The 4th Year Geriatrics/Rehabilitation Clerkship MDC 7140
MDC7140, is a four-week required geriatrics rotation for all 4th year medical students at multiple north Florida locations in Gainesville and Jacksonville.
Monday through Thursday of each week will be spent at the assigned clinical rotation site. Each Friday there will be MANDATORY didactic and experiential learning sessions. All students will meet in the assigned rooms to participate in required small group activities. Requests for excusable absences and make up must be submitted at least 4 weeks in advance (see syllabus for details). We highly discourage Friday absences and encourage you to use professional judgement to manage your personal time in your final year of medical school (including policy review).
The clerkship consist of 3 rotations
- 1 week of geriatric medicine (outpatient clinic or hospital consults)
- 1 week of palliative care (UF Health, Marion or Haven Hospice)
- 2 weeks of rehabilitation (skilled nursing and rehab facilities)
The student will evaluate frail elders in an outpatient clinic, a hospital consultative service, a palliative care facility, a sub-acute rehabilitation facility, or long-term care facility. Students will manage medical problems and also will learn how to function as part of an interdisciplinary team.
Focus: to familiarize the students with the different settings in which geriatrics care is provided.
Goal of the Geriatric Medicine week: to understand how to talk to older patients and to be able to do a history and physical exam in a geriatrics setting.
The Palliative Care rotation will expose students to end of life and hospice issues, rotating in either UF Health Palliative or area Hospices (Marion and Haven),
Friday Mornings all students on the Geriatric Medicine and the Palliative Care rotations will do the recorded simulation with standardized patient at the UF Health Senior Care Clinic, unless specified otherwise (see syllabus for details)
The Rehabilitation rotation goals are twofold
- Week 1: Understand Falls and Dysmobility
- Week 2: Neurocognitive issues in the Elderly
Required: Friday afternoon Group sessions at the Gainesville VA GRECC T2
The Objectives of the Clerkship are: (see syllabus for details)
This clerkship is designed to promote self-directed learning. Students are to be involved in every aspect of their patients’ care: interviewing patients, documenting visits, 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 didactic sessions, 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.
The Department’s expectations of your performance are in line with the College of Medicine’s competency based curriculum. There are several objectives, both general and specific. You will experience, be taught, and evaluated specifically in the following competencies:
- Patient care (PC)
- Medical knowledge (MK)
- Experience-Based Learning and Improvement (EB)
- Interpersonal Communication (IC)
- Professionalism (P)
- System based practice (SBP)
- Students will demonstrate professionalism and a caring attitude in working with older adults and in particular, frail elderly. (P)
- Recognize and treat each patient as a whole person, integrating body, mind and spirit. (P) (PC)
- Students will be able to obtain historical information and conduct medication reviews and evaluate medication interactions and side effects. (MK) (EB)
- Students will be able to describe geriatric syndromes, including but not limited to: falls, delirium, incontinence, pressure ulcers, polypharmacy, depression, dementia, osteoporosis, sensory deficits including hearing loss, visual and gait impairment, failure to thrive, osteoarthritis, immobility and functional capacity. (MK)
- Students will be able to form a patient-centered, interprofessional and evidence-based management plan. (PC) (EB)
- At the end of the one week palliative care rotation students will be able to (MK) (SBP)
- Perform a patient assessment
- Create a care plan to address physical, psychological, social, practical and spiritual needs
- Discuss treatment withdrawal (antibiotics, hydration)
- Discuss advance directives with patients
- Discuss DNR orders
- Describe the members of a palliative care team
- Describe venues available to patients for palliative and end of life care
- Reflect on personal response to working with dying patients
No text book required. All required readings will be posted on Canvas E-Learning.
The aim of this clerkship is to provide students with a four-week in-depth experience working as a geriatrician and 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 in multiple settings and restoring health and function of older patients through rehabilitation therapies. 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 care and rehabilitation plans for each patient with the aim of maintaining or 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 medical care, goals of life, and 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?
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