CARE OF ELDERLY PROGRAM
PROGRAM DESCRIPTION & EDUCATIONAL OBJECTIVES
FOR ENHANCED SKILLS RESIDENTS
INTRODUCTION
As the population continues to age and live longer, the complexity of care for the elderly patient
has become increasingly challenging. The goal of the Care of the Elderly program is to train
family medicine residents to become leaders academically, clinically and socially for this portion
of the population.
LEARNING ENVIRONMENT
Rotations will take place in both the hospital and clinic settings affiliated with UWO, SJHC and
LHSC.
HIERARCHAL STRUCTURE
1) Director – Dr. Scott McKay
2) Multiple specialists throughout SWOMEN as elective supervisors.
DUTIES
1) Patient care on which ever service they are scheduled, including admissions, discharges
and daily rounds. To be supervised by the attending physician.
2) Participation in teaching/grand rounds depending on current rotation.
3) Fellowship project focusing on patient care, leadership, quality or safety improvements,
or efficiency/utilization improvements.
4) On Call duties. The Enhanced Skills resident will take home call according to PAIRO
guidelines.
5) Teaching of clinical clerks and junior residents if they are on service and of course to be
aware of the clerkship learning objectives.
ORGANIZATION
The program includes a combination of block rotations with selected horizontal continuing
clinical experiences. Experience in the following clinical settings is usually provided in block
rotations:
- Acute Care Ward Consultation
- Geriatric Rehabilitation Unit
- Outreach
- Geriatric Psychiatry
- Geriatrics and Family Medicine
- Palliative Care
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-
Long term care facility experience
Electives
The horizontal experiences include:
- Ambulatory clinics
- Seminars
- Resident project
- Rounds
- Developing teaching skills
- Experience in program planning, development, and administration
Following is a description of the major rotations offered through the Care of the Elderly Program:
Geriatric Rehabilitation Unit
The geriatric rehabilitation unit is a 30-bed unit located at Parkwood hospital. It accepts patients
from a variety of regional and local settings that include home, LTC, residential care, and acute
care. The resident will participate as a member of the interdisciplinary team in the assessment,
treatment and discharge planning of frail elderly patients.
The GOAL of the Geriatric Rehabilitation rotation is to provide the resident with the opportunity to
develop and apply skills to a frail geriatric rehab population.
Geriatric Day Hospital & Parkwood Consult Service
In Day Hospital, the resident will participate in new patient assessments and work with the
interdisciplinary team and patient to develop rehabilitation goals. The resident will participate in
and, as appropriate, lead interdisciplinary team meetings.
The resident will also complete geriatric consultations, on an as needed basis, for the in patients
and residents at Parkwood hospital. On average, approximately 5 consults are requested monthly.
The GOAL of the Geriatric Day Hospital and Parkwood Consult service is to provide the resident
with the opportunity to explore and develop skills in both an ambulatory and inpatient rehabilitation
population, as well as in residential setting that includes both long term and retirement level care.
Geriatric Psychiatry
The Geriatric Psychiatry component draws upon two settings: and ambulatory multidisciplinary
team setting that serves London and Middlesex County and the Regional Psychogeriatric
Program that serves the ten counties of Southwestern Ontario.
The GOAL of the Geriatric Psychiatry rotation is to provide the resident with the opportunity to
develop and expand their skills in an ambulatory and outpatient geriatric psychiatry setting.
Acute Care of the Elderly Unit
The Acute Care of the Elderly Unit is a CTU at Westminster Victoria Campus of LHSC. While on
this service the resident will act in the capacity of a junior attending under the supervision of a
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Geriatrician. The resident will be responsible for the daily operation of the ACE unit, including
bed management, patient care, and facilitation of team meeting and family conferences.
The GOAL of the ACE Unit rotation is to provide the resident with the opportunity to develop
knowledge and skills in an acute care geriatric environment.
Geriatric Consultation Liasion Service
The Consultation Liaison Service is an acute care combined geriatric medicine and geriatric
psychiatry consultation service that operates at each acute care site of LHSC. The team is
composed of nurse clinicians, NP, CNS, geriatricians and a geriatric psychiatrist. During this
rotation, in conjunction with other team members, the resident will complete comprehensive
geriatric and psycho-geriatric assessments on medically and cognitively frail elderly inpatients.
The GOAL of the Consultation Liaison rotation is to provide residents with the opportunity to
develop and apply their knowledge in an acute care geriatric consultation service.
Geriatric Outpatient Clinic
The resident completing the Geriatric Outpatient Clinic rotation will have the opportunity to
select from 6-8 half-day clinics that will broaden their expertise in geriatric medicine.
Opportunities include geriatric subspecialty clinics (aging brain, osteoporosis, continence),
general geriatric clinics, and neurology, rheumatology, movement disorders, physiatry, and
wound management clinics.
The GOAL of the Outpatient Clinic rotation is to provide the resident with the opportunity to
develop/enhance their skills in an ambulatory setting.
Geriatric Regional Outreach Program
Geriatric residents on the Geriatric Outreach rotation will have the opportunity to work in a
multidisciplinary team while provide geriatric consultations in residential settings (home, retirement
home, LTC) within urban and rural southwestern Ontario. The resident will gain insight into
healthcare system administration and structure, the philosophy of community development and
capacity enhancement and the differences that exist between primary, secondary and tertiary
health care sectors.
The GOAL of the outreach rotation is to provide the resident with the opportunity to develop and
apply knowledge in a community outreach setting.
Longitudinal Geriatric Assesment Clinic
The longitudinal clinic is an ongoing outpatient experience for residents. Residents will be
assigned to one site, under the supervision of a faculty member, and will attend a half-day clinic
for a minimum of 6 months.
The GOAL of the clinic is to provide residents with a venue and experience where the resident
can help patients transition from inpatient to ambulatory, community based or long term care
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while enhancing their skills through their longitudinal exposure to an ambulatory geriatric
population.
Palliative Care
The Palliative Care rotation is primarily hospital-based although it does have the opportunity for
exposure to community Palliative Care. While this rotation includes palliative care for older
adults it also provides exposure to palliative care issues in some cases to younger adults.
The GOAL of the palliative care rotation is to provide the resident the experience, knowledge
and understanding of how to care for a palliative patient.
Long-Term Care Facility Experience
There is the opportunity within the program for residents to work in a long-term care facility.
Specific objectives are identified with the resident at the time of shaping their individual program
if they choose this rotation; but the experience provides residents with the opportunity to
develop knowledge and skills related to working collaboratively with the Nursing Director in a
long-term care facility, establishing protocols and policies to ensure high quality care,
developing strategies for periodic reviews of patients, and developing knowledge and skills
related to outbreaks and other problems within a long-term care facility.
SCHOLARLY ACTIVITIES
1) All residents in the Enhanced Skills program are required to complete a scholarly
project. A written report is not required but welcome. A formal presentation at resident
research day in June is required. Topics should be discussed with Dr. Grushka
(Enhanced Skills Program Director), and Dr. Feightner. Please refer to the Enhanced
Skills Orientation Manual for more direction regarding project requirements and
departmental assistance with funds, ethics approval, literature reviews, etc.
2) All residents are required to attend the academic half days and teaching sessions
provided through the departments of Internal Medicine, Psychiatry and Family Medicine
as it pertains to the rotation they are on. Goals, objectives and resources should be
discussed with Dr. Feightner.
3) The resident is encouraged to teach at PGY-1/PGY-2 academic half day on a topic
related to their field of specialization. This can be discussed with the Academic Program
Director (Dr. Wickett) and the Enhanced Skills Program Director (Dr. Grushka).
EVALUATION
1) The resident will be supervised on a daily basis and will obtain 1 evaluation per block
from a Care of the Elderly Consultant on the one45 system.
2) The resident will meet informally with Dr. Feightner to discuss cases and review any
concerns.
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3) A midterm review with the program director will take place to ascertain the resident’s
progression either in person, by phone or by video-link (skype).
OBJECTIVES FOR HOSPITALIST PROGRAM AS CONSIDERED BY THE CANMEDS-FM ROLES
I.
Family Medicine Expert
1. The Family Medicine Resident will become knowledgeable in the following general
areas as it pertains to Care of the Elderly:
1.1 Be able to discuss the aging process with patients, family members and health care
professionals.
1.2 Be able to discuss the disorders of old age.
1.3 Be able to demonstrate a high index of suspicion for treatable disease and dysfunction.
1.4 Be able to demonstrate expertise in the medical, functional, social and psychological
dimensions of ill health in the elderly.
1.5 The physician shall demonstrate the special skill required to take an accurate, relevant
history from the patient and/or relative or friend.
1.6 The physician shall demonstrate a physical examination technique modified to an
appropriate scheme for the elderly patient.
1.7 The physician shall demonstrate knowledge of the use of functional assessment methods
in routine practice.
1.8 The physician shall demonstrate expertise in risk assessment and management.
1.9 The physician shall demonstrate expertise in diagnosing and treating the common disorders
of old age, aiming for realistic goals.
1.10 The physician shall assess the mental function and competency of the elderly
patient.The physician shall demonstrate expertise in diagnosis and management of
psychogeriatric disorders.
1.11 The physician shall accurately assess the required levels of care for any particular
patient.
1.12 The physician shall manage the patient with multiple disorders and rank these in order
of priority.
1.13 The physician shall discuss the special problems of retirement.
1.14 The physician shall discuss the special problems of the terminally ill patient and the
family.
1.15 The physician shall discuss the special problems of drug therapy for the aging patient.
1.16 The physician shall assess the patient’s suitability, for care at home against the
background of family, mental capabilities, physical status, economic feasibility, and home
facilities.
1.17 The physician shall demonstrate expertise in managing the problems of the family in
relation to elderly people.
1.18 The physician shall use the team approach to the geriatric patient. (Experience at levels
of team leader, team participant and as group facilitator shall be included. Post-meeting
follow-up and evaluation of team function are to be emphasized).
1.19 The physician shall appropriately utilize rehabilitation therapy.
1.20 The physician shall demonstrate expertise in the recognition and management of elder
abuse.
1.21 The physician will be able to understand, manage, treat and refer regarding the following
common disease processes:
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1.21.1 Acute Coronary Syndrome
1.21.2 Acute Renal Failure
1.21.3 Alcohol and Drug withdrawl
1.21.4 Anemia
1.21.5 Asthma
1.21.6 Cardiac arrythmia
1.21.7 Cellulitis
1.21.8 Chronic obstructive pulmonary disease
1.21.9 Community acquired pneumonia
1.21.10
Congestive heart failure
1.21.11
Delerium
1.21.12
Dementia
1.21.13
Diabetes mellitus
1.21.14
Gastrointestinal bleeding
1.21.15
Hospital acquired pneumonia
1.21.16
Pain management
1.21.17
Pulmonary embolism
1.21.18
Sepsis and SIRS
1.21.19
Stroke and TIA
1.21.20
Urinary tract infections
1.21.21
Venous thromboembolism
1.21.22
Understand the principles surrounding the following topics:
1.21.23
Care of the elderly patient
1.21.24
Care of the vulnerable population
1.21.25
Drug safety
1.21.26
Nutrition and the hospitalized patient
1.21.27
Prevention of healthcare associated infections and antimicrobial
resistance
1.21.28
Transitions of care (i.e. acute care, long term care, palliative care)
1.21.29
Patient safety
2. The Family Medicine Resident will become knowledgeable regarding the Geriatic
Hospital Care and Inpatient & Outpatient Consultations:
2.1 The resident will know and understand the professional, legal and ethical codes to which
physicians are bound and apply these to practice in the ambulatory setting.
2.2 The resident will be able to demonstrate consultative skills and the practice of an evidence
based approach to common geriatric issues including the management of chronic diseases
and their acute exacerbations, as well as delirium and dementia.
2.3 It will be observed that the resident can perform both a comprehensive geriatric assessment
including physical exam and a focused history and physical exam relevant to a specific
medical complaint.
2.4 The resident will be able to identify intrinsic and extrinsic factors that may predict the
success of the patient both in Day Hospital setting and after discharge, in the community.
2.5 The resident will understand the physiological changes of ageing and recognize common
pathological conditions and chronic illnesses and their presentation in the elderly.
2.6 The resident will become familiar with major geriatric syndromes ie: falls, depression,
dementia, continence, stroke, neurological conditions (such as Parkinson’s disease) and
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musculoskeletal disorders.
2.7 The resident will become familiar with atypical presentation of illness in the elderly and the
literature behind such presentations.
2.8 The resident will gain expertise in utilizing special tools that are used in geriatric
assessment including ADL/IADL assessment, screening cognitive testing, nutritional
assessment, and gait and balance assessment.
2.9 The resident will demonstrate practical knowledge of the interface between inpatient care,
Day Hospital and community services which is important in ensuring the successful
reintegration of the frail elder into the community.
2.10 The resident will be able to accurately verbalize the roles of allied health professionals
and draw on their resources as required to effect the care of their patients.
2.11 The resident will demonstrate the ability to balance appropriate investigations and
therapies for the older person with the social obligation to control health care costs.
2.12 The resident will recognize caregiver stress and gain experience in its management.
2.13 The resident will effectively apply evidenced based practice in the geriatric day hospital
and consult settings.
2.14 The resident will develop appropriate patient assessment and management skills in an
ambulatory setting including:
 Medical assessment
 Functional/social assessment
 Cognitive assessment
 Competency assessment
 Medication assessment
 Prevention in the elderly
 Developing strategies for outpatient management
2.15 The resident will demonstrate skill in communication through communication with
referring physicians, patients and families, the dictation of consultation notes, and
maintenance of patient charts.
2.16 The resident will demonstrate the ability to determine an elderly patient’s ability to
consent to a medical or personal care decision.
2.17 The resident will demonstrate skill in collaboration with referring and attending
physicians, specialists and community agencies to ensure quality and continuity of care for
their patients.
2.18 The resident will understand the interaction between ambulatory care and other aspects
of specialized geriatric care including community agencies, long-term care facilities, ACE
Unit, Day Hospital, Outreach, Rehabilitation and Palliative care.
2.19 The resident will be able to discuss the determinants of health relevant to an aging
population.
2.20 The resident will demonstrate professional attitudes, behaviors and interactions
including punctuality and relationships with clinic staff.
2.21 The resident will be familiar with the common ethical and legal issues that are
encountered in an ambulatory geriatric population.
2.22 The resident will elicit a history that is relevant, concise, accurate and appropriate to the
older patient’s problem(s).
2.23 The resident will perform a physical exam that is relevant, sufficiently elaborate and
appropriate including examination of cognition, basic mobility, nutritional status, vital signs.
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The resident will be skilled in the physical assessment of arthritis, Parkinsonism, autonomic
insufficiency, and other common neurologic syndromes. The examination will take into
account the physical, functional and sensory limitations that may exist in an older individual.
2.24 The resident will be able to analyze a symptoms or disability by determining the exact
manoeuvres required for further assessment and determining contributing causes for the
symptom or disability by a targeted history, physical and laboratory evaluation.
2.25 The resident will be able to identify other health practitioners who should be utilized in
effectively assessing or managing the health problem of an older patient.
2.26 The resident will demonstrate their ability to communicate effectively with patients, their
families and caregivers and other members of their health care team demonstrated by
excellent verbal skills, ability to communicate results of the assessment, and organized and
concise consultation notes.
2.27 The resident will demonstrate an understanding of the determinants of health by
identifying important factors in a older patient, adapting the assessment and management of
the patient accordingly and accessing the older person’s ability to access various services in
the health and social system.
2.28 The resident will be able to describe the special assessment tools that are used to
perform a comprehensive geriatric assessment including assessment of mental status,
mobility and function.
2.29 The resident will demonstrate knowledge of the pharmacokinetics and pharmacodynamic changes with aging and how these changes modify the choice of drugs and
dosages of prescription and non-prescription drugs in the elderly.
2.30 The resident will assess, investigate and manage common geriatric syndromes including
falls, urinary incontinence, delirium, dementia, depression, osteoporosis, and Parkinson’s
disease.
2.31 The resident will demonstrate knowledge of atypical disease presentation in the frail
elderly.
2.32 The resident will describe the principles of rehabilitation in the elderly and understand
which patient profile can best benefit from inpatient evaluation.
2.33 The resident will demonstrate knowledge of the differential diagnosis of unexplained
functional decline, weight loss and failure to thrive in the elderly.
2.34 The resident will demonstrate knowledge of a comprehensive functional assessment of
an elderly patient that includes mental status examination and assessment of mobility. This
requires familiarity with assessment instruments (eg. Folstein’s standardized Mini-Mental
State Examination, the Tinetti Scale, Lawton-Brody, etc.)
2.35 The resident will be able to assess the capacity of an older person to consent to
treatment, make personal care decisions, to make financial decisions and to drive a motor
vehicle.
2.36 The resident will demonstrate the ability to communicate effectively with attendings,
patients, their families and caregivers and other members of their health care team
demonstrated by excellent verbal skills, ability to lead a family conference and ability to
share results of the assessment with the patient and family so that the information is easily
understood.
2.37 The resident will understand the necessity for communication between consultants and
referring physicians.
2.38 The resident will demonstrate an ability to plan strategies for the continuing care and
follow-up of the elderly patient with chronic and complex conditions.
2.39 The resident will demonstrate an ability to work with the consult team to prioritize
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assessments and provide appropriate consultative expertise.
2.40 The resident will recognize the role and importance of the family and caregiver in the
care of the elderly.
2.41 The resident will recognize the ethical issues around investigation and treatment of the
elderly including an understanding of competency and living wills and their relevance to
clinical decision making.
2.42 The resident will recognize the importance of balancing patient autonomy and the
principles of ethics with investigations and treatment of the geriatric patient.
2.43 The resident will accurately refer patients and families to community supports and
resources
2.44 The resident will demonstrate an ability to integrate critical appraisal skills in to the
evaluation and management of medical problems.
2.45 The resident will demonstrate an understanding of the evidence for delirium prevention
in hospitalized elderly patients.
3. The Family Medicine Resident will become knowledgeable regarding the Geriatic
Rehabilitation:
3.1 The resident will demonstrate the ability to perform a comprehensive geriatric assessment
relevant to a rehabilitation service, including accurate and reliable assessment of basic and
instrumental activities of daily living both at the bedside and in effectively documented chart
notes and discharge summaries.
3.2 After assessing an older patient, the resident will be able to identify the factors that may
predict how well a candidate may perform in a rehabilitation setting (including the impact of
cognitive decline), recognizing however, that these factors are not steadfast and that elders
are a heterogeneous group.
3.3 The resident will demonstrate an ability to set treatment and rehabilitation goals in
conjunction with the older patient, family, consultant and allied health professionals in the
setting of hip fracture, joint replacement, surgical complications and significant medical
illness.
3.4 The resident will select medically appropriate investigations in a cost effective, ethical and
useful manner while keeping the best interest of the patient in mind.
3.5 The resident will be able to identify patient need for community based or facility based care
in effective discharge planning.
3.6 The resident will through discussion demonstrate comprehension of the relationship
between impairment, disability and function.
3.7 The resident will be able to perform and effectively utilize standardized scales including the
standardized MMSE, GDS, Cornell, Lawton Brody, TUG and Berg Balance Scale.
3.8 The resident will be able to assess the capacity of an older person to consent to treatment,
make personal care decisions, to make financial decisions and to drive a motor vehicle.
3.9 The resident will demonstrate an approach to the diagnosis and management of pain, falls,
continence, cognitive impairment, delirium and depression in the medically ill and frail and
will be able to prioritize these rehabilitation goals.
3.10 The resident will demonstrate an ability to communicate effectively with patients, their
families and caregivers and other members of their health care team demonstrated by
excellent verbal skills, ability to lead a family conference, and organized and concise
consultation notes.
3.11 The resident will demonstrate a patient centred, compassionate and empathetic
approach to patients and their families that includes concern for the psychosocial, cultural
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and economic implications of a patient’s unique situation and disability.
3.12 The resident will demonstrate proficiency in completing a detailed history through
discussions with patients, family, caretakers and a review of relevant documentation, with
particular emphasis on the patient’s functional abilities, impairment, disability and handicap.
3.13 The resident will communicate a patient’s diagnosis, diagnostic plan and treatment plan
in a way that is easily understood by the patient and/or family.
3.14 The resident will demonstrate ability to collaborate and function effectively within an
interdisciplinary team to promote the well-being of an older patient.
3.15 The resident will demonstrate a patient centred approach to health care.
3.16 The resident will assist patients and families in accessing health and social resources in
the community.
4. The Family Medicine Resident will become knowledgeable regarding Geriatic
Psychiatry:
4.1 The resident will be able to assess the capacity of an older person to consent to treatment,
make personal care decisions, and to make financial decisions and will recognize the role of
the physician in these circumstances.
4.2 The resident will demonstrate proficiency in completing a detailed history and mental status
examination of an elderly patient, taking into account communication difficulties.
4.3 The resident will develop comprehensive, problem-oriented treatment plans for elderly
psychiatric patients, with special emphasis on the coexistence of multiple medical issues as
well as poly-pharmacy.
4.4 The resident will demonstrate knowledge of indications for involuntary psychiatric
admissions and the process of applying for such an assessment.
4.5 The resident will demonstrate the ability to differentiate between the presentations of
dementia and depression and delirium in the older patient.
4.6 The resident will be able to describe the indications, side-effects and common drug
interactions of psychotropic drugs in the elderly.
4.7 The resident will conduct, when indicated, and participate effectively in multidisciplinary
team meetings and family conferences.
4.8 The resident will demonstrate proficiency in completing a detailed history with an
emotionally impaired elderly individual, their families and caregivers with particular
emphasis on the patient’s psychosocial issues.
4.9 The resident will communicate with other medical staff, in oral and written format, a concise
patient’s history, differential diagnosis, diagnostic and treatment plan.
4.10 The resident will demonstrate ability to collaborate and function effectively within an
interdisciplinary team to promote the well-being of an older patient.
4.11 The resident will demonstrate an understanding and respect for the role of the other
members of the interdisciplinary team and a willingness to deal with differences of opinion in
a professional and sensitive manner.
4.12 The resident will demonstrate a patient centred and compassionate approach to patients
and their families that includes concern for the psychosocial stresses associated with
psychiatric illnesses.
4.13 The resident will demonstrate an approach to elderly patients with psychiatric illness that
is empathetic and positive while creating an environment that is favourable to the
development of a therapeutic relationship that will foster efficient care.
4.14 The resident will be able to describe the nature of institutions and community resources
providing care for the mentally ill elderly and assist patients and families in accessing health
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and social resources in the community.
5. The Family Medicine Resident will become knowledgeable regarding the Acute Care
of the Elderly Patient:
5.1 The resident will recognize and describe common disease processes, which may present
atypically in the elderly and contrast this to younger adults (e.g. coronary disease, infection,
neoplastic disease, etc.)
5.2 The resident will select medically appropriate investigations in a cost-effective, ethical and
useful manner.
 The resident will be able to assess, investigate and manage common geriatric
syndromes:
 Dementia, delerium, depression
 Falls
 Dizziness
 Postural hypotension
 Osteoporosis
 Urinary incontinence
 Parkinson’s Disease
5.3 The resident will demonstrate knowledge in functional assessment and capacity
assessment.
5.4 The resident will demonstrate knowledge in the assessment and management of nutritional
status in the elderly.
5.5 The resident will demonstrate knowledge of the pharmacokinetic changes which occur with
aging and how these changes modify the choice of drug, dosage and prescriptions in the
elderly.
5.6 The resident will demonstrate practical knowledge of the interface between acute care,
chronic care and outpatient services and apply this in planning successful discharges from
hospital.
5.7 The resident will complete organized and concise summary notes and discharge summaries
in a problem oriented fashion which effectively communicate information to family
physicians and other care providers.
5.8 The resident will be able to conduct an interview and history with an elderly patient with
sensory/cognitive impairment including the mental status exam, functional assessment and
assessment of capacity.
5.9 The resident will convey bad news in a sensitive, flexible, understanding and balanced
manner.
5.10 The resident will demonstrate effective methods of communicating the results of
investigations to elderly patients and their families.
5.11 The resident will understand the importance of the interdisciplinary team and will
demonstrate the ability to collaborate and function effectively within an interdisciplinary team
to promote the well-being of an older patient.
5.12 The resident will understand the role and importance of the family and caregiver in the
care of the geriatric patient.
5.13 The resident will utilize community resources and services to help optimize function and
independency in the geriatric patient.
5.14 The resident will demonstrate the ability to deal effectively with the multiple complex
problems of an elderly patient and prioritize these according to urgency and patient concern.
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5.15 The resident will recognize the complexity of the ethical and legal issues involved in
clinical management of the elderly and in treating chronic illnesses including an
understanding of competency and living wills and their relevance to clinical decision making.
6. The Family Medicine Resident will become knowledgeable regarding care of the
elderly in an community outreach setting:
6.1 The resident will demonstrate an awareness of the evidence for community based
comprehensive geriatric assessment and case management through effective/evidenced
based consultation notes and plan for follow up.
6.2 The resident will be able to assess an older person with multiple physical,
cognitive/psychiatric, and functional and/or social problems in their residential environment.
6.3 The resident will demonstrate the ability to deal effectively and efficiently with clinical
complexity by strategies such as prioritizing problems in consultation with the older patient,
their family, and other health care providers when appropriate.
6.4 The resident will access, retrieve and apply relevant information in dealing with the older
patient’s problem and will incorporate validated research findings into clinical practice.
6.5 The resident will demonstrate an understanding of family dynamics and those factors, which
cause family dysfunction.
6.6 The resident will identify the presence and capabilities of caregivers for older disabled
patients, recognize caregiver stress and identify methods of dealing with this stress.
6.7 The resident will demonstrate expertise in dealing with medico-legal issues pertaining to the
care of an older patient such as assessment of capacity to consent to treatment, make
personal care decisions, make financial decisions, and drive a motor vehicle.
6.8 The resident will be able to communicate effectively with patients, their families and
caregivers and other members of their health care team demonstrated by excellent verbal
skills, and ability to inform a patient and their family of the results of the assessment and
proposed management plan.
6.9 The resident will demonstrate ability to collaborate and function effectively within an
interdisciplinary psycho/geriatric assessment team to promote the well being of an older
patient.
6.10 The resident will become familiar with the community resources available in South
Western Ontario.
6.11 The resident will demonstrate an understanding of how to function effectively and
efficiently in providing outreach services by setting realistic priorities and utilizing time,
energy and resources effectively in order to achieve a balance in providing patient care,
learning needs, planning a research or quality assurance project, outside activities and
personal life.
6.12 The resident will demonstrate the ability to promote integrated care of older patients and
ease transitions across a variety of settings including clinics, hospitals, LTC and home
where they may receive services.
6.13 The resident will demonstrate an understanding of the specialist’s role to intervene on
behalf of the community with respect to the social, economic, and biologic factors that may
impact on community health as it relates to older people.
6.14 The resident will recognize and respond appropriately to advocacy situations.
7. The Family Medicine Resident will become knowledgeable regarding palliative care:
7.1 The resident will demonstrate the ability to manage pain in the elderly using both
pharmacologic and non-pharmacologic strategies.
7.2 The resident will demonstrate an awareness and appropriate use of institutional and nonOBJECTIVES FOR CARE OF THE ELDERLY PROGRAM
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institutional resources available for palliative care.
7.3 The resident will demonstrate proficiency in the assessment and management of elderly
patients with a variety of end-stage clinical illness and cancer in a variety of settings.
7.4 The resident will demonstrate sensitivity and empathy in exploring the personal and cultural
relief regarding death and dying – both with patients and their families.
7.5 The resident will demonstrate the ability to assess the contributors to patient discomfort
including medical illness, skin breakdown, and psychosocial factors.
7.6 The resident will demonstrate the capacity to work with a multi-disciplinary team in both
assessment and the formulation of a treatment plan.
7.7 The resident will demonstrate the ability to counsel dying patients and their families.
II.
Manager
Family Medicine residents will
1. Order appropriate and economical selection of diagnostic and screening tests.
2. Make referrals effectively.
3. Demonstrate understanding of roles of all health care providers in the team.
4. Demonstrate understanding of hospital care planning and policy-making.
5. Understand how to mobilize a health care team in an emergency situation.
6. Understand the principles of a high reliability organization and the role of the team in an
emergency.
7. Demonstrate the ability to make effective diagnostic decisions.
8. Understand the need and abitlity to assess for risk management, quality assurance and
improvement.
9. Understand the role of information management in the care of hospitalized patients.
III.
Communicator
Family Medicine Residents will be able to communicate effectively with patients, family
members and members of the health care team
1. Demonstrates listening skills.
2. Demonstrates language skills (verbal, writing, charting).
3. Demonstrates non-verbal skills (expressive and receptive).
4. Demonstrates skills in adapting communication appropriately to a patient’s or colleague’s
culture and age.
5. Demonstrates attitudinal skills (ability to respectfully hear, understand and discuss an
opinion, idea or value that may be different from their own).
6. Apply these communication skills to facilitate shared and informed decision-making.
7. Able to coordinate community resources including knowledge of the Community Care
Access Centre (CCAC) and other outreach services.
8. Function within a team composed of members from various health care disciplines.
9. Recognizing situations where a specialist consultation is appropriate, and effectiveness in
communicating the purpose of the referral, the patient’s clinical condition and pertinent
previous medical history.
IV.
Collaborator
Family Medicine Residents will be able to collaborate
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1. Work collaboratively in different models of health care.
2. Engage patients and families as active participants in their care.
3. Understand the role of the hospitalist as a teacher and consultant.
V.
Health Advocate
Family Medicine Residents will be able to advocate for the health of patients
1. Acting as an effective patient advocate with employers and social service agencies.
2. Identify patients who are vulnerable or marginalized and assist them in issues (i.e.
occupational issues, special diet application forms, etc.) that promote their health.
3. Identify patients at risk because of social, family or other health situations and to work
appropriately with social services.
VI.
Professional
Family Medicine Residents will have demonstrated professionalism
1. Demonstrates (i.e. day to day behaviour) that reassures that the resident is responsible,
reliable and trustworthy.
2. Identify patients at risk because of social, family or other health situations.
3. Demonstrate leadership, professional and ethical qualities.
VII.
Scholar
The Family Medicine Resident will have demonstrated their scholarly proficiencies:
1. Strategies for lifelong learning and continuing maintenance of professional competence.
2. Demonstrates self-directed learning based on reflective practice.
3. Access, critically evaluate and use medical information in health care decisions.
Developped by: Dr. Daniel Grushka, Dr. Scott McKay and the Care of the Elderly Program
Subcommittee
Last reviewed: June 2013
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