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Undergraduate Education

Queen's medical students continue to be exposed to Geriatric Medicine at several stages in their training, although the bulk of their clinical exposure takes place in the clerkship (Phase III).

The undergraduate educational objectives include:

In the pre-clerkship phases, members of the division provide the following sessions:

Phase 1:

Phase IIa

 

Phase IIb

A recent innovation is "Clinical Skills in the Nursing Home" which takes place in the students' second year (Phase II B). All students rotate through Providence Manor Home for the Aged in groups of 10, with 2 or 3 tutors (family physicians and specialists). Dr. Gibson and Dr. G.I. Stewart (Medical Director of Providence Manor) teach students about nursing homes and their residents, and how to interview a frail older adult, focusing on assessing function and cognition. 

Phase III: Clerkship

All of the clerks receive a half-day orientation to Geriatric medicine within the Orientation week to Clerkship. Geriatric Medicine is an elective within the Internal Medicine  block of the clerkship.

Approximately 40% of students elect to complete a 4 week rotation. We also contribute to monthly rounds within both the surgical and medical block which all of the clerks will attend at least four times.

The four week clerkship rotation will include the following experiences.

1. Core Geriatric Tutorials

The clerks are expected to attend core tutorials at which time specific topics will be discussed. Notes and/or computer-assisted learning resources pertaining to the specific topic of each tutorial are provided ahead of time to assist the clerk in preparing an interactive tutorial session. Clerks are expected to come prepared to actively participate in discussion about the topic. There will be an overview of Geriatric Services and Community Services for Seniors. In addition, access to library searches and computer assisted learning will be made available.

2. Individual Patient Assignments

Each clerk will be involved in the care of assigned patients. It is expected that a thorough investigation of the various biophysical, psychosocial and environmental facts that have an impact on each of the patients will be undertaken. This may be done by:

Studying their charts
Interviewing the patient and taking a history
Performing examinations (history and physical within 24 hours)
Talking to the staff
Attending therapy sessions or any investigative procedures in which the patients are involved (i.e.. Social Work, Occupational or Physiotherapy, CAT scans, etc)
Reading pertinent literature for each case by doing a literature review

Attending Multidisciplinary Team Conferences, Family Conferences and possibly visiting/interviewing the family and/or family physician


The clerk will actively participate in regular medical rounds. They will present their patient during formal rounds. This will consist of a brief background on the patient, issues identified and the progress of the patient over the past week.

3. Guided Case Studies

By guided self-directed learning the clerks will explore issues pertinent to the geriatric population and present the findings of the project to colleagues.

4. Other Clinical Activities

Clerks will be scheduled for various activities to enrich their geriatric experience. For example, there will be opportunities to attend clinics, consults, multidisciplinary team conferences, home visits and ward rounds.

Day Hospital Experience
The purpose of the Day Hospital experience is to learn where the Day Hospital Services fit in the context of Geriatric Services. In addition, it is hoped that the student will begin to gain an understanding of the nature and complexity of assessment and treatment of a typical geriatric client who attends Day Hospital.

Outreach/Consult Experience
The purpose of this experience is to learn where the Outreach Service or Consult Service fit in the context of Geriatric Services and to gain a better understanding of the nature and complexity of assessing the geriatric client in their own setting in the community or acute hospital.

Geriatric Medicine Clinic
The purpose of the Geriatric Medicine Clinic is to directly observe and participate in the comprehensive geriatric medicine assessment. This will demonstrate the interactions of illness, medications, functional status and psychosocial aspects of the case.

Palliative Care Case Study
This session will provide an opportunity for the clerks to meet with the Attending Staff on a less formal basis to facilitate discussions of clinical and ethical issues (e.g.. Palliative care) or any other topic of interest to the students.

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Resident Education

Residents from family medicine, physical medicine & rehabilitation, psychiatry, and internal medicine rotate through geriatric medicine for 1 or 2 month exposures. The majority of residents are from family medicine, where geriatric medicine can be a core rotation (internal medicine) or an elective. At Queen's, geriatric medicine is a mandatory rotation for psychiatry residents, a selective rotation for PM&R, and an elective for internal medicine residents.

The popularity of the residents experience is attested to by the fact that  we supported in 2003 42 months of resident rotations within a mixture of inpatient and ambulatory exposures.

Regardless of the learner's background, one of our main objectives is to expose the students to positive physician role models who are providing care to the older adult, be they specialists in geriatric medicine or geriatric psychiatry, or family physicians with interest and expertise in Care of the Elderly. We feel that we provide considerable 1:1 experience with attending physicians, in order to facilitate this.

The Care of the Elderly Program residents have a number of core rotations within Geriatric Medicine services as well as rotations within Physical Medicine and Rehabilitation, Geriatric Psychiatry and Medical Clinics. The goals and objectives for the rotations are consistent with the generally accepted goals and principles for Family Physicians (Goals and Objectives for Care of Elderly)

Family medicine

Family medicine residents can do 1 or 2 month rotations in geriatrics. Each resident is based on either the inpatient unit or in the day hospital, or, if they are doing a 2‑month rotation, they might split their time between the 2 services. Regardless, they also participate in other services, such as clinics, acute care consults, and outreach assessments. A regular teaching schedule is organized monthly. The residents are also responsible for providing some of the teaching in supervised professorial and education rounds.

The objectives for family medicine residents are based on the CFPC objectives and the four principles of family medicine. Dr. Frank has adapted the objective‑based evaluations developed for the Care of the Elderly program to family medicine residents. When family medicine residents request electives, we attempt to individualize the experience.

Psychiatry

All psychiatry residents complete a 2‑month rotation in geriatric medicine. They are generally based on the inpatient unit, although they also participate in other services such as clinics and acute care consults. They benefit from the weekly attendance of geriatric psychiatry consult liaison on rounds on the inpatient unit.

 

Physical medicine and rehabilitation

The PM & R program at Queen's has 1 resident per year, and they usually do 1 month of geriatrics as a selective. This resident is based on the inpatient unit, but we also emphasize acute care consultations, especially those with a focus on assessing rehabilitation potential.

 

Internal medicine

Internal medicine residents can do an elective in geriatric medicine. This experience is individualized, with a focus on geriatric medicine clinics, memory clinic, and acute care consults. They are also exposed to other services, namely the inpatient rehabilitation unit and the Day Hospital.

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Continuing Medical Education.

The Geriatric Medicine 2003 CME Day organized in conjunction with the SERGP Conference "Towards Best Geriatric Practice: Overcoming the Challenges", October 2nd, 2003, Kingston, Ontario.

Discussions have commenced with the director of CME to establish a Geriatric series within the next 12 months utilizing the newly available Dementia Website Communication tools. These are intended to run over a lunch period and be available to several groups of Family Physicians within the Region. The unique feature is that it will occur over the internet and not require specialized equipment or travel.

A number of events have also occurred through the Provincial Alzheimer Disease and Related Disorders Initiative #2 strategy. Members of the Division of Geriatrics coordinate some of the initiatives within that strategy. This has included: the Family Medicine Academic Faculty Development and Preceptor Program in Alzheimer Disease and Related Dementias; and the associated WWW site development.

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Other Educatuonal Resources

Use of Information Technology in Education: Medical Grand Rounds by Dr J Puxty

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