Medical residents often lack the opportunity to work with seniors who are not acutely ill or to understand the kinds of services available to help keep them well. To address this deficit, the Division of Geriatrics and Gerontology has created a geriatrics rotation that includes experiences inside and out of the hospital.

Each PGY-2 resident is assigned a 4-week geriatric block consisting of:

• 2 weeks managing a panel of patients on the 10N team
• 1 week covering nights on the 10N team
• 1 week in an outpatient module that introduces the resident to the systems of care that help meet the medical and psychosocial needs of community-dwelling older adults

During the systems-based practice (outpatient) module, residents:

• Visit a PACE (Program of All-inclusive Care for the Elderly) site
• Make hospice and geriatric house calls
• Accompany geriatric care managers on client visits
• Tour a nursing home, independent living, and other levels of senior housing
• Visit an elder abuse shelter
• Assist with transitional care clinic and Wright Center walk-ins.

Residents also present one of their own WCIMA patients in the weekly geriatrics team meeting for discussion and advice. An oral exam and debriefing at the end of the week enable the resident to integrate the experiences and put them in context of their inpatient and outpatient responsibilities.

Goals of the geriatrics rotation include:

1. Apply the principles of assessment, treatment, and prevention of specific geriatric problems and syndromes
2. Promote wellness and maintenance of function in older patients
3. Manage acute illnesses common to geriatric patients, such as pneumonia, urinary tract infections, fractures, cellulitis, and syncope
4. Use a functional approach to patient problems
5. Collaborate with other members of the health care team to ensure comprehensive care for older patients
6. Understand the importance of safe transitions and how to optimize them
7. Understand and utilize the multidisciplinary resources necessary to provide optimal care for older patients
8. Recognize the adverse consequences of hospitalization and the interventions that can reduce them
9. Value the important role of families and caregivers; communicate effectively with older patients and their families across a broad range of socioeconomic and cultural backgrounds
10. Initiate discussions about end-of-life care
11. Apply the principles of continuity of care
• Coordination of care between settings
• Effective communication with outside physicians and agencies
• Documentation and order writing
• Available services
• Patient and family education
12. Identify the risks for institutionalization and differentiate between the levels of care provided in different institutions