Periods	Pre-requisite	Sites & Slots	Hours	Weeks
1,2,3,4,5,6,7,8,9,10,11	Year 4 status	1@LVHN	FT, 40 hr wk	4

Drs. Anne Yawman, Catherine Glew, Gainneos Goldie, Russell Rentler, Francis Salerno, and Tatyana Kemarskaya

The geriatric rotation will offer experience to observe and manage elderly patients with a wide variety of medical conditions on an inpatient and outpatient basis. Students function as members of a team with a resident and attending physicians, offering care for patients in acute, ambulatory, community and long-term care settings, in order to understand the interaction of natural aging and disease as well as the techniques of assessment, therapy and chronic and acute disease management.

Objectives

Understand the normal anatomical and physiologic changes associated with aging and the concepts of homeostenosis and frailty.
Recognize the atypical presentations of illness in the geriatric patient
Evaluate and manage the common geriatric conditions including: delirium, dementia, depression, gait disorder and falls, syncope, unintentional weight loss, pain syndromes, urinary incontinence, and constipation
Assess for and prevent the hazards of hospitalization of the geriatric patient including: 'polypharmacy', delirium,deconditioning and functional decline, malnutrition and pain syndromes
Recognize the prevalence of complex and chronic disease in the elderly and its impact on functionality and quality of life
Understand and utilize the AGS Beer’s Criteria for potentially inappropriate medication use in the older adult
Administer and interpret the various standardized instruments used for assessment of cognitive function, psychological affect and physical function in the geriatric population
Understand the various post-acute rehabilitation and long-term care settings, including the duties of the interdisciplinary team members and Medicare/Medicaid and other insurance payment options

Students will see patients on the hospital geriatric consultation service, the ambulatory primary care and out patient consultation service and in several post-acute care rehabilitation and long-term care settings under the direct observation of the geriatric attendings with focus on addressing all the above listed objectives. They will participate in monthly geriatric journal club and geriatric trauma meetings. Students will be given hard copy reading booklets they are expected to review, and will be expected to informally present a geriatric journal article at the end of the rotation. Students will choose one acute hospital patient from the consultation service for continuty follow through to the post-acute rehabilitation setting and provide a written summary about the experience including: a summary of the patients course in hospital through rehabilitation, interviews and examinations done with the patient, transitions of care concerns, care plan formulations for post-rehab and their own recommendations for improvement of the system.

Evaluation

The students will be evaluated based on the ACGME competencies. Students will receive a short pre-test and post-test of geriatric cases with multiple choice answers they are expected to complete at the beginning and again at the end of the rotation with expectation of a post-test score >/=80% correct . Grades are determined by: 50% clinical evaluation, 25% continuity patient summary writeup, 15% post-test score, 10% journal article presentation.

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