INTEGRATED CARE OF THE ELDERLY ~ Example
Dr. Scott MacLean, PGY2 Family Medicine Resident (2011-2012) is currently involved in the Integrated
Care of the Elderly learning opportunity. The Family Medicine Residency Program gratefully
acknowledges and thanks Dr. MacLean for sharing the following information and his plan for meeting the
requirements of this experience.
Program Requirements
The current structure of the Care of the Elderly curriculum includes the following:
 Four weeks of Geriatrics including a maximum of 1-in-4 call (7 calls maximum).
 This curriculum generally includes:
o Outpatient assessment of Geriatric patients, including multidisciplinary management
o Inpatient assessment of patients for suitability for rehabilitation or requirements for
increased level of care
o Management of patients at a Long-term-care facility
Objectives for the program are available online at:
http://www.familymed.med.ualberta.ca/Library/Documents/CareoftheElderly.pdf
Personal Goals and Objectives
 Gain experience and a level of comfort in managing elderly patients in the long-term care
setting, helping to incorporate this discipline in future practice
 Maintain skills learned during FM residency
 Manage geriatric patients in the long-term care setting, as well as acting as a member of
the multidisciplinary geriatric assessment team.
Staff Members involved:
 FM Residency Faculty Advisor
 Long-term Care Preceptor
 Geriatric Assessment Preceptor
Educational Requirement
 A 500-word reflective journal to be completed. This journal will be reviewed by preceptors
and faculty advisor, and be a deliverable at the end of the experience.
Call Requirement
 Become part of the evening-weekend call rotation at the specific long-term care facility that
patient panel resides in. (Frequency of call is approximately once every 3 months and is
for 1 week in duration).
 Also on call for individual patients with issues during the daytime hours.
Long-term Care
 Meet with Long-term Care Preceptor and staff at a long-term care facility
 In conjunction with Long-term Care Preceptor, assume care for a patient panel of
approximately 25 patients for PGY2 year, with the exception of days when on vacation or
out of town during rural rotation.
 Responsibilities include being on-call during the daytime hours for issues arising with
patient panel, as well as on-call requirements as outlined above. Additionally, weekly
rounds with nursing staff are scheduled (same day each week)
Geriatric Assessment Team
 Participate in 3-6 Geriatric Assessment Team Clinics (may be in conjunction with an
established Health Care Centre), time permitting.
 Responsibilities include working with family members to determine the patient’s context
and history, working with members of the multidisciplinary team on assessment of
functional status, and working with Geriatric Assessment preceptor to develop a care plan
for patients.
Timeline
 Assume care for long-term care residents immediately.
 Geriatric Assessment Clinics take place throughout the year, when scheduling permits.
 During the following time periods, the experience will be on hold:
o Sept (Vacation)
o December –February (Rural Rotation)
o May -June (Elective, out of town)
Deliverables
 Reflective Journal
 Evaluation