisticated nursing home environment.
- gain knowledge about the management of patients in long-term care settings and of the administration, regulation, and financing of long-term institutions. Learn the continuum of available care, from short to long term care.
- gain experience with the basics of geriatric rehabilitation to include principles related to the use of physical medicine modalities, exercise, functional activities, assistive devices, environmental modification, patient and family education, and psychosocial counseling.
- gain awareness of the ethical and legal issues pertinent to geriatric medicine, including limitation of treatment, competency, guardianship, right to refuse treatment, advance directives, wills, and durable power of attorney for medical affairs.
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 left toolbar of 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.
SELECTIVE HEALTH CARE SITES
Visit the maps website for directions to other geriatric healthcare sites OR click on each site below for additional information on the site.
NIX SENIOR HEALTH CENTER
Parking - Park at Mid City Garage (see map). Validate your parking each day at the NIX garage (ground 
floor of the Nix Hospital). Identify yourself as a resident Nix Senior Health Care Center physician. We can not pay for parking if you do not follow these instructions.
If you drive down to the Nix after hours, park in Valet. If you happen to be in the Mid City Garage after 5pm, contact Nix security at 271-1800 to escort you to your car.
Call Room - Although no call rooms are available, Nix Senior Health Care outpatient office (11th floor) has computer access and a place to rest during the night. There is coded entry so please take down the code when you get there. If you need to spend the night in-house contact the nursing supervisor to arrange for a private room.
Cafeteria - 6th floor. There is a 25% physician discount with jacket and UHS id on. The cafeteria takes both cash and credit cards. Lunch is provided free during the Monday Geriatrics Grand Rounds, but not at any other time.
Surgeons Lounge - 23rd floor. Please wear your jacket. If anyone asks you tell them you work with the geriatrics group. Free breakfast, lunch, coffee and sodas are available while they last.
SACU ATM - available on the first floor in valet parking.
Further Information - For further information on the Nix Hospital, go to www.nixhealth.com .