Internal Medicine — Rotation Detail
Geriatrics at MKH
Tutors
Description
Given the rise in the number of older adults in our patient population, KIMS Internal Medicine Program introduced Geriatric Medicine as a rotation in the training program.
This one month rotation (previously two months, reduced to one month since COVD pandemic) consists of inpatient geriatric consultations, telemedicine, and geriatric clinics. The residents will have a schedule to know where they will be assigned each day. The aim is to give an introduction to Geriatric medicine and common geriatric syndromes , learn how to conduct a comprehensive Geriatric Assessment (CGA), and understand the team assessment tools.
Attachment:
For the geriatric medicine rotation, residents will be assigned to Mubarak Al-Kabeer Hospital
Geriatric Medicine Unit.
Rotation Structure and Schedule:
On the first day of the rotation, the residents will be introduced to the MDT team and the role
of each member of the team will be explained. An introduction to geriatrics will be given as well as a general guide on how to conduct a comprehensive geriatric assessment (CGA) by one of the attending geriatricians. The resident will then join the attending geriatrician to see the new consults and follow up patients on the ward, or to join Geriatric OPD, or the telemedicine service, according to where they are assigned on the schedule that day. The resident will be expected to see new cases and conduct a CGA following the guide given and to review the case with the attending geriatrician in order to formulate an impression and appropriate plan with regards to mind, mobility, polypharmacy, multi-morbidity, and patient centered goals. Teaching points and guidance will be given throughout the rotation and on a case to case basis.
By the last week of the rotation the resident will be expected to take a lead role to formulate an impression and management plan and lead the MDT team. This is under the supervision of the attending geriatrician.
Expected patients number assigned for resident:
Inpatient services: 15 consults per week
outpatient service: 8-12 new referrals and 18 follow up cases per week.
general geriatric clinic per week
Daily Schedule of geriatric team:
7:30 - 8:00 Internal Medicine Morning Meeting*
8:00 – 8:30 MDT meeting
8:30-9:00 Educational Session
9:00 - 1:30 See new consultations and follow up inpatients on the geriatric list.
Follow up selected patients
Discussion with the referring units
Family meetings if scheduled
One to one case discussions
candidates will do the above activities as inpatient services Or Clinic
All educational activities are mandatory with Residents must maintain at least 75% attendance.
Educational Activities:
Teaching at 8:30- selected topic given by attending physician
Geriatric Academic Day: Every last Wednesday of the month
Presentations:The resident is expected to:
1. Present the inpatient cases they have seen in the 8 AM morning meeting to the MDT team
2. Present a pre-assigned topic to the Geriatric Team and residents on the last week of the
rotation (resources and topic will be provided on the first week of the rotation)
The teaching schedule is subject to minor changes.
On-call Schedule:
It is the resident’s responsibility to contact the internal medicine department site coordinator at Mubarak Hospital to get the Internal Medicine on-call schedule.
Leave:
All planned leaves need to be discussed and approved prior to the rotation.
Objectives:
By the end of the rotation, the resident will be able to:
- Distinguish between normal aging and the diseases of aging.
- Demonstrate the ability to perform an appropriate history and physical examination on
geriatric patient. - Understand the differences in managing common chronic diseases in older adults, such as common infections, Diabetes, Hypertension, Hyperlipidemia, Anemia, Thyroid diseases, Pain, compared to younger patients.
- Recognize the common “atypical presentations” of illness in older adults
- Use of formal geriatric assessment tools and present these findings in an appropriate manner 6. Describe the basic approach, Recognize, evaluate, and initiate appropriate treatment for
the “geriatric giants” and other common medical problems in older adults including:
A. Functional Decline and Rehabilitation
B. Cognitive impairment and psychogeriatric issues including major neurocognitive disorders (dementia), delirium, depression, anxiety, and sleep disorders.
C. Falls.
D. Polypharmacy and medications review.
E. Bone health and osteoporosis.
F. Movement disorders in elderly with focus on Parkinson’s disease, essential tremor and drug induced dyskinesia’s.
G. TIA and minor Stroke.
H. Incontinence.
I. Constipation.
J. Nutritional issues
K. Pressure ulcers basic care - Describe the impact aging has on pharmacology and safe drug prescribing.
- Able to interpret appropriate data related to the geriatrics patient and arrive at reasonable diagnostic and management decisions, weighing alternatives, benefits, and risks of diagnostic and therapeutic options, and co-managing patients appropriately with other specialists.
Evaluations:
Verbal feedback will be given throughout the rotation to discuss strengths & weaknesses and
ensure objectives are being met. At the end of the rotation, a written evaluation will be
completed by the one of the geriatric attendings on the KIMS website.
Typical Resident Schedule— include inpatient, outpatient, teaching activities:
Sunday-Thursday
7:30-8:00 IM meeting
8:00-8:30 MDT meeting
8:30-9:00 Educational Session*
9:00-1:30 Inpatient consults and follow ups, Geriatric OPD, or telemedicine according to schedule
Residents will rotate each day to get exposure to all services (schedule will be provided on day 1 of rotation)
Future Plans:
1.Increased rotation duration back to 2 months for better clinical exposure and cover all
geriatric syndrome .
2.Link with care of elderly in the community ( administration of elderly , primary care and
ministry of social services for possible exposure to home visits, rehab facilities, and long
term facilities (Farah Specialist Center for the Care and Rehabilitation of the Elderly).
3.Improve presentations assigned to candidate with addition to geriatric MCQs cover
Curriculum:
EPA How will you cover it?
C2a. Assessing and managing patients with complex chronic conditions - Part A: Assessment, Diagnosis, and Management
Performing a comprehensive geriatric assessment for complex frail older patient with discussion of diagnosis and treatment plan with tutor.
C3a. Providing internal medicine consultation to other clinical services - Part A: Patient Assessment and Decision-Making
Both inpatient and outpatient geriatric consultations from internal medicine and subspecialties with use of geriatric assessment tools and filling a full plan prior to discussion with tutor.
C6. Assessing capacity for medical decision-making
Exposure to delirium and advance frailty /Dementia in the ward and clinic for basic capacity assessment steps as official capacity assessment done in mental health center in Kuwait .
C9a. Caring for patients at the end of life - Part A: Symptom Management in End of Life
Exposure to end stage frailty and dementia cases with both MDT , patient and family discussions . basics of palliative symptoms management including pain , respiratory distress , nausea , agitation and restlessness , nutritional status .
C9b. Caring for patients at the end of life - Part B: Discussion about transition away from disease modifying treatment
Exposure to end stage frailty and dementia cases with MDT , patient and family discussions with overlap of palliative medicine colleagues
TTP4. Providing consultation to off-site health care providers
Continues telemedicine consultations and care for patients and caregivers with discussion of cases with primary care doctors , dietitians , physiotherapist and clinical pharmacist when required
TTP7. Identifying learning needs in clinical practice, and addressing them with a personal learning plan
Discussion of the need for personal learning plan in our educational activities with supply of resources plus direct clinical bedside learning . mainly to cover the prevalent geriatric syndromes highly needed in clinical practice like falls , dementia care, polypharmacy , Frailty .
TTP8. Identifying and analyzing system-level safety, quality, or resource stewardship concerns in healthcare delivery Focus on both paper and electronic documentations of medical information and connecting different needed services for the patient care . Follow local hospital quality control recommendations.