Geriatric Medicine Subspecialty Education Program

From U of M Internal Medicine Wiki

Ancestor document: http://umanitoba.ca/faculties/health sciences/medicine/units/intmed/students/othersubsp/geriatricedu.html

Contact

For further information regarding the Geriatric Residency Training Program please contact:

Overview

The subspecialty residency training program in Geriatric Medicine is a two-year program accredited by the Royal College of Physicians and Surgeons of Canada. The first eight months of the program are designed to provide the trainee with a strong core of clinical experience in geriatrics.

Year 1: PGY 4

In-Patient: The first three months are spent on the inpatient Geriatric Assessment and Rehabilitation Unit at St. Boniface Hospital and this is combined with hospital consultations. In this rotation the resident sees a broad range of clinical diagnoses, gains familiarity with the geriatrician’s approach to the hospital care of the frail elderly and gains experience working intermittently with a multidisciplinary team. Working with hospital consultation begins the process of developing effective consultation skills. Out-Patient: The following three months are spent in a day hospital; here the resident gains the ability to manage complex outpatients. In addition the resident now gains familiarity with community-based supports available to the frail elderly. During the rotation the resident will work closely with the Geriatric Program Assessment Team including accompanying the team on several home visits and performing urgent consultations as needed. The resident is expected to visit a minimum of four community agencies. Finally, it is during this rotation that the resident starts to gain an understanding of broader issues in managing programs and systems and starts to initiate quality assurance project. Geriatric Psychiatry: The third rotation is geriatric psychiatry.

Year 2: PGY 5

After gaining a solid footing in geriatric content the resident has twelve months to expand their knowledge base in specialized areas of geriatrics. Longitudinal Clinics: Together with the Program Director the resident will choose a series of outpatient experiences (such as Movement Disorders Clinic, Continence Clinic, Diabetic Foot Ulcer Clinic) and will work in these clinics longitudinally for a minimum of two month period. Palliative Care/Rural: Time is spent in palliative care as well as a month combining experience in community hospitals in Winnipeg as well as rural Manitoba. Electives/Research: During this twelve month block there are five months of electives as well as three months of research under the supervision of [Dr. Philip St. John]. Administration/Management: The final four months of the training program are designed to ensure the resident can function at the level of a consultant at the completion of the training program. There is a one month rotation focusing on administrative and management skills as well as developing awareness of the unique issues in long term care. Finally, there is a three month rotation on the Geriatric Assessment Unit and inpatient consults. At this stage the resident is expected to function as a junior consultant taking responsibility for priorizing patients on the waiting list, taking leadership with the multidisciplinary team and taking leadership in terms of teaching rotating residents.

Resident Selection Criteria

Candidates for fellowships within the Geriatric Medicine Postgraduate Program will be selected based on the following:

  • Academic achievement
  • Communication/interpersonal skills
  • Reference letters, 3 including one from candidate’s current Program Director
  • Demonstrated interest in geriatric medicine

Interview

The initial application process consists of the applicant forwarding a letter of interest, curriculum vitae and three letters of reference to the Postgraduate Program Director - Geriatric Medicine. One letter of reference must be from the current Program Director. Applicants must be Canadian citizens or have landed immigrant status, applicants who are completing their Internal Medicine training outside of Canada must have documentation indicating that the Royal College will recognize their training; they must have passed MCCQE 1 and 2. Applications are reviewed by the Program Director; applicants meeting minimum requirements are then invited for an interview. Applicants outside of Canada may have an initial telephone interview with the Program Director to clarify their circumstances. If they are serious applicants they must still attend for an in person interview.

Specialty Training in Geriatric Medicine

The design and content of the training program is guided by the “Objectives of Training and Specialty Requirements in Geriatric Medicine” (2002) Interro-01.gif That seems a long time ago - are these still the standards used? Could we link to them? User:Ttenbergen 10:25, 22 November 2018 (CST) and the specialty specific Accreditation Standards. The philosophy of the training program is to work with trainees to ensure they have the necessary skills and knowledge to excel in their chosen practice direction. We promote active learning and acquiring the necessary skills to effectively practice and promote life long learning. We strive to foster admiration for the achievements of senior members of our society, empathy as they and their family struggle with illness and decline and a desire to advocate for improvements in systems of care on their behalf.

Overall Program Objectives

  1. Role of Medical Expert
    1. Understand the anatomic and physiologic characteristics of aging.
    2. Recognize the impact of environment as it affects the health care of the elderly.
    3. Diagnose and manage diseases in the elderly:
      1. Describe multiple disease patterns in the elderly and their relationships.
      2. Diseases most often seen in the elderly - arteriosclerotic heart disease, Parkinson's disease, cerebrovascular disease, neoplastic disease, urinary tract disease.
    4. Understand and manage the common syndromes seen in the elderly:
      1. change in mental status including dementia and delirium
      2. falls and immobility
      3. incontinence
      4. polypharmacy
      5. malnutrition
    5. Understand and manage psychological and psychiatric problems of the elderly.
      1. psychology of aging including grief
      2. depression
      3. alcoholism and substance misuse including pharmaceuticals
      4. dementia
    6. Understand and apply the pharmacology principles of drug therapy in the elderly and perform a rationalized drug review.
    7. Obtain a history and perform a physical on each elderly patient, taking into account age-adjusted changes.
    8. Demonstrate skills in assessment of physical, mental, and social status of elderly patients including the administration and interpretation of standardized scales.
    9. Apply age-adjusted standard to X-ray and laboratory data on elderly patients.
    10. Understand the principles of rehabilitation in the elderly.
    11. Understand management of the terminally ill and the ethical, legal, and discretionary aspects of treating mortal illness and irremediable disability.
    12. Formulate an appropriate problem list with achievable goals.
    13. Understand the impact of research and health care of the elderly. Become familiar with specific clinical literature related to the elderly.
    14. Function effectively as consultant to provide optimal, ethical and patient-centred care.
  2. Role of Communicator
    1. Develop rapport and trust with patients and their families.
    2. Listen and respond effectively to patient, family and caregiver concerns.
    3. Provide relevant information to the older patient and their family in a manner that is understandable, encourages discussion and promotes patient and family decision making. Integrate the older patient’s beliefs and value structure into the development of a care plan. Understand the impact of individual values on an elder's health care.
    4. Participate in ongoing dialogue with multidisciplinary staff regarding patient management including provision of relevant information and development of a common understanding of issues and goals.
    5. Communicate effectively through orally and through written records. Demonstrate effective consultation skills by presenting clearly justified recommendations in written or verbal form.
  3. Role of Collaborator
    1. Consult effectively with other physicians, in particular the family physician and health care professionals.
    2. Contribute effectively to interdisciplinary team activities.
    3. When indicated, be able to effectively lead multidisciplinary/interdisciplinary team meetings and family conference.
  4. Role of Manager
    1. Work effectively and efficiently in a health care organization.
    2. Understand the breadth of community, hospital and long term care resources and their organization.
    3. To understand the basic principles of program evaluation and quality improvement as they apply to the care of the elderly patient.
    4. Effectively utilize information technology to optimize older patients care.
  5. Role of Health Advocate
    1. Understand the important determinants of health and successful aging affecting older Canadians.
    2. Understand challenges in accessing resources for unique geriatric populations: e.g. chronic mental health, substance abuse, long term care residents, First Nations, rural populations.
    3. Understand and apply principles of prevention in the elderly, including vaccination, screening, and lifestyle choices.
    4. Recognize issues where advocacy is appropriate.
  6. Role of Scholar
    1. Demonstrate the ability to critically appraise relevant geriatric literature. Understand the limitations of evidence currently to manage the elderly, particularly those patients in those over age 80.
    2. To recognize gaps in knowledge and expertise around a clinical question and formulate a plan to fill such gaps by critically appraising the literature and/or consulting other physicians and health professional.
    3. Participate in a research program, including doing a relevant literature review, formulation of a research question and research design to answer the question, and work towards completing the research project.
    4. Demonstrate effective communication and teaching strategies to facilitate learning of patients, students and other health professionals.
  7. Role of Professional
    1. Deliver the highest quality care with integrity, honesty and compassion.
    2. Understand the ethical and legal issues in practicing as a physician.
    3. Demonstrate respect for other physicians, professionals and staff.

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