Orientation to the Geriatric Inpatient Service (Med A)

Memorial Hospital 8 Bed Tower

The Acute Care of the Elderly (ACE) Service, or Med A, is an inpatient service that is staffed by a faculty member within the Division of Geriatric Medicine, a Nurse Practitioner, an upper level Internal Medicine resident, and two interns.  There are usually 1-2 third year medical students and occasionally a fourth year, Acting Intern, medical student.  In addition, students and residents from other disciplines including PMR, pharmacy, and nursing may be present.

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Schedule:

7:45-8:30 am:  Resident Morning Report (fellow may attend report, or work with interns to see night floats or ill patients;  this is to be discussed with the attending at the start of the service)

8:30-11:00:  Morning work rounds

1 PM:  Interdisciplinary Team Rounds

Teaching Session:  Either 11:30-12 or later in the afternoon, depending upon the team’s schedule

12-1:  Intern and resident conferences; Grand Rounds for all on Thursdays

Goals for the Fellow on service:

  1. Develop teaching skills
  2. Develop leadership skills
  3. Improve upon physical exam skills
  4. Improve communication skills
  5. Gain an awareness of skills needed to supervise an interdisciplinary medical team caring for acutely ill older patients in the hospital

Specific Expectations and Responsibilities of Fellows: 

    1. The fellow should discuss their specific role on rounds with the attending and resident at the beginning of the rotation.
    1. Although the fellow will need to continue to have an continuity clinic and an afternoon session at their Long Term Care facility, the remainder of their time during the month should be dedicated to the inpatient service.
 
    1. The fellow and attending should  work out a plan for admissions that arrive after standard work hours, balancing the need for continued patient care with the necessary resident work hours and other obligations.
 
    1. The fellow should expect to work at least one weekend day each week (preferably the day when the supervising resident is off).  Fellows should expect at least one day off each week, which should be a mutually agreed upon day with the attending.  
 
    1. The fellow is expected to lead in an educational role.  Fellows should lead attending/teaching rounds, bringing articles and other information to the team based upon the patients that are seen.  Fellows are expected to prepare several such teaching sessions each week, based upon a curriculum for the rotation established in conjunction with the attending on service.
 
  1. The fellow should work specifically with the medical students, and should help them to complete their observed History and Physical and presentations.
  2. The fellow will perform complete geriatric assessments on  at least 3 complicated patients, identified by the team as patients in need of a more detailed assessment, and record their findings in the EMR.
  3. The fellow will take a leading role in at least 2 family and patient discussions, and record these discussions in the Advanced Care Planning Note
  4. The fellow is responsible for attending the daily Interdisciplinary team meetings and contributing to the team discussions and management plans for patient care.
  5. The fellow should serve as a liaison with outside physicians and consultants in order to ensure that continuity of care is provided during transitions to other settings of care.
 
  1. Each day, the fellow should review with the team for each patient the following:
    1. Presence of lines: are they needed?
    2. Foley catheter: why?
    3. Telemetry box: needed or not?
    4. Delirium screening
    5. ADLs/IADLs assessment
    6. Falls risk/Gait assessment: Has it been done? Is the patient safe for d/c?
    7. Cognitive assessment: has it been done? Is it needed? Is the patient at risk for delirium?
    8. Psychosocial assessment
    9. Medication review and reconciliation.
    10. Advanced directives and code status.
    11. Contact with primary physician
    12. Discharge planning needs

 

Reading List

  1. Augaard E, Teherani A, Irby DM.  Effectiveness of the One-Minute Preceptor Model for Diagnosing the Patient and the Learner:  Proof of Concept.  Acad. Med.  2004; 79: 42-49.
  2. Stenert Y, Snell LS.  Interactive lecturing: strategies for increasing participation in large group presentations.  Medical Teacher. 1999; 21(1): 37-42.
  3. Vickery AW, Lake FR.  Teaching on the run tips 10: giving feedback.  MJA. 2005;  183 (5): 267-268.
  4. Wong JD, Bajcar JM, Wong GG, Alibhai SMH, Huh J, Cesta A, Pond GR, Fernandes OA.  Medication reconciliation at hospital discharge: evaluating discrepencies. The Ann of Pharm. 2008; 42: 1373-9.