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Upcoming GRAND ROUNDS - Friday, May 20, 2016- “Stem Cells and Aging”
by Nicole Burnside - Thursday, 19 May 2016, 9:18 AM
 

SPEAKER: Guy A. Howard, PhD

Miami VAHS GRECC, Research Director, Research Professor of Medicine, Division of Geriatric and Palliative Medicine, and Biochemistry & Molecular Biology, University of Miami Miller School of Medicine

When: Friday, May 20, 2016, 8:00 – 9:00 AM

Where: VA Research Conference, 2nd floor, Room 207

 

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  • This 4-week rotation is based at the Miami VA Medical Center.Students will assume responsibility for the care of older patients under the supervision of board-certified geriatricians, geriatric medicine fellows, and members of the interdisciplinary care team. Clinical activities will take place on the Intermediate Care Unit, the Nursing Home Care Unit and the Geriatrics Primary Care Clinic. Clinical exposure will include longitudinal care of selected patients as well as “first responder” activities for patients with a change in status. Innovative learning sessions, small group sessions and self-learning (training modules on GeriU, assigned readings, and PBL-style learning issues) will emphasize the knowledge and skills required. Student will attend the division’s Geriatrics Grand Rounds and other educational conferences. The clerkship has a strong competency-based component which focuses on core geriatric syndromes. The student must complete online and simulated patient competency assessments and demonstrate the performance standards in order to receive a passing final grade. In addition, a graded evaluation of performance is used which includes the following elements: the standard UMMSM clerkship student evaluation form, required written assignments and oral presentations, a final exam, attendance and participation. Students will maintain an electronic patient encounter log and submit a learning objective checklist and course evaluation to the Geriatric Medicine Education Office at the end of the rotation.

  • This 4-week rotation is based at the Miami VA Medical Center.Students will assume responsibility for the care of older patients under the supervision of board-certified geriatricians, geriatric medicine fellows, and members of the interdisciplinary care team. Clinical activities will take place on the Intermediate Care Unit, the Nursing Home Care Unit and the Geriatrics Primary Care Clinic. Clinical exposure will include longitudinal care of selected patients as well as “first responder” activities for patients with a change in status. Innovative learning sessions, small group sessions and self-learning (training modules on GeriU, assigned readings, and PBL-style learning issues) will emphasize the knowledge and skills required. Student will attend the division’s Geriatrics Grand Rounds and other educational conferences. The clerkship has a strong competency-based component which focuses on core geriatric syndromes. The student must complete online and simulated patient competency assessments and demonstrate the performance standards in order to receive a passing final grade. In addition, a graded evaluation of performance is used which includes the following elements: the standard UMMSM clerkship student evaluation form, required written assignments and oral presentations, a final exam, attendance and participation. Students will maintain an electronic patient encounter log and submit a learning objective checklist and course evaluation to the Geriatric Medicine Education Office at the end of the rotation.

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  • This is a 2-week geriatrics clerkship for FIU fourth year medical students offered at several community sites: Hollywood Memorial Hospital, the Miami VA and Mt. Sinai Hospital.

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  • This 4-week rotation is based at the Miami VA Medical Center.Students will assume responsibility for the care of older patients under the supervision of board-certified geriatricians, palliative medicine physicians, geriatric and palliative medicine fellows, and members of the interdisciplinary care team. Clinical activities will take place on the Intermediate Care Unit, the Nursing Home Care Unit and the Geriatrics Primary Care Clinic. Clinical exposure will include longitudinal care of selected patients as well as “first responder” activities for patients with a change in status. Innovative learning sessions, small group sessions and self-learning (training modules on GeriU, assigned readings, and PBL-style learning issues) will emphasize the knowledge and skills required. Student will attend the division’s Geriatrics Grand Rounds and other educational conferences. The clerkship has a strong competency-based component which focuses on core geriatric syndromes. The student must complete online and simulated patient competency assessments and demonstrate the performance standards in order to receive a passing final grade. In addition, a graded evaluation of performance is used which includes the following elements: the standard UMMSM clerkship student evaluation form, required written assignments and oral presentations, a final exam, attendance and participation. Students will maintain an electronic patient encounter log and submit a learning objective checklist and course evaluation to the Geriatric Medicine Education Office at the end of the rotation.

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  • University of Miami Miller School of Medicine at Holy Cross Hospital Internal Medicine Residency Program Geriatric Medicine Curriculum Subspecialty Coordinator: Reinaldo Camargo Salcedo, MD Reinaldo.carmargo@holy-corss.com 954-351-5931 In its landmark report in 2008, Retooling for an Aging America: Building the Health Care Workforce, the Institute of Medicine (IOM) identified a critical need to expand geriatrics competence among all physicians1,2. This is especially pertinent to trained internists in the state of Florida, a state which holds the highest percentage of elderly patients.3 Since 2012, the US population age 65 or is expected to more than doubled from 41.6 million to 84 million by the year 2050. The need for healthcare professionals trained in complex problems associated with the geriatric patient will be high in demand and dangerously short supply. The residents will have many different opportunities to learn about geriatrics, and care for the geriatric population. The first will be part of the Ambulatory Block, in which the resident will spend a day during their 2 week ambulatory block throughout the first year involved in the care of the geriatric patient. While it take place in the Ambulatory Block, it will include both ambulatory and inpatient experiences, as well as exposure to long term care facilities. The residents will also have the opportunity to care for elderly patients while on the inpatient rotation. During the third year, residents will rotate on a 2 week elective in geriatrics where they will spend one week working in long term care facilities as well as in clinic, and one week working with hospice and palliative care providing inpatient and outpatient consultation. Rotation Goals and Objectives 1. Residents will acquire knowledge of the presentation, diagnosis, and management of common and significant as well as more complex and unusual geriatric syndromes, and perform a complete geriatric assessment. Objectives: Patient Care: PGY1: • Resident will demonstrate ability to perform a comprehensive geriatric assessment • The resident will be able to list and elaborate on common geriatric syndromes • The resident will be able list common psychiatric disorders in the elderly patient • The residents will be able voice understanding of the interactions of multiple co morbidity, and their effect on the patient’s primary problem • Resident will list the appropriate differential diagnoses for common geriatrics complaints, based upon the history, physical and laboratory assessment. • PGY-2 • The resident will be able to perform a comprehensive assessment of functional ability. PGY-3 • The resident will develop a cost effective diagnostic and management plan, and discuss the implication of co-morbidities on the diagnostic plan.. Medical Knowledge: PGY-1 • The resident will vocalize an understanding of the biology of aging. • The residents will cite the pertinent literature. • The residents will demonstrate an understanding of the current clinical guidelines for common geriatric syndromes. PGY-2: • The resident will identify outliers to common presentation of disease, requiring divergence from the clinical guidelines. Practice Based Learning and Improvement PGY-1 • The resident will be able to self- identify gaps in knowledge. • The resident will be able to query the literature to address his or her gaps in knowledge • The resident will actively participate in conferences PGY-2 • The resident will be able to teach his or her peers about the information obtained through the process of inquiry. Interpersonal and communication skills PGY-1 • The residents will demonstrate ability to present a comprehensive geriatric assessment in an organized fashion • The resident will be able to vocalize the rationale of an assessment and plan in an organized fashion. Professionalism PGY-1 • The resident will demonstrate professional behavior toward the patient and the healthcare team. • The resident will be prepared for rounds and conferences. Systems Based Practice PGY-1 • The resident will list potential barriers to health care for his or her patients. • The resident will vocalize solutions to the potential barriers to health care PGY-2 • The resident will request consultations and diagnostic studies in a cost conscious fashion. Evaluation Methods: Direct Observation, 360 Evaluations, Journal Club Evaluations, Mini CEX 2. The residents will act as a consultant: The residents understand the appropriate clinical scenarios in which consultation with a geriatric or palliative care specialist is appropriate and when management by a subspecialist would be most valuable. They will learn the basic approach to be used for a thorough geriatric consultation and Hospice and Palliative Medicine consultation. Objectives: Patient Care: PGY-1 • The resident will voice understanding of polypharmacy and its effects on the elderly. • The resident will list the complications associated with commonly used medication in the elderly population. PGY-2 • The resident will voice understanding of a preoperative assessment in the geriatric population. • The resident will be able to manage a geriatric patient post operatively. PGY-3 • The resident will develop a cost effective diagnostic and management plan for the patient. Medical Knowledge: PGY-1 • The residents will demonstrate an understanding of the current clinical guidelines for common Geriatric Syndromes PGY-2 • The resident will identify outliers to common presentation of disease, requiring divergence from the clinical guidelines. • The residents will be able to list the recommendations for appropriate dosing for commonly prescribed medications. Practice Based Learning and Improvement PGY-1 • The resident will request consultations that are clear and concise. PGY-2 • The resident will be able to self- identify gaps in knowledge. • The resident will be able to query the literature to address his or her gaps in knowledge. • The resident will actively participate in conferences • PGY-2 • The resident will create consultations with clear and concise recommendations for the primary team. • The resident will be able to teach his or her peers about the information obtained through the process of inquiry. Interpersonal and communication skills PGY-1 • The resident will be able to vocalize the rationale of an assessment and plan in an organized fashion. PGY-2 • The residents will communication recommendations in a clear and concise manner. Professionalism PGY-1 • The resident will demonstrate professional behavior toward the patient and the healthcare team. • The resident will be prepared for rounds and conferences. Systems Based Practice PGY-1 • The resident will list potential barriers to health care for his or her patients. PGY-2 • The resident will vocalize solutions to the potential barriers to health care • The resident will request consultations and diagnostic studies in a cost conscious fashion. Evaluation Methods: Direct Observation, 360 Evaluations, Mini CEX, Conference Participation The resident will be able to care for patients in a multidisciplinary setting, especially in special situaitons • Effective utilization of the resources to optimize care specific to the geriatric • population • Pharmacotherapy and pharmacodynamics of the older patient • Assessment, prevention and treatment of pressure ulcers 3. Objectives: Patient Care: PGY-1 • The resident will demonstrate an ability to Care for chronically ill and elderly patients with acute issues • The resident will voice an understanding of Geriatric pre-operative and post-operative assessment and management PGY-2 • The resident will be able to discuss the care of terminally ill patients and the approach to their families • The resident will vocalize a cost effective a cost effective diagnostic and management plan. Medical Knowledge: PGY-1 • The resident will list the indications and contraindications and risks associated with common laboratory, radiologic, procedures in the elderly population. . Practice Based Learning and Improvement PGY-1 • The resident will be able to self- identify gaps in knowledge. • PGY-2 • The resident will be able to query the literature to address his or her gaps in knowledge PGY-3 • The resident will be able to teach his or her peers about the information obtained through the process of inquiry. Interpersonal and communication skills PGY-1 • The resident will be able to vocalize the rationale of an assessment and plan in an organized fashion. • The resident will be able to vocalize to the patient the indications, contraindications and risks associate with common Gastroenterologic procedures, laboratory and radiologic tests in a logical, and understandable fashion. Professionalism PGY-1 • The resident will demonstrate professional behavior toward the patient and the healthcare team. • The resident will explore all options of care with the patient, treating this individual with respect. • The resident will demonstrate an altruistic demeanor in interacting with patients. • The resident will demonstrate cultural awareness in interacting with patients. Systems Based Practice PGY-2 • The resident will demonstrate an appreciation for the role of Interdisciplinary discharge planning to optimize use of community and outpatient services available to older adults and determination of appropriate levels of care. • The resident will participate in Interdisciplinary discharge planning rounds. • The resident will list potential barriers to appropriate diagnostic and therapeutic work up for his or her patients. • The resident will vocalize solutions to the potential barriers. • The resident will request diagnostic studies and procedures in a cost conscious fashion. Evaluations Methods: Direct Observation, 360 degree evaluations, counseling checklist A. Rotation Description: The rotation consists of a varying schedule of ½-day clinical experiences. Residents will round daily with a faculty member and be assigned various rotations including but not limited to rounding with the interdisciplinary team, the clinic journal club, and didactic sessions. The Resident will start the day on the hospital unit for working rounds. B. Teaching Conferences: The Resident is required to attend at all regular departmental conferences, including Grand Rounds, and Noon Lecture Series/journal club/ resident presentations. Residents will meet for morning rounds with the attending assigned to the rotation to discuss the current patients on the unit and review specific geriatric medicine core concepts. C. Scholarly Activities: 1. Journal Club Residents will attend the monthly Geriatric Medicine Journal Club, which focuses on the review of current topics in geriatric medicine, palliative care and end-of-life care. The attending physician will distribute the article(s) to the resident in advance of the scheduled journal club. Residents are to read the article(s) in advance and prepare to be an active participant in the discussions. Residents rotating during weeks without scheduled journal club will read previous months’ articles and discuss with attending as designated by attending. 2. Learning Assignments Residents will be assigned a topic for presentation at the end of the rotation. Self-study will be an expectation throughout this rotation and will be supplemented by faculty discussions. Residents will be expected to assimilate this information and be ready to discuss and/or present the information. Residents are expected to read on their own time. In addition, the residents will be assigned specific online modules through the Geri-U Curriculum, for completion during their assigned Geriatrics Rotation. 3. End-of-Rotation Presentation At the end of the rotation, each resident is expected to present a geriatric medicine case he/she has been primarily managing and be able to discuss the geriatric concepts involved in the particular case. Residents and faculty members will attend this 30-minute presentation at the end of the rotation. Didactic and Journal Club Sessions Core Topics The purpose is to review and expand the understanding of core topics in the form of didactic lectures and journal reviews. Such core topics include, but are not limited to the following: Biology of aging Multimorbidity Pharmacotherapy Mistreatment of the Older Adult Perioperative Care Palliative Care Frailty Visual and hearing impairment Dizziness Syncope Malnutrition Eating problems Urinary Incontinence Gait disturbances Osteoporosis Dementia Delirium Sleep disturbances Wound Care Depression Anxiety Pain management Polypharmacy/The Beers List D. Resident Evaluation: Faculty feedback will be compiled and summarized for the resident’s final evaluation; faculty members will be asked to comment on a) attendance/work ethic/professionalism, b) fund of knowledge/ clinical assessment skills/medical decision-making, and c) interpersonal skills/communication. The extent to which the Resident invests their effort into the related assignments will also be valued in the overall rotation evaluation. The Resident’s final presentation, and their preparation for and participation in case vignette discussions and other conferences will also be taken into account. E. Resources: 1. Power Point Presentations 2. Geri-U Modules 3. Some On-line Resources www.americangeriatrics.org www.uptodate.com www.eperc.mcw.edu www.aahpm.org www.nhpco.org www.growthhouse.org http://www.hardchoices.com/toc_hc.html 4. Core Articles/Resource Materials will be distributed during the rotation. • Pharmacologic Management of Persistent Pain in Older Persons • Guiding Principles for the Care of the Older Adults with Multi-morbidity: An approach for Clinicians • American Geriatrics Society Feeding Tubes in Advanced Dementia Position Statement • 2010 AGS/BGS Clinical Practice Guideline: Prevention of Falls in Older Persons Summary of Recommendations • AGS Updated Beers Criteria for Potentially Inappropriate Medications Use in Older Adults Citations 1. Institute of Medicine. Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: The National Academies Press; 2008. 2. The AAMC-Hartford Geriatric Curriculum Program: reports from 50 schools. Anderson MB, ed. Acad Med. 2004;79(suppl 7):S1–S226. 3. http://www.census.gov/population/socdemo/statbriefs/agebrief.html

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