Geriatrics Clerkship Objectives

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Objectives Linked ActivitiesLinked AssessmentsMcMaster Program Competencies

Approach to the Patient

Patient History

Take a history from a geriatric patient, with special emphasis on physical and mental functioning.
Clinical Exposure: Patient History
Large Group Session: Patient History

Validate and obtain historical information from other relevant informants (e.g. partner, caregiver, community care access centre, family physician) when indicated.
Clinical Exposure: Patient History
Large Group Session: Patient History

Communicate results of the direct and collateral history in well organized written and oral reports.
Clinical Exposure: Patient History

Functional Assessment

Collect accurate information regarding function in basic and instrumental activities of daily living.
Clinical Exposure: Functional Assessment
Large Group Session: Functional Assessment

Communicate results of the functional assessment in well organized written and oral reports.
Clinical Exposure: Functional Assessment

Examination

Perform a physical examination on an elderly patient, adapting it to possible conditions of frailty, immobility, hearing loss, memory loss and other impairments.
Clinical Exposure: Examination
Large Group Session: Examination

Perform a mental status examination to evaluate confusion and/or memory loss in an elderly patient, including the use of appropriate tools (e.g. Mini Mental Status Examination)
Clinical Exposure: Examination
Large Group Session: Examination

Communicate the relevant results of the physical and cognitive examination in well organized and written and oral reports.
Clinical Exposure: Examination

Diagnosis

Generate a problem list
Clinical Exposure: Diagnosis
e-Learning Module: Diagnosis
Self-Assessment Quiz: Diagnosis
Tutorial: Diagnosis
Clerkship Key Feature Exam: Diagnosis
Clerkship Tutorial Evaluation: Diagnosis
e-Learning Module Completion: Diagnosis

For a specific symptom, form an impression including differential diagnosis
Clinical Exposure: Diagnosis
e-Learning Module: Diagnosis
Self-Assessment Quiz: Diagnosis
Tutorial: Diagnosis
Clerkship Key Feature Exam: Diagnosis
Clerkship Tutorial Evaluation: Diagnosis
e-Learning Module Completion: Diagnosis

For a geriatric syndrome, generate a list of probable contributing factors.
Clinical Exposure: Diagnosis
e-Learning Module: Diagnosis
Self-Assessment Quiz: Diagnosis
Tutorial: Diagnosis
Clerkship Key Feature Exam: Diagnosis
Clerkship Tutorial Evaluation: Diagnosis
e-Learning Module Completion: Diagnosis

Management Plan

Consider community and hospital resources available to assist in the management of the older patient.
Clinical Exposure: Management Plan
e-Learning Module: Management Plan
Self-Assessment Quiz: Management Plan
Tutorial: Management Plan
Clerkship Key Feature Exam: Management Plan
Clerkship Tutorial Evaluation: Management Plan
e-Learning Module Completion: Management Plan

Respect the increased risk of iatrogenic complications among elderly patients.
Clinical Exposure: Management Plan
e-Learning Module: Management Plan
Self-Assessment Quiz: Management Plan
Tutorial: Management Plan
Clerkship Key Feature Exam: Management Plan
Clerkship Tutorial Evaluation: Management Plan
e-Learning Module Completion: Management Plan

Consider economic and psychosocial issues.
Clinical Exposure: Management Plan
e-Learning Module: Management Plan
Self-Assessment Quiz: Management Plan
Tutorial: Management Plan
Clerkship Key Feature Exam: Management Plan
Clerkship Tutorial Evaluation: Management Plan
e-Learning Module Completion: Management Plan

Consider ethical issues.
Clinical Exposure: Management Plan
Tutorial: Management Plan
Clerkship Tutorial Evaluation: Management Plan

Develop a management plan including:
Clinical Exposure: Management Plan
e-Learning Module: Management Plan
Self-Assessment Quiz: Management Plan
Tutorial: Management Plan
Clerkship Key Feature Exam: Management Plan
Clerkship Tutorial Evaluation: Management Plan
e-Learning Module Completion: Management Plan

Laboratory and diagnostic studies
Clinical Exposure: Management Plan
e-Learning Module: Management Plan
Self-Assessment Quiz: Management Plan
Tutorial: Management Plan
Clerkship Key Feature Exam: Management Plan
Clerkship Tutorial Evaluation: Management Plan
e-Learning Module Completion: Management Plan

Involvement of allied health professionals
Clinical Exposure: Diagnosis
e-Learning Module: Management Plan
Self-Assessment Quiz: Management Plan
Tutorial: Diagnosis
Clerkship Key Feature Exam: Management Plan
Clerkship Tutorial Evaluation: Management Plan
e-Learning Module Completion: Management Plan

Treatment
Clinical Exposure: Management Plan
e-Learning Module: Management Plan
Self-Assessment Quiz: Management Plan
Tutorial: Diagnosis
Clerkship Key Feature Exam: Management Plan
Clerkship Tutorial Evaluation: Management Plan
e-Learning Module Completion: Management Plan

Patient and Family Education
Clinical Exposure: Management Plan
e-Learning Module: Management Plan
Self-Assessment Quiz: Management Plan
Tutorial: Management Plan
Clerkship Key Feature Exam: Management Plan
Clerkship Tutorial Evaluation: Management Plan
e-Learning Module Completion: Management Plan

Follow-up plans
Clinical Exposure: Management Plan
e-Learning Module: Management Plan
Self-Assessment Quiz: Management Plan
Tutorial: Management Plan
Clerkship Key Feature Exam: Management Plan
Clerkship Tutorial Evaluation: Management Plan
e-Learning Module Completion: Management Plan

Interdisciplinary Approach

Appreciate the role of team members such as family physician, occupational therapist, physiotherapist, recreation therapist, social worker, pharmacist, nurse and family members.
Clinical Exposure: Interdisciplinary Approach
e-Learning Module: Interdisciplinary Approach
Self-Assessment Quiz: Interdisciplinary Approach
Tutorial: Interdisciplinary Approach
Clerkship Tutorial Evaluation: Interdisciplinary Approach
e-Learning Module Completion: Interdisciplinary Approach

Participate in an interdisciplinary approach to assessment, management and rehabilitation of elderly patients.
Clinical Exposure: Interdisciplinary Approach
Tutorial: Interdisciplinary Approach
Clerkship Tutorial Evaluation: Interdisciplinary Approach

Personal Interaction and Communication Skills

Demonstrate respect to older patients and make efforts to preserve their dignity
Clinical Exposure: Personal Interaction and Communication Skills

General Concepts

Normal Aging

Consequences of normal aging versus disease including an understanding of the heterogeneous nature of the aged population, and Canadian demographics of aging.

Frailty

The concept of "Frailty" as it applies to older adults

Preventative Care and Health Maintenance

Preventive health care strategies for the elderly and the importance of this

Specific Syndromes and Clinical Problems

Required Competencies

Functional Decline

Performs comprehensive geriatric assessment to evaluate the underlying etiologies of undifferentiated functional decline.
Clinical Exposure: Functional Decline
e-Learning Module: Functional Decline
Self-Assessment Quiz: Functional Decline
e-Learning Module Completion: Functional Decline

Dementia

Collects appropriate history
Clinical Exposure: Dementia
e-Learning Module: Dementia
Self-Assessment Quiz: Dementia
Clerkship Key Feature Exam: Dementia
e-Learning Module Completion: Dementia

Performs appropriate neurological exam
Clinical Exposure: Dementia
e-Learning Module: Dementia
Self-Assessment Quiz: Dementia
Clerkship Key Feature Exam: Dementia
e-Learning Module Completion: Dementia

Performs MMSE /- frontal testing as indicated
Clinical Exposure: Dementia
e-Learning Module: Dementia
Self-Assessment Quiz: Dementia
Clerkship Key Feature Exam: Dementia
e-Learning Module Completion: Dementia

Applies diagnostic criteria for dementia
Clinical Exposure: Dementia
e-Learning Module: Dementia
Self-Assessment Quiz: Dementia
Clerkship Key Feature Exam: Dementia
e-Learning Module Completion: Dementia

Orders appropriate work up based on Canadian Consensus guidelines
Clinical Exposure: Dementia
e-Learning Module: Dementia
Self-Assessment Quiz: Dementia
Clerkship Key Feature Exam: Dementia
e-Learning Module Completion: Dementia

Delirium

Applies DSM or CAM criteria for diagnosis of delirium
Clinical Exposure: Delirium
e-Learning Module: Delirium
Self-Assessment Quiz: Delirium
Tutorial: Delirium
Clerkship Key Feature Exam: Delirium
e-Learning Module Completion: Delirium

Identifies risk factors for delirium
Clinical Exposure: Delirium
e-Learning Module: Delirium
Self-Assessment Quiz: Delirium
Tutorial: Delirium
Clerkship Key Feature Exam: Delirium
e-Learning Module Completion: Delirium

Searches for reversible etiologies
Clinical Exposure: Delirium
e-Learning Module: Delirium
Self-Assessment Quiz: Delirium
Tutorial: Delirium
Clerkship Key Feature Exam: Delirium
e-Learning Module Completion: Delirium

Recommends appropriate supportive and symptomatic care
Clinical Exposure: Delirium
e-Learning Module: Delirium
Self-Assessment Quiz: Delirium
Tutorial: Delirium
Clerkship Key Feature Exam: Delirium
e-Learning Module Completion: Delirium

Identifies strategies to prevent complications
Clinical Exposure: Delirium
e-Learning Module: Delirium
Self-Assessment Quiz: Delirium
Tutorial: Delirium
Clerkship Key Feature Exam: Delirium
e-Learning Module Completion: Delirium

Depression

Performs and interprets Geriatric Depression Scale
Clinical Exposure: Depression
Tutorial: Depression
Clerkship Key Feature Exam: Depression

Recognizes relationship between cognitive impairment and depression
Clinical Exposure: Depression
Tutorial: Depression
Clerkship Key Feature Exam: Depression

Recognizes how clinical presentation of depression differs in older adults
Clinical Exposure: Depression
Tutorial: Depression
Clerkship Key Feature Exam: Depression

Falls, Immobility and Gait Disturbances

Identifies patients at high risk for falls
Clinical Exposure: Falls, Immobility and Gait Disturbances
e-Learning Module: Falls, Immobility & Gait Distrubances
Self-Assessment Quiz: Falls, Immobility and Gait Disturbances
Clerkship Key Feature Exam: Falls, Immobility and Gait Disturbances
e-Learning Module Completion: Falls, Immobility and Gait Disturbances

Is familiar with screening tools for mobility and balance (e.g. Timed get and Go)
Clinical Exposure: Falls, Immobility and Gait Disturbances
e-Learning Module: Falls, Immobility & Gait Distrubances
Self-Assessment Quiz: Falls, Immobility and Gait Disturbances
Clerkship Key Feature Exam: Falls, Immobility and Gait Disturbances
e-Learning Module Completion: Falls, Immobility and Gait Disturbances

Performs appropriate assessment and recommendations
Clinical Exposure: Falls, Immobility and Gait Disturbances
e-Learning Module: Falls, Immobility & Gait Distrubances
Self-Assessment Quiz: Falls, Immobility and Gait Disturbances
Clerkship Key Feature Exam: Falls, Immobility and Gait Disturbances
e-Learning Module Completion: Falls, Immobility and Gait Disturbances

Incontinence

Evaluates acute urinary incontinence
Clinical Exposure: Incontinence
e-Learning Module: Incontinence
Self-Assessment Quiz: Incontinence
Clerkship Key Feature Exam: Incontinence
e-Learning Module Completion: Incontinence

Evaluates chronic urinary incontinence
Clinical Exposure: Incontinence
e-Learning Module: Incontinence
Self-Assessment Quiz: Incontinence
Clerkship Key Feature Exam: Incontinence
e-Learning Module Completion: Incontinence

Iatrogenesis

Demonstrates awareness of why the elderly are more vulnerable to aggressive efforts at diagnosis and treatment as well as recognizes an example of iatrogenesis
Clinical Exposure: Iatrogenesis
Tutorial: Iatrogenesis
Clerkship Key Feature Exam: Iatrogenesis

Failure to Thrive/Weight Loss

Identifies physical, medical and psychosocial factors that contribute to malnutrition and weight loss in an elderly person
Clinical Exposure: Failure to Thrive/Weight Loss
e-Learning Module: Failure to Thrive/Weight Loss
Self-Assessment Quiz: Failure to Thrive/Weight Loss
Tutorial: Failure to Thrive/Weight Loss
Clerkship Key Feature Exam: Failure to Thrive/Weight Loss
e-Learning Module Completion: Failure to Thrive/Weight Loss

Polypharmacy and Appropriate/Inappropriate Prescribing of Medications

Accurately performs a medication review with recommendations
Clinical Exposure: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications
e-Learning Module: Polypharmacy & Appropriate/Inappropriate Prescribing of Medications
Self-Assessment Quiz: Polypharmacy & Appropriate/Inappropriate Prescribing of Medications
Tutorial: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications
Clerkship Key Feature Exam: Polypharamcy and Appropriate/Inappropriate Prescribing of Medications
e-Learning Module Completion: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications

Identifies drugs that have a high frequency of adverse effects in the elderly
Clinical Exposure: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications
e-Learning Module: Polypharmacy & Appropriate/Inappropriate Prescribing of Medications
Self-Assessment Quiz: Polypharmacy & Appropriate/Inappropriate Prescribing of Medications
Tutorial: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications
Clerkship Key Feature Exam: Polypharamcy and Appropriate/Inappropriate Prescribing of Medications
e-Learning Module Completion: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications

Identifies drugs that require adjustment for renal insufficiency
Clinical Exposure: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications
e-Learning Module: Polypharmacy & Appropriate/Inappropriate Prescribing of Medications
Self-Assessment Quiz: Polypharmacy & Appropriate/Inappropriate Prescribing of Medications
Tutorial: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications
Clerkship Key Feature Exam: Polypharamcy and Appropriate/Inappropriate Prescribing of Medications
e-Learning Module Completion: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications

Calculates CrCl
Clinical Exposure: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications
e-Learning Module: Polypharmacy & Appropriate/Inappropriate Prescribing of Medications
Self-Assessment Quiz: Polypharmacy & Appropriate/Inappropriate Prescribing of Medications
Tutorial: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications
Clerkship Key Feature Exam: Polypharamcy and Appropriate/Inappropriate Prescribing of Medications
e-Learning Module Completion: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications

Can identify methods of improving compliance
Clinical Exposure: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications
e-Learning Module: Polypharmacy & Appropriate/Inappropriate Prescribing of Medications
Self-Assessment Quiz: Polypharmacy & Appropriate/Inappropriate Prescribing of Medications
Tutorial: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications
Clerkship Key Feature Exam: Polypharamcy and Appropriate/Inappropriate Prescribing of Medications
e-Learning Module Completion: Polypharmacy and Appropriate/Inappropriate Prescribing of Medications

Desired Competencies

Chronic Pain
Clinical Exposure: Chronic Pain

Osteoporosis
Clinical Exposure: Osteoporosis

Heart Failure
Clinical Exposure: Heart Failure

Pressure Ulcers
Clinical Exposure: Pressure Ulcers

Sensory Alteration, including Visions and Hearing Impairment
Clinical Exposure: Sensory Alteration, including vision & hearing impairment

Atypical Presentation of Disease
Clinical Exposure: Atypical Presentation of Disease

Decision Making Capacity
Clinical Exposure: Decision Making Capacity
Tutorial: Decision Making Capacity