Competency Based Curriculum

Program: Internal Medicine

Program Director: Mohamed Siddique, MD

Specialty/Course: Geriatrics

Curriculum Coordinators: 1. Joel Steinberg, MD

2. Marc Feldman, MD, FACP

Administrative Support: 1. Carol Maurizio

2. Carla Marshall

Date Revised: February 1, 2009

Competency	Objectives Specific	Educational Experiences Knowledge/ Skills Integration/Application	Assessment Tools
Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health	Learner based and not teacher based education. Learners should be able to examine patients efficiently and accurately Learner should learn how to evaluate, work-up and treat common geriatric problems under supervision of board certified geriatricians.	Inpatient Geriatrics consultation Memory Clinic at DMC Physiatry Clinic Nursing Homes ACE (Acute Care of Elders) Unit Morning report Clinical-pathological conference Medical grand rounds M & M conference PERKS (Promoting Excellence in Resident’s Knowledge and Skills) – OSCE	Mid & End of rotation evaluation by attending PERKS – Evaluated at the end of each session - OSCE
Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care	Learn patho-physiology, clinical presentation, lab & radiographic evaluation and management of important geriatric problems. Commitment to continuous evidence based learning Demonstrate analytical thinking Learn management of geriatric emergencies e.g. the agitated patient.	Morning conference three times a week by the Geriatric Faculty Interdisciplinary meetings with the ACE unit team Case based discussions Board review course for PGY-II and III Medical grand rounds M & M	Monthly exam for all house staff Pre and post test on geriatric issues. Monthly PERKS program - OSCE In-Training exam Monthly evaluation by attending of residents knowledge & clinical skills. 6. Quarterly evaluation with the advisor
Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals	Communicate effectively with attending faculty Demonstrate effective patient/family interviewing skills Establish excellent relationships with patients/families Able to educate and counsel patient/families Improve listening skills Able to maintain comprehensive, timely, legible medical records Prepare and present effective medical presentations to peers	Ambulatory case discussions with attending. PERKS program - OSCE Oral/Poster presentation and discussion Peer-group discussion Interaction & communication with other health care personnel involved in patient care e.g. radiologist, pathologist, dietitian and social worker.	Rounder’s evaluation through direct observation and feedback by patients & ancillary staff. PERKS program – OSCE
Professionalism as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population	Treat patient and families with respect and consideration Treat nursing and other health care professional with respect Understand issues of race, religion, sexual orientation, disability, age, culture, gender etc. in patients and other health care providers Always respect patients’ autonomy Serve the interest of the patients Maintain trust by managing conflicts of interest Always be honest with patients Always maintain patients’ confidentiality Strive to improve patients’ quality of care Maintain appropriate relations with patients	MDM course Noon lectures by faculty ABIM case modules – Done during MDM course Daily interaction with health care professionals Peer-group discussion Faculty Role modeling	Monthly rotation evaluation by attending Quarterly Advisor/Advisee meeting CMR and faculty feedback at residency operation committee meetings
Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care	Self directed learning to keep up with new developments in the management & changes in practice guidelines. Learn and demonstrate knowledge of scientific study design and statistical methods Learn to accept feedback from others Regularly self-assess Use information technology to manage information Facilitate learning of others	Ambulatory lectures MDM course for all house staff Evidence Based Medicine course for all house staff Journal club, M & M exercises Book: Users’ guides to the Medical Literature (JAMA) Self-directed inquiry Interactive computer programs	Residents’ Grand Round presentation Residents’ Journal club presentation Poster/Oral presentation at scientific meetings i.e. ACP-MI Chapter, National Meetings, annual OHEP research day, annual Departmental research day Periodic chart audit for compliance with current guidelines and compare to NCQA benchmarks Quarterly Advisor meetings
Systems-Based Practice as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system for health care and the ability to effectively call on system resources to provide care that is of optimal value	Practice cost-effective care Learn to minimize patient care errors Understand various types of health insurances and how it impacts patient care in both in-patient/out-patient settings i.e. LOS, UR and prescriptions Advocate for patients within the health care system	MDM course Net learning Medical Errors – Workshop M & M conference Noon lectures by faculty on the following topics: § Introduction to Managed Care § Insurances § Negotiating Managed Care Contracts § Economics of Managed Care Contracts	Monthly rotation evaluation by attending Weekly Interdisciplinary case conference Quarterly evaluation with the advisor

Specific educational experience expected during geriatric rotation:

Geriatric assessment by appropriate use of:

1. History, physical, mental status examination.

2. Evaluation of functional status and independence in ADLs

3. Laboratory studies.

4. Evaluation of social and economic support, and safe living environment

Topics of special interest to geriatric medicine

1. Cognitive impairment,

2. Depression and related disorders

3. Falls,

4. Incontinence

5. Osteoporosis and fractures

5. Sensory impairment

6. Pressure ulcers

7. Sleep disorders

8. Senior (elder) abuse

9. Malnutrition

10. Functional impairment

11. Pharmacologic problems associated with aging including changes in pharmacokinetics and pharmacodynamics, drug
interactions, overmedication, appropriate prescribing, and adherence.

12. Psychosocial aspects of aging, interpersonal and family relationships, living situations adjustment disorders, depression,
bereavement, and anxiety.

13. The economic aspects of supporting services such as Medicare, Medicaid, capitation, and cost containment.

14. Ethical and legal issues pertinent to geriatric medicine: limitation of treatment, competency, guardianship, right to refuse
treatment advance directives, wills, and durable power of attorney for medical affairs.

15. General principles of geriatric rehabilitation, physical medicine modalities, exercise, functional activities, assistive devices

environmental modification, patient and family education, and psychosocial and recreational counseling.

16. Home care, including the components of a home visit, accessing appropriate community resources to provide care in the
home setting.

17. Hospice care, including pain management, symptom relief, comfort care, and end-of-life issues.
Resource Materials

Recommended Textbooks:

1. Principles of Geriatric Medicine and Gerontology

William R. Hazzard, Fifth Edition, 2003

2. Harrison’s textbook of Internal Medicine

3. MKSAP 14

Relevant Practice Guidelines and Electronic/Web Based Resources:

(a) Guidelines at www.guidelines.gov by the American Geriatrics Society

(b) Guidelines at www.americangeriatrics.org

(c) Resources at www.alz.org (Alzheimer’s Association)

(d) Medline at OVID