Division of Geriatric Medicine

Postgraduate Information

Welcome!

The educational purpose of the Geriatric Medicine rotation is to expose the Resident learner to the wide spectrum of diagnoses and management of clinical presentations of common diseases in older adults. The second purpose is to help the Family Medicine resident to develop the appropriate clinical knowledge and attitudes required for high quality care of the frail elderly.

Core Objectives

By the end of the rotation each Resident will have gained a knowledge base that includes the important changes that takes place with aging, key illnesses common to seniors, principles of medication optimization in the elderly, knowledge of the differences between normal and abnormal aging, and understand ageism and dispel myths/stereotypes.

Each Resident will have learned the components and performed a Comprehensive Geriatric Assessment (history, physical, function and cognition/affective or mental health screens, social supports)

Each Resident will be able to synthesize a comprehensive care-plan that incorporates both long and short term goals. Such a plan should include appropriate follow up, coordination and management of chronic conditions.

The Resident will have mastered a basic approach, and be able to work up and manage the following (non-exhaustive) Geriatric Medicine problems and syndromes specific to seniors; Cognitive Impairments (Dementia, Delirium, & Mild Cognitive Impairments), Affective Disorders, Frailty, Falls, Failure to Thrive/Weight Loss, Incontinence, and atypical disease presentations.

The Learning Environment

Learning these core objectives will take place in one or more of the inpatient, ambulatory / outpatient & outreach (i.e. home visit) settings.

A) Hamilton Health Sciences: Geriatric Inpatient Unit

In patient care of elderly patients takes place in the Complex Medical Rehabilitation  (CMR) ward (formerly known as Geriatric Assessment and Rehab Unit or GARU) on the second floor M wing of the Juravinski Hospital, Hamilton Health Sciences.

The Resident will:

  1. Complete an appropriate Comprehensive Geriatric Assessment for new admissions to CMR
  2. Follow assigned in-patients admitted to the CMR on a daily basis
  3. Generate timely clinical reports incorporating  information that includes a comprehensive care plan for both short and long term goals
  4. Supervise junior clinical learners on the CMR
B) Hamilton Health Sciences: Geriatric Medicine Inpatient Consults

An important aspect of care in hospitalized older patient is sub-specialty consults from Geriatric Medicine to other hospital services at Hamilton Health Sciences (including but limited to Internal Medicine, General & Orthopedic Surgery, Oncology, & Physical Medicine & Rehab). Many consults will be requests for assistance with discharge planning, evaluation and management of delirium and other cognitive impairments, and medication optimization. Consultations will take place either at the Juravinski Hospital or the General Hospital campus depending on the resident’s schedule.

The Resident will:

  1. Obtain an appropriate Geriatric Medicine history and perform a physical examination for new consultations.
  2. See follow-up patients on at timely basis and communicate findings to appropriate Geriatric Medicine attending (and Fellow if available).
  3. Communicate findings to the appropriate service after discussing case with
    Geriatric Medicine attending
  4. Be contacted from a variety of sources about all new consults (Senior’s Health RN Clinician, Central Intake Office (Barb Ross, HHS extension 74202), or Attending).
  5. See the patient the same day and call attending to discuss the timing of review for the case.

C) Hamilton Health Sciences: Ambulatory/Outpatient care

This is another focus of the core rotation, and will mostly usually take place in the Centre for Healthy Aging Outpatient Clinic at St. Peter’s Hospital, Hamilton Health Sciences. Family Medicine resident half days may conflict with clinic schedules. It will be the responsibility of the Family Medicine resident to notify the academic administrative assistant for Geriatrics, Karen Archer (extension 74132 or archerka@HHSC.ca ) of their half days. If changes can be made to the Family Practice resident's schedule to accommodate these ambulatory clinics, this would naturally be preferred..
 
The Resident will:

  1. Perform an appropriate Comprehensive Geriatric Assessment for new patients.
  2. Obtain an appropriately focused Geriatric history and perform an appropriate physical examination for follow up patients.
  3. Generate timely clinical reports incorporating the above information and which includes a comprehensive care plan for both short and long term goals

D) Hamilton Heath Sciences: Outreach (“Home Visits”)

Home assessments of frail elderly patients are occasionally performed when they are unable to attend the  clinic or hospital .  Dr. Misiaszek performs Geriatric Medicine Outreach visits with case managers from PMAC (Psychiatry & Medicine for the Aged in the Community) one day every other week, and if assigned to him the resident  may be able to participate in assessments and follow up visits in patients’ homes, retirement homes or long term care facilities.

The objectives and responsibilities are similar to the above.  A schedule will be forwarded to the resident or medical trainee on the day prior to the home visit.

E) St. Joseph’s Hospital Center for Ambulatory Health Services (CAHS)

The CAHS is located in east Hamilton and provides an additional setting for ambulatory Geriatric services and a variety of different outpatient experiences.  Geriatric outpatient clinics are held  Mondays through Fridays, and are staffed by four different Geriatricians, thus providing a broad range of perspectives. 

From Monday's through to Thursday residents will have the opportunity to work in the Geriatric Day Hospital which is located in the same setting.  This provides a different mix of patients with more of a physical rehabilitation emphasis, as well as an opportunity to follow geriatric patients on an ongoing basis during their stay in the day hospital.

Residents may also spend a  day in a Geriatric Psychiatry clinic with a Geriatric Psychiatrist as well as in a specialized incontinence clinic, both which can be arranged in on an individual basis. The contact person at this site is Dr. David Cowan's personal assistant, Natalie Hlacar, at 905 573 4804.

The objectives and responsibilities are similar to those described above in c)

Rotation Details

This will vary depending on the educational stream of the advanced trainee. Specific information for Resident learners about the Learning Environment, Rotation Details (Orientation, Clinic Schedule, Call Schedule, Teaching Sessions, Evaluations, etc.) can be found by clicking on the relevant links below.

Family Medicine Resident

Internal Medicine Resident

Basic Core Trainee

That being said, the following information will apply to most Residents:

Orientation

An Orientation Session regarding call responsibilities for those residents assigned to the GARU or doing call on the GARU will be provided by Dr. Cheryl Allaby on the morning of the first day of the monthly rotation on the CMR (2nd floor M wing Juravinski Hospital) beginning at 9:00 am.

Clinical Schedule

A monthly schedule will be provided to the Trainee prior to the first day of their rotation; as a general rule the day begins at 8 am (but please clarify this with the attending assigned to the medical trainee). They should arrive early to allow time to review charts before seeing the first patient at outpatient clinics.

Any changes in the schedule must be approved of and communicated to the preceptor well ahead of time.

Call Schedule

This is available on the Presentations link on the main page some weeks prior to the beginning of the rotation.  If you are NOT listed on the call schedule, please rectify this ASAP by calling Karen Archer at 905.521.2100 X74132 if you have a scheduling problem please contact Karen at  the above extension well in advance so that we can make changes to the schedule anticipating your absence.

While Internal Medicine & Basic Core Trainees are excluded from call (they are on the Internal Medicine Call Schedule), Family Practice Residents must be available for out-of-hospital night-call and weekend call (one weekend/month) with appropriate back up by a Geriatric Medicine Fellow (usually) and Geriatrician.  For acutely unwell patients this will mean the Resident coming in to review and examine. The weekend resident will make rounds on Saturday morning prior to reviewing patients with the Geriatrician.

Educational Resources

The Division of Geriatric Medicine at McMaster University has a Educational Resource page that has downloadable files that may be very helpful for this rotation.  In particular, there is a Power-point presentation (and accompanying podcast) on how to perform a Comprehensive Geriatric Assessment called gPOD and it is an the expectation that the Family Medicine resident will have reviewed this presentation prior to the beginning of this rotation.

There is also a 152 page down-loadable Geriatric Medicine Survival Guide that may be helpful to have a copy of, either on a PDA, smart-phone, or printed out in hard-copy and spiral bound.  This same handbook will also be available shortly as a print-on-demand (via their new Expresso Book Machine) soft-cover pocketbook from McMaster University's Titles Bookstore for a nominal fee

There are several other Power-point presentations on such topics as the work up and management of Dementia & Delirium that are available for review.

Teaching Sessions & Rounds

Residents will be expected to attend and participate in certain rounds.

  1. Daily teaching sessions are provided at the Henderson site at noon usually in the M-wing 4th floor conference room (two floors above Complex Medical Rehab Unit aka CMR). Learners from other sites are invited to attend if scheduling permits. Check with Dr. Allaby for topic of the day.
  2. Residents assigned to the Juravinski site are expected to provide teaching on a Geriatric Medicine topic of their choice to more juniors learners (such as clinical clerks) on the CMR, at least one half-hour noon session during their four week rotation. Feedback from both staff and other learners will be provided.
  3. Geriatric Medicine Rounds are held in the fourth floor rounds room at the MUMC site (Room 4E20) on the 2nd Friday of each  month during the academic year (time, date and speaker TBA). Check the Event Tracking Assistant for further information and possible cancellations.
  4. There will be a regular Geriatric Medicine Journal Club that will be held quarterly.  Details will be provided to the trainee if there is a meeting the month they are on service.
  5. All Residents are strongly encouraged to attend the weekly Medical Grand Rounds.
  6. Finally, all Residents are encouraged to attend their individual programme's eduational half-day.

Evaluations

The resident will be evaluated on WebEval by all Geriatric Medicine attending staff  based on case discussion, chart reviews and direct observation. Feedback from other staff (i.e. RNs, Allied Health) and other medical learners will also be incorporated.