Department of Geriatric Medicine

Department of Geriatric Medicine Electives

Contact: Misty Yee
(808) 523-8461 or mistyy@hawaii.edu

1. GERIATRIC AND PALLIATIVE MEDICINE: (not available to visiting students)
Coordinator: Aida Wen, M.D.
Location(s): Various inpatient/outpatient/nursing home/hospice facilities in Honolulu
Objectives:
Students should have a good understanding of both Geriatric Medicine and Palliative Care. The curriculum is aligned with the
JABSOM Graduation Objectives, emphasizes the development of competence and excellence in the knowledge, skills, and professional
habits necessary for the care of our elderly in outpatient, inpatient, home care, nursing home and end-of-life settings.

I. Life Long Learning Skills
Following patient care interactions, or in anticipation of future learning needs, students will be life-long learners by:

  • Searching for and retrieving (from electronic databases and other resources) biomedical and psychosocial information,
    critically appraising this information, and applying it appropriately to patients and populations (self-directed learning).
  • Identifying and managing a personal learning agenda, learning from clinical experience, and recognizing the need for life-long
    learning in the care of older people, the seriously, chronically, and terminally ill.

II. Biological Sciences
Students will apply the biological sciences to the practice of medicine by:

  • Stating differences between chronological aging, physiologic aging and disease, and applying knowledge of basic sciences to
    clinical situations.
  • Stating the principles of pharmacology in older people: appropriateness, dosing, adverse effects, interactions, compliance,
    costs, errors, etc., and applying them to clinical practice.

III. Patient Care
When seeing a patient in the Geriatrics and Palliative Care Medicine rotation, students will be able to care for that patient by:

  • Approaching each patient with an awareness and sensitivity to the impact their age, gender, culture, spiritual beliefs,
    socioeconomic background, family support, sexuality, healthcare beliefs, and other non-biological determinants of health may have
    on the development, diagnosis, and treatment of their illness.
  • Ability to gather accurate information, perform a detailed physical exam, order appropriate diagnostic tests, and develop a
    therapeutic plan by applying clinical reasoning, critical thinking and problem-solving skills.
  • Diagnosing and treating the major medical and psychiatric illnesses of late life, managing complexity associated with multiple
    illnesses, evaluating atypical presentations of illness and geriatric syndromes, identifying iatrogenesis and medication side effects
    in older and seriously ill patients.
  • Providing a comprehensive geriatric patient assessment, including medical, psychiatric, cognitive, functional and social aspects.
    (including mental status assessment and screening for depression)
  • Identifying goals of care and stating the value of non-curative interventions such as improving functional status, symptoms,
    and quality of life.
  • Performing a basic spiritual assessment, and assessing and managing pain and non-pain symptoms at the end of life.
  • Managing care when a patient is actively dying, completing death pronouncement, and managing grief and bereavement.

IV. Oral and Written Communication Skills
When in a classroom, clinical, or other healthcare setting, students will communicate effectively with others by:

  • Using the four habits model, stating the principles of relationship-based communication, listening actively to patients,
    family members, caregivers, other healthcare workers and the medical team, and educating them about health conditions.
  • Conducting a family conference, identifying and responding proactively to conflict.
  • Sharing bad news effectively and compassionately, discussing advance directives and care planning, nutrition and hydration.
  • Orally presenting cases clearly and concisely.
  • Writing legible, comprehensive progress notes, history and physical exams, and prescriptions.

V. Populational and Community Health
When communicating with others in the clinical setting, students will appreciate the epidemiology of disease and the role of
the physician in populational and community health by:

  • Stating the social, demographic, cultural and economic issues associated with chronic and terminal illness in the elderly
    population, including sources of healthcare financing.
  • Stating the recommendations for health maintenance in older patients.
  • Explaining dying trajectories and the challenges of prognostication, and stating the philosophies and delivery of hospice
    and palliative care.

VI. Professionalism
Students will exhibit the highest standards of professional and ethical behavior in the context of Geriatrics and Palliative
Care Medicine by:

  • Identifying and addressing personal attitudes regarding aging, chronic illness and death, showing respect for older patients
    with serious chronic illness, with a focus on patient dignity and patient confidentiality.
  • Active engagement in the interdisciplinary process of care, showing respect for others, honesty, integrity and an absence of
    arrogance, rudeness and coercion in all interactions with patients, their families, and other healthcare workers.
  • Demonstrating self-motivation, interest and initiative, and a professional appearance.
  • Applying self-awareness and personal insight as the core of oneÕs integrity and professionalism, and actively seeking and humbly
    accepting feedback.
  • Being punctual and completing assignments, duties, surveys, forms, and other school and professional requirements on a timely basis.

VII. Personal Health and Well-Being
Students will maintain their personal health and well-being by:

  • Recognizing the importance of balancing personal, family and career goals, and stating strategies to maintain personal physical
    and mental health.

Method(s):

This four-week rotation provides medical students with an overview of Geriatric and Palliative Medicine in the outpatient, inpatient,
home care, and/or nursing home settings. A variety of instructional methods will be utilized, including clinical experiences and
seminar sessions. In addition to a range of clinical settings and patient experiences, this rotation also involves a range of
interdisciplinary teachers such as nurses, social workers and chaplains. Teaching and learning across disciplines is a key component
of both geriatric and palliative medicine.

Evaluation:

Students will be evaluated by their preceptors based upon the following parameters: basic science and clinical science knowledge,
problem-solving ability, clinical skills, professional comportment (attitude, behavior, motivation and interest, communication skills
and ability to work with others).

2. GERIATRIC MEDICINE RESEARCH ELECTIVE:
Coordinator: Kamal, Masaki, M.D.
Location(s): Kuakini Medical Center
Objectives:

By the end of this elective, the student will be able to

  1. Develop and complete a research project in the field of epidemiology of aging
  2. Demonstrate the knowledge of basic principles of epidemiology and statistics

Method(s):

  1. The student must submit a research proposal that is acceptable to the Department of Geriatric Medicine’s Research Committee.
    The proposal will include background information, hypothesis, methods, and significance of the project. If necessary, the student must
    submit an IRB application. The student will be expected to present their research findings to the department. In addition, the student
    will be expected to either present their research findings at the Hawaii Chapter American College of Physicians (ACP) meeting, or submit
    a manuscript to a journal for publication, or both.
  2. The student must complete the NIH web-based tutorial on “Human Subject Protection for Researchers”, and submit a copy of the completion
    certificate to the Department of Geriatric Medicine.
  3. Credit will be given for full-time research for 4 to 8 weeks of effort as an elective, as pre-arranged by the student and mentor.
    One week credit is equivalent to approximately 40 hours of work. It is possible that some of the research work will be performed during
    other stages of the student’s JABSOM matriculation, but only the actual spent in the designated elective unit will receive credit.
  4. Research mentors must have a faculty appointment with the JABSOM, and must be recognized by the Department of Geriatric Medicine’s
    Research Committee as being an active participant in research. The Research Committee will have final authority in approving research
    mentors.
  5. Final approval for this elective will be given by the Chair of the Department of Geriatric Medicine, based on recommendations from the
    Research Committee.

Evaluation:

  1. The student will be expected to complete the elective evaluation form to the Department of Geriatric Medicine.
  2. The mentor will be asked to complete an evaluation form for the student, based on effort, productivity and the final presentation.

Last revised: April 23, 2013