The 4th Year Geriatric/Rehabilitation Clerkship
The M-4 Clerkship is a two-week required geriatrics rotation for all 4th year medical students at one of four locations – two located in Gainesville, FL and two located in Jacksonville, FL. The student will serve as the acting intern for frail elders in a subacute, rehabilitative, palliative care, or long term care setting. Students will manage medical problems and also will learn how to function as part of an interdisciplinary team. The clerkship focus is twofold: Falls and Dysmobility during the first week, and Dementia and Psychosocial Issues in the Elderly during the second week. Monday through Friday morning of each week will be spent at the assigned facility, and each Friday afternoon all students will meet in the conference room at the Gainesville VA GRECC to participate in required small group activities.
The Objectives of the Clerkship are:
- Patient Care
- Diagnostic - History
- Diagnostic – Physical Exam
- Information Management – Recording and presenting data gathered from history and physical exam
- Medical Knowledge: Encompasses fund of knowledge AND ability to interpret and synthesize data into an assessment and plan
- Practice-Based Learning - Encompasses self-assessment, reading, critical appraisal, and use of information technology to enhance clinical skills/patient care, recognizing errors and learning from mistakes
- Interpersonal and Communication Skills
- Systems-Based Practice – Encompasses collaboration with entire interdisciplinary health care team, resource utilization, cost-conscious/evidence-based care, and using the “system” to optimize individual patient care.
The aim of this clerkship is to provide students with a two-week in-depth experience working on an interdisciplinary team to improve the function of frail older patients and manage their acute and chronic medical problems. Older people over age 65 account for 50% of hospital usage and a large share of other medical services. An older patient sees on average 14 physicians in various medical or surgical specialties every year. In order to care for the unique needs of this rapidly growing segment of the population, graduating medical students must have the knowledge and understanding of the focus of geriatric medicine and rehabilitation, which is to provide effective and compassionate care in restoring health and function of older patients. Goals of care must be individualized, with an appreciation that function is usually the outcome of primary importance and that palliation rather than cure is often paramount.
A geriatrician is a member of an interdisciplinary health care team which develops personalized rehabilitation plans for each patient with the aim of restoring their physical, cognitive, and social function. Whenever students are involved in the care of frail older patients during this clerkship, we urge you to answer these questions in order to understand their rehabilitation needs:
- What are the physical, cognitive, and social functions your patient has lost as a result of debility?
- What functions does your patient need to regain in order for him/her to be able to go home?
- What are the conditions preventing the patient from improving their functions?
- What types of services, support, and equipment, will your patient and caregiver need in order to compensate for his/her functional loss?
This clerkship is designed to promote self-directed learning. Students are to be involved in every aspect of their patients’ care: writing orders, observing rehabilitation therapy sessions, participating in the interdisciplinary health care team conferences and holding patient/family meetings. Students are expected to actively participate in weekly case conferences and complete on-line, self-assessment questions on topics in geriatrics before each conference. These topics are carefully selected to complement other clerkships and minimize overlap between clerkships. The clerkship also is designed to create a humane environment that fosters respect, personal integrity, service orientation and a sense of personal well-being.
Caring for older patients takes time. The presence of concurrent chronic conditions, the use of multiple medications and atypical presentations of illness in this population make clinical decision-making more complex and time-consuming. Impairments in a patient’s mobility, vision, hearing, and cognition, combined with the frequent need to involve family members and other health care surrogates in complex discussion of benefits and risks of clinical care require more physician time and attention. In Geriatric Medicine, we favor “high-touch” over “high-tech.” In this clerkship, the students are expected to treat their patients with respect, compassion and humility as if they were treating their own family members.
For further information contact:
John Meuleman, MD, Clerkship Co-Director
Laurence Solberg, MD, Clerkship Director
Brian Stanton, Clerkship Coordinator, firstname.lastname@example.org