|
Family Practice Residency
Transitions of Care Community Based Service Learning Experience
Objectives
Apply the principles and practices of transitional care assessment and management including clinical assessment, medication management, patient and family education, coordination of in home services, and communication with physicians and other health professionals involved in the patient’s inpatient and post discharge care.
Describe the community resources that can be used to facilitate healthy living and enhance the active participation of patient’s and families in patient centered care.
Activities
The Hospital of the University of Pennsylvania has implemented a new Transitions Care Model Program conceived and led by Dr. Mary Naylor of the School of Nursing, aims to prevent unnecessary readmissions and improve the quality of care of older patients discharged from the Hospital of the University of Pennsylvania after a diagnosis of COPD, CHF, DM or CAD. This program offers primary care internal medicine and family medicine residents an opportunity to learn geriatrics as participants of a real clinical care experience in transitional care, encompassing interdisciplinary collaboration, communication, person centered care, and home care. All family medicine residents, during their month on geriatrics, will be assigned an older adults referral to the transitions program. The residents review the teaching web module on the transitions program, and visit the patients in the hospital with the nurse practitioner. During the debriefing, the attending will review problems with communication among health professionals, patient and family, medication adherence, and appropriateness of family and community support necessary to maintain the patient out of the hospital.
Community Health Education Experience
Objectives
Communicate effectively while educating lay audiences about health problems in older adults
Activities
Residents working in pairs select a community organization serving older adults with whom they will provide two geriatric presentations each over the course of 12 months. Topics delivered (selected partly based upon requests from community partners) will include dementia, falls and gait disorders, osteoarthritis, prostate cancer, hypertension and heart disease. A faculty preceptor will observe residents during their community presentations, and give them structured feedback on presentation skills and talk content.
Top
Internal Medicine Residency
Objectives
Identify, assess and treat geriatric syndromes and acute clinical problems in older adults
Accurately diagnose and manage acute illnesses, recognizing atypical presentations
Apply the principles and practices of transitional care assessment and management including clinical assessment, medication management, patient and family education, coordination of in home services, and communication with physicians and other health professionals involved in the patient’s inpatient and post discharge care.
Manage geriatric patients across settings
Communicate effectively in educating lay audiences about health problems in older adults
Transitions of Care Community Service Learning
All primary care medicine residents participate in the transitions of care community service training during their two-week primary care block, as described under the family practice experience.
Community Health Education
All primary care residents are paired with community organizations for whom they will present a geriatric presentation each over the course of 12 months.
Top
Orthopaedics Residency
Objectives
Recognize common medical problems found in the hospitalized elderly
Appropriately identify older patients who are at risk for delirium, and create a care plan to
prevent episodes of delirium
Identify complex older patients who would benefit from a geriatric medicine consultation
Assess and treat post-operative pain in older adults
Activities
Five one-hour sessions per year will be added to the orthopaedic surgery residents’ required presentation series in the venue of resident report meetings and weekly teaching conferences. Topics to be covered include: 1) osteobiology of aging and osteoporosis, 2) preoperative assessment of risk, 3) identifying complex elderly patients, particularly those with dementia and delirium, 4) improving transitions of care, and 5) pain management.
Top
Physical Medicine and Rehabilitation Residency
Objectives
Recognize and assess common medical problems and geriatric syndromes.
Assess older patients for common geriatric medicine syndromes in the outpatient setting.
Effectively consult and interact with members of interdisciplinary teams caring for older adults in diverse settings including the outpatient clinic, nursing home, and home care.
Activities
PMR PGY 2 residents will undertake a one-week rotation in geriatrics under a geriatric attending at the Philadelphia VA Medical Center. This will be a multiple site exposure involving the geriatrics clinic, the nursing homes, and the home care program. In addition, a lecture series has been developed and delivered by geriatric faculty.
Top
Psychiatry Residency
Objectives:
Know the course and complications of common psychiatric disease and disability in older adults.
Establish ongoing treatment relationships with elderly patients and their families and caregivers, and observe their response to treatment over time.
Function as effective consultants and members of an interdisciplinary team in the various healthcare settings.
Activities
A required half-day geriatrics ambulatory care experience incorporated into the weekly schedule of all psychiatry residents, ultimately requiring one half-day per week during the second six months of PGY-3 and the first six months of PGY-4. Rotation sites include VA Home Based Primary Care, VA CLC, LIFE program, Philadelphia District Health Center, VA Geriatric Memory Clinic, and Penn Memory Center.
A series of six monthly seminars for all the PGY-3 residents focuses on common geriatric psychiatry consultation issues.
Top
Chief Resident Immersion Training (CRIT)
Modeled after the Boston University CRIT, and planned and delivered in collaboration with Boston University, the principal goals of the CRIT are to 1) foster collaboration across disciplines in the care of complex older adults, 2) incorporate geriatrics principles into teaching roles of chief residents, 3) develop teaching skills around the care of older adults, and 4) develop a geriatrics scholarly project related to resident education to be conducted during the chief residency year. The core component of the program is a two-day retreat based around three case modules. Each module includes mini lectures on geriatrics topics, small group interactive exercises, and seminars designed to enhance teaching and leadership skills.” Over the ensuing year, chief residents undertake a scholarly teaching activity in aging, which make take the form of a paper, presentation, or other teaching exercise.
CRIT Brochure for 2011
| 
