EARLY CLINICAL EXPERIENCES IN GERIATRIC MEDICINE

PRIMARY CONTACTS:
     Lee Lindquist, MD MPH
     Cory Ritter, MD 
     Divisions of Geriatrics and Hospital Medicine
     750 North Lakeshore Drive 10th Floor (Academic Office)
     675 North St. Clair – Galter Pavilion  Suite 14 –100 (Clinical Office)

Lee Lindquist, MD MPH                                     Cory Ritter, MD
Email: LAL425@md.northwestern.edu            Email: corydr3@yahoo.com
  

SPECIFIC AIMS:
     1. To develop an early exposure patient-oriented geriatric curriculum for the M1 class
     2. To improve medical care for the elderly by minimizing common errors learned by physicians from "wrong practice          
          methods" in medical school
     3. To increase knowledge and satisfaction of medical students in their first year curriculum.
     4. To assess attitudes of medical students towards the elder patient.

BRIEF BACKGROUND:
Care of the elder adult is encompassing many diverse medical fields. However, physicians are graduating from medical schools with a deficit in geriatric knowledge. The increasing proportion of health cares expenditures for people older than 65 years has been widely documented. But despite growth in this segment of the population, few new physicians are gaining training in geriatrics.  This lack of knowledge is carrying over to internships and residencies where decisions made for elderly patients are sometimes leading to poor sequlae and injury.  The most impact of medical knowledge is obtained through the use of patient and direct patient contact. Most physicians remember their first patient experiences 30 years ago versus the textbook they read in medical school. Very little patient contact as well as miniscule amounts of geriatric medicine are obtained in the first two years of medical school. Early exposure to geriatrics in medical schools and powerful role models were called for in the report of the Committee on Leadership for Academic Geriatric Medicine*.   Through this project, we seek to expose 1st year medical students to clinical geriatric issues through the use of geriatric patients who are actively dealing with these issues over a 10 week period as well as assess the medical students attitudes toward the elder patient.

*The Geriatrics Imperative: Meeting the Need for Physicians Trained in Geriatric Medicine Lillian Chiang JAMA. 1998;279:1036-1037. Committee on Leadership for Academic Geriatric Medicine. Report of the Institute of Medicine: Academic geriatrics for the year 2000. J Am Geriatr Soc 1987:35;773-791

RESPONSES FROM STUDENTS WHO HAVE COMPLETED THE GERIATRIC IMMERSION PROGRAM

“This is one of the most meaningful experiences of my first year in medical school. I was given the opportunity to integrate what I learned in Structure-Function & PEX into a clinical setting. This allowed me to orient myself and focus more on learning key topics in lecture, instead of getting lost & inundated by countless facts. Furthermore, I learned valuable information on Geriatrics that are not taught in class. Because of this experience, I feel that I gained a boost of confidence as I interacted with standardized patients in PEX. Also, the relaxed yet intellectually stimulating environment established by our preceptor (Dr. Lindquist) made this truly a worthwhile experience. If there is such a program for second years, please sign me up."

“We, as first-years, get very little clinical experience, so I found the program to be a valuable learning experience. It was great being able to apply what we're learning in class to a clinical setting. Having learned about issues specific to geriatrics is important because of the growing number of people falling into that category and because of the specific care they require. I feel that I will be more confident and more effective when treating elderly people my third and fourth year as a result of the Geriatrics Immersion Program. Also, the handouts you gave us are great. I've saved every one.”

“I found the Geriatrics  program to be the best clinical experience I've had this year. In fact when our classmates heard about the things we were learning during our Wednesday sessions and in clinic, they were extremely envious. It sounds cliche', but there really is so much text book course work and so little clinical interaction first year that it is easy to lose sight of the big picture- how our studies will relate to treating patients. Learning the things we learned during our meetings and in clinic helped me in our physical examination skills class. I felt more comfortable in the exam room setting thanks to the exposure I had in the geriatric clinic. Also during our problem based learning, many of the medications and tests that we had talked about in our meetings were brought up and I was able to offer information to our group based on the information you presented to us. Finally, I knew very little about medical care and even less about geriatric care coming into medical school. Having this clinical experience has made me interested in a field of medicine that I might ordinarily have not learned about until late in my third or fourth year. I would highly encourage offering this experience to every first year class if possible. Please let me know if you have any experiences for 2nd year students or students here over the summer.”

“I have to tell you how I'm incredibly glad I am that I participated in the geriatrics program. Learning about some clinical applications to all the basic science covered in first year was immensely helpful intellectually and also emotionally motivating. It was thrilling to know that there is in fact some application for the material we learn during first year. This was particularly evident because the lectures coincided well with the units in the M1 structure function course. Most importantly I found the clinical experiences, shadowing a geriatrician irreplaceable. The program provided a safe environment for me to practice my doctor-patient communication skills and physical exam skills. Such an opportunity I would not have had elsewhere during the M1 year. In addition, this was a valuable opportunity to bond with a subset of my classmates. The geriatrics group is still close and probably will always be friends. I wish there was a 2nd year component to the program.”

EARLY CLINICAL EXPERIENCES IN GERIATRIC MEDICINE

M1 2007- 2008  SCHEDULE

SEPT 4th NOON    *****ORIENTATION MEETING with TOUR *****

SEPT 25th   NOON     #1   *BASIC EXAM WITHOUT ANY TOOLS
                                            - Time to see, hear, and touch the old dudes!

OCT 5th NOT MEETING -   Week of Written Exam

OCT 9th      NOON      #2   VISION AND HEARING LOSS – What?

OCT 16th    NOON      #3   FALLS and OSTEOPOROSIS  –I’ve fallen and I can’t get up!

OCT 23rd    NOON      #4   *PRESSURE ULCERS – Get off your butt old man! 

OCT 30th  NOT MEETING - Week of Written Exam

NOV 5th  NOT MEETING - Week of Written Exam

NOV 13th   NOON      #5    CONSTIPATION AND NUTRITION - FOOD IS COMING TODAY 
 Why are there no obese old people?

NOV 20th   NOT MEETING - Thanksgiving week
DEC  10th    NOT MEETING -   Week of Written Exam
DEC  - JAN - Winter Break

JAN 8th     NOON       #6     BAD DRUGS and BACK TO SCHOOL PARTY

JAN 15th   NOON       #7    *REAL-TIME PRACTICES IN THE HOSPITAL
- What to do on the wards to avoid scary situations
- Drugs, Chest Pain, and Shortness of Breath! 

JAN 22nd  NOON      #8    *WOULD YOU GO TO SLEEP ALREADY?
- Sleep and oxygenation in the elderly

JAN 29th  NOON       #9   *The Liquid Gold is coming – INCONTINENCE (aka Pisser!)

FEB 5th    NOON     #10   *MENTAL CONFUSION – DEMENTIA vs DELRIUM – Don’t forget!

FEB 12th  NOT MEETING -  Week of Written Exam

FEB 19th  NOON       Wrap Up Lunch and Wild Delirium Party

FEB 26th  No lecture - Clinic and Hospital Times (optional)

Cory Ritter, MD
Clinical Instructor
Division of Hospital Medicine
Northwestern University, Feinberg School of Medicine
corydr3@yahoo.com