SYLLABUS
College of Medicine
AY 2015-2016
Course title and number
Term (e.g., Fall 200X)
Meeting times and location
IMED 863-00T Community Based Geriatrics
Clinical Rotation 2 or 4 weeks ( All Year except September, December,
March, and May)
Dr. Aval Green will email you the time and location to report
Course Description and Prerequisites
This elective is designed to give 4th year medical students the opportunity to practice
community based geriatric medicine. The students will examine and evaluate patients in their
home environments within senior living communities as opposed to hospital based care. This
approach provides a rich opportunity to put into practice the concepts of multi-faceted geriatric
assessment taught during the 3rd year ambulatory internal medicine block. The students will
also have case-based interactive learning sessions, which will focus on integrating
pharmacology and patho-physiology as they apply to the aging population. This elective will
cover common geriatric syndromes such as falls, incontinence, atypical presentation of disease,
failure to thrive, elder abuse, pressure ulcers, end of life care, gait instability and
debility. Transportation to distant clinical sites is available via carpool
Instructor Information
Elective Director
Aval-Na’Ree Green
Name
254-771-4171
Telephone number
asgreen@sw.org
Email address
By appointment
Office hours
Temple Meredian
Office location
Clinic
Coordinator
Martha Chandler
Name
254-724-2607
Telephone number
mschandler@sw.org
Email address
254-724-2607
Office hours
Brindley Circles, 6th
Office location
floor, room 640
Learning Outcomes & Objectives
COM Competency Based Learning Objectives: http://medicine.tamhsc.edu/academicaffairs/curriculum/objectives/
Principles and Guidelines for Curriculum Development:
http://medicine.tamhsc.edu/policies/pdf/curriculum-principles-guidelines.pdf
Upon completion of the course, students will be able to:
Date Created/Revised: 4/22/2015 By: _msc
Course Objective:
(Example shown)
1. Perform medication reconciliation
and consistently identify potential
drug-drug and drug-disease
interactions
2. Calculate the creatinine clearance
of an elderly patient and dose
renally cleared medications
accordingly
3. Identify and correctly stage a
pressure ulcer; outline strategies for
pressure ulcer prevention
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COM Competency
Based Learning
Objectives
Taught
(T)
and/or
Evaluate
d (E):
Evaluation:
MK1: Demonstrate
knowledge of normal
human structure and
function at the organsystem, tissue,
cellular and molecular
level; and of the
interaction of human
systems in
maintaining
homeostasis
Taught
AND
Evaluated
Clinical
Performance
Rating/Checklist
PC8: Demonstrate an
understanding of the
principles involved in
the care of patients
across the spectrum
of the human life cycle
Taught
AND
Evaluated
Clinical
Performance
Rating/Checklist
SBP2: Advocate for
continuous quality
improvement in
patient care and
patient safety
Taught
AND
Evaluated
Clinical
Performance
Rating/Checklis
t
MK1: Demonstrate
knowledge of normal
human structure and
function at the organsystem, tissue,
cellular and molecular
level; and of the
interaction of human
systems in
maintaining
homeostasis
PC8: Demonstrate an
understanding of the
principles involved in
the care of patients
across the spectrum
of the human life cycle
Taught
AND
Evaluated
Clinical
Performance
Rating/Checklist
PC2: Perform both
complete and systemfocused physical
examinations
MK1: Demonstrate
knowledge of normal
human structure and
function at the organsystem, tissue,
Taught
Clinical
Performance
Rating/Checklist
Taught
cellular and molecular
level; and of the
interaction of human
systems in
maintaining
homeostasis
MK2: Describe the
basic mechanisms
involved in the
causation of human
disease and their
influence on clinical
presentation and
therapy
4. Perform and interpret a
multifaceted geriatric assessment
including cognitive assessment,
functional gait assessment, and
geriatric depression screening
MK3: Demonstrate an
understanding of how
healthy lifestyles,
psychosocial factors,
and behavioral factors
influence heath
5. Demonstrate the proper use of
common assistive devices for gait
instability
PC13: Perform basic
health risk
assessment and
formulate appropriate
screening plans
PC12: Educate
patients in
personalized health
maintenance
6. Perform a home safety evaluation
for a geriatric patient, identify
environmental risk factors for falls,
and formulate a plan for reducing
fall risk in an elderly individual
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MK5: Demonstrate an
understanding of the
epidemiology of
common diseases
within a population
and the approaches
which are useful in
reducing their
incidence and
prevalence
PC12: Educate
patients in
personalized health
maintenance
SBP1: Apply
knowledge of health
care systems to
improve and optimize
patient care
SBP2: Advocate for
continuous quality
improvement in
patient care and
patient safety
Taught
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
Taught
Taught
Taught
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7. Analyze case presentation and
identify red flags that potentially
signal elder abuse. Demonstrate
knowledge of available community
resources to assist physicians in
helping individuals and families
affected by elder abuse.
8. Develop an appropriate pain
management strategy for elderly
individuals with moderate to severe
pain
9. Distinguish age related changes
from pathology and associate the
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PC13: Perform basic
health risk
assessment and
formulate appropriate
screening plans
Taught
ICS3: Communicate
effectively with
patients, patients'
family members,
peers, and other
members of the health
care team
PROF1: Demonstrate
an understanding of
legal and ethical
principles governing
the physician-patient
relationship
PROF3: Act in the
patient's best interest
and serve as a patient
advocate
PROF11: Respond to
conflicts in a
professional manner
PC8: Demonstrate an
understanding of the
principles involved in
the care of patients
across the spectrum
of the human life cycle
Taught
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
PC10: Discuss the
principles of pain
management and
formulate a basic
multidisciplinary care
plan
PC15: Formulate
preventive, curative,
rehabilitative, and
palliative therapeutic
strategies for common
disorders
MK2: Describe the
basic mechanisms
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
Taught
Taught
Taught
physiologic changes of aging and
atypical presentation of disease in
elderly individuals
10. Obtain, record, and present H&P's
on geriatric patients
11. Select and interpret appropriate
diagnostic studies with special
consideration given to risks,
benefits, goals of care, and cost to
patient
12. Compare and contrast the
presentations of delirium and
dementia. Outline strategies for
delirium prevention in at risk
individuals
13. Perform and interpret the Trails
Making Part A and Part B tests in
older high risk drivers; council
older high risk drivers and their
families regarding the options
available to help maintain
Date Created/Revised: 4/22/2015 By: _msc
involved in the
causation of human
disease and their
influence on clinical
presentation and
therapy
PC1: Obtain both
complete and systemfocused medical
histories that include
psychosocial and
behavioral
determinants of health
PC2: Perform both
complete and systemfocused physical
examinations
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
PC8: Demonstrate an
understanding of the
principles involved in
the care of patients
across the spectrum
of the human life cycle
SBP2: Advocate for
continuous quality
improvement in
patient care and
patient safety
PC3: Develop
appropriate differential
diagnoses by
integrating collected
clinical information
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
PC15: Formulate
preventive, curative,
rehabilitative, and
palliative therapeutic
strategies for common
disorders
ICS2: Discuss
diagnostic and
treatment options in a
manner
comprehensible to the
patient
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
PC5: Interpret the
results of commonly
used laboratory and
radiologic studies
Clinical
Performance
Rating/Checklist
Clinical
Performance
Rating/Checklist
independence in the setting of
driving cessation
ICS3: Communicate
effectively with
patients, patients'
family members,
peers, and other
members of the health
care team
ICS4: Educate
patients, patients'
family members,
peers, and other
members of the health
care team at an
appropriate level using
appropriate
technologies
PROF1: Demonstrate
an understanding of
legal and ethical
principles governing
the physician-patient
relationship
PROF3: Act in the
patient's best interest
and serve as a patient
advocate
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
PROF10: Demonstrate Taught
knowledge of
and
responsibilities to
Evaluate
patients, peers, and
d
other members of the
health care team
PROF11: Respond to
conflicts in a
professional manner
14. Analyze clinical vignettes
involving healthcare financing
options for seniors and discuss the
pros and cons of choosing those
various options
Date Created/Revised: 4/22/2015 By: _msc
ICS2: Discuss
diagnostic and
treatment options in a
manner
comprehensible to the
patient
ICS3: Communicate
effectively with
patients, patients'
family members,
peers, and other
members of the health
care team
ICS4: Educate
patients, patients'
family members,
peers, and other
Clinical
Performance
Rating/Checklis
t
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Clinical
Performance
Rating/Checklist
Clinical
Performance
Rating/Checklist
15. Analyze clinical vignettes
involving doctor/caregiver (nurse)
communication where similar
clinical presentations represent
vastly different situations and
decision making depends heavily
on asking the right questions of the
caregiver (nurse); discuss effective
strategies for doctor/caregiver
communications
Date Created/Revised: 4/22/2015 By: _msc
members of the health
care team at an
appropriate level using
appropriate
technologies
SBP1: Apply
knowledge of health
care systems to
improve and optimize
patient care
SBP3: Demonstrate
an understanding of
cost containment
principles and their
application in the
delivery of health care
SBP4: Demonstrate
an understanding of
the legal and
regulatory frameworks
governing the practice
of medicine which
affect payment,
reimbursement,
referrals and
incentives
SBP5: Recognize
various approaches to
the organization,
financing, and delivery
of health care
PROF6: Work with
other health
professionals in a
collaborative fashion
Evaluate
d
PROF10: Demonstrate
knowledge of
responsibilities to
patients, peers, and
other members of the
health care team
ICS1: Demonstrate
effective listening
skills
Taught
and
Evaluate
d
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Clinical
Performance
Rating/Checklist
Clinical
Performance
Rating/Checklist
16. Analyze clinical vignettes
involving elderly patients with
lower urinary tract symptoms and
constipation; choose the
appropriate clinical diagnostic
approach and treatment plan
ICS3: Communicate
effectively with
patients, patients'
family members,
peers, and other
members of the health
care team
ICS4: Educate
patients, patients'
family members,
peers, and other
members of the health
care team at an
appropriate level using
appropriate
technologies
MK1: Demonstrate
knowledge of normal
human structure and
function at the organsystem, tissue,
cellular and molecular
level; and of the
interaction of human
systems in
maintaining
homeostasis
MK2: Describe the
basic mechanisms
involved in the
causation of human
disease and their
influence on clinical
presentation and
therapy
MK5: Demonstrate an
understanding of the
epidemiology of
common diseases
within a population
and the approaches
which are useful in
reducing their
incidence and
prevalence
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Taught
and
Evaluate
d
Clinical
Performance
Rating/Checklist
Textbook and/or Resource Material
Grading Policies
GRADING SCALE
Satisfactory
70-100
Unsatisfactory
69 and below
Should the course director determine remediation is required, the remediation plan will be at the
discretion of the course director and on a case by case basis depending on the issues involved.
Remediation plans could entail some (or all) of the following examples: Additional clinical shifts,
Date Created/Revised: 4/22/2015 By: _msc
research papers, presentations, article reviews, exams, directed reading, web-based modules, etc. If the
student performance results in a failure of the elective, it will be recommended that the elective be taken
again in its entirety.
Attendance and Make-up Policies
The Department of Internal Medicine adheres to attendance policies and duty hours as set forth in the
College of Medicine Student Handbook. In the case of personal illness, critical illness within your
immediate family, family death, or other circumstances where you will not be able to participate in
required activities, you must contact the Internal Medicine Medical Education Coordinator and contact
the attending Faculty. Students who miss more than 20% of a 4th year elective for any reason (2
weekdays during a two-week rotation or 4 weekdays during a 4-week rotation), will require a remediation
plan. The Course Director will consider student attendance and remediation if the student is requesting
extended time off during interview season.
Other Pertinent Course Information
Textbooks (Required and Recommended Resources)
Date Created/Revised: 4/22/2015 By: _msc
Updating the Beers criteria for potentially inappropriate medication use in older adults:
results of a US consensus panel of experts. Fick DM, Cooper JW, Wade WE, Waller JL,
Maclean JR, Beers MH. Arch Intern Med. 2003 Dec 8-22;163(22):27 16-24
Delirium - Inouye SK.; N Engl J Med. 2006 Mar 16;354(11):1157-65
Fall assessment in older people - Close JC, Lord SR. BMJ. 2011 Sep 14;343:d5153.doi:
10.1136/bmj.d5153. Review
www.virginiageriatrics.org
Americans with Disabilities Act (ADA)
The Americans with Disabilities Act (ADA) is a federal anti-discrimination statute that provides
comprehensive civil rights protection for persons with disabilities. Among other things, this legislation
requires that all students with disabilities be guaranteed a learning environment that provides for
reasonable accommodation of their disabilities. If you believe you have a disability requiring an
accommodation, please contact Disability Services, in Cain Hall, Room B118, or call 845-1637. For
additional information visit http://disability.tamu.edu
Any student with a disability who needs accommodation should inform the instructor at the beginning of
the course.
Academic Integrity
For additional information please visit: http://aggiehonor.tamu.edu
“An Aggie does not lie, cheat, or steal, or tolerate those who do.”
College of Medicine
Professionalism and integrity Statement (Academic Honesty and Plagiarism)
All College of Medicine students are required to comply with the student code of conduct and the academic integrity and
honesty standards published in each component’s Student Handbook. Disciplinary action will be taken in accordance with
the policies of each component. Students found guilty of Academic Dishonesty will receive an “F”/Unsatisfactory in the
course. For a full list of actions qualifying as academic dishonesty, please review the College of Medicine Student
Handbook at http://medicine.tamhsc.edu/student-affairs/docs/handbook.pdf.
According to the Aggie Honor System Office, plagiarism is defined as the appropriation of another person's ideas,
processes, results, or words without giving appropriate credit. Intentionally, knowingly, or carelessly presenting the work of
another as one’s own (i.e., without crediting the author or creator). Plagiarism and other academic misconduct definitions
can be viewed on the Aggie Honor System Office website;
http://aggiehonor.tamu.edu/RulesAndProcedures/HonorSystemRules.aspx#definitions.
E-mail Access and FERPA
The College of Medicine is communicating all official information to students through the students’ TAMHSC e-mail
accounts. Please check the account frequently during the semester for updates.
Date Created/Revised: 4/22/2015 By: _msc
This course is supported with web-based and/or e-mail activities. In order to take advantage of these additional resources
and participate fully in the course, you have been assigned an e-mail address by the Texas A&M Health Science Center.
This e-mail address is for internal use only, so that faculty may communicate with you and the entire class. By registering
for this course, you are agreeing to allow your classmates to have access to this e-mail address. Should you have any
questions, please contact the TAMU’s Office of the Registrar at 979-845-1031.
The Family Educational Rights and Privacy Act of 1974 (FERPA), which the HSC complies fully, is intended to protect the
privacy of education records, to establish the rights of students to inspect and review their education records and to
provide guidelines for the correction of inaccurate or misleading data through informal and formal hearings. Students also
have the right to file complaints with the Family Educational Rights and Privacy Act Office of the Department of Education
in Washington, D.C., concerning alleged failures by the HSC to comply with the act.
Mistreatment of Students
The College of Medicine is committed to providing a positive learning environment in which students can meet their
academic goals based on mutual respect in the teacher/learner relationship. Both parties must be sensitive to the needs
of others and differences in gender, race, sexual orientation, religion, age or disability. As outlined in the Student
Handbook under the section titled Standards of Conduct in the Teacher-Learner Relationship, belittlement, intimidation
and humiliation are unacceptable for effective learning and undermine self-esteem. Breaches involving student
mistreatment may result in a faculty or staff member being sanctioned or the loss of faculty and/or staff appointment.
These policies address student mistreatment involving College of Medicine employees, residents, affiliate staff, or
patients. Mistreatment may be reported through the College of Medicine telephone hotline, 1(855)-397-9835 or through
an online form at http://medicine.tamhsc.edu/current/student-mistreatment-form.html. For a full list of reporting avenues,
please refer to the Student Handbook under the Mistreatment Policy.
Exposure and Occupational Hazard
The Needle Stick Policy and Bloodborne Pathogen Exposure information for Medical Students may be accessed in the
Student Handbook at: http://medicine.tamhsc.edu/student-affairs/docs/handbook.pdf
Note: More information is available on the aforementioned topics to all students on the College of Medicine website.
Date Created/Revised: 4/22/2015 By: _msc