Seniors Assisting in Geriatric Education Faculty Guidelines

Transcription

1 Seniors Assisting in Geriatric Education Faculty Guidelines REYNOLD S GERIATRIC EDUCATION IN TEXAS TRAINING PROGRAM UNT HEALTH SCIENCE CENTER

2 OVERVIEW SAGE is a competency-based learning activity impacting all first and second year Texas College of Osteopathic Medicine medical students and UNTHSC Physician Assistant students. Initiated in 2009, SAGE is a collaborative effort between the UNTHSC Reynolds Geriatric Education and Training in Texas Program, Tarrant County Meals on Wheels, Inc, and community seniors. Students are paired and assigned to a community senior client. Students are paired into groups of 2 and assigned to a senior in the community. Students make eight home visits to their senior client and complete eight assignments over two years. Assignments allow students a real life opportunity to practice their clinical medicine skills and address recommended minimum geriatric competencies. This dynamic real world experience exposes students to a diverse population of older adults, helping prepare them to care for the growing and diverse geriatric population. This relationship allows students to know the senior as a person who is more than just medical conditions or diseases, and to observe how their quality of life and coping mechanisms are impacted. The SAGE program is designed to enhance and strengthen the students training in geriatrics. SAGE seniors receive free blood pressure checks, a limited physical exam, a nutritional assessment, a home safety assessment, discussions on available community resources and advance care planning, and benefit from the students companionship as well as having an opportunity to contribute to the students medical school training. Both students and Fort Worth Metroplex senior adults are benefiting from this innovative senior mentoring program. PURPOSE OF THE PROGRAM Increase your exposure to a home-bound, diverse population of older adults Provide a needed service to the community Establish a long-term relationship with an older person. This relationship will help to improve positive attitudes and reduce previous stereotypes you may have about aging Provide an out-of-classroom process for increasing your geriatric knowledge and skills Increase the breadth and depth of geriatric content in the osteopathic medical school curriculum Improve the way future osteopathic physicians care for older adults GOALS AND OBJECTIVES OF THE PROGRAM 1. Strengthen the TCOM medical students medical education through increased development of competency in attitudes, knowledge, and skills in their care of older adults. In this experience with their senior client medical students will: a) Obtain a medical history and mental status exam b) Practice history and physical examination skills c) Perform evaluations, assessments, advance care planning d) Complete other assignments assigned in medical school 2. Allow an opportunity for seniors to assist in medical students development of competency in attitudes, knowledge, and skills in their care of older adults. To ultimately impact the way future doctors care for older adults. By participation in the SAGE program, senior clients will assist in the geriatric education of TCOM medical students by participating in: a) Providing evaluative feedback on their experience with their assigned students

3 b) Participating in research related to geriatric education; care-giver attitudes, knowledge, and skills; attitudes about medical professionals; demographic and biopsychosocial factors and life-transition issues related to aging c) Participate in scheduled SAGE visits and assignments with their assigned medical students d) Provide demographic, biopsychosocial, and life-transition information through written questionnaires, interviews, surveys, and or evaluations STUDENT ORIENTATION An orientation is provided to incoming students by the Division of Geriatrics which provides an overview of the SAGE Program, an overview of each visit for that semester, professional and ethical behavior requirements, blackboard and assignments, and helpful hints and safety. They will also receive a presentation from the program partner Meals on Wheels, Inc. of Tarrant County describing the services they provide to the community, a presentation from UNTHSC campus police on public safety as well as a presentation from second year students. Second year students share their personal lessons learned during their first year and how the program relates to what they learned in the classroom. Students also discussed how they dealt with program challenges such as scheduling of visits, senior mentors with cognitive impairments, and emergencies in the community. An orientation is conducted at the beginning of each semester in the Clinical Medicine course to provide an overview of that semester visit requirements and to get feedback on the previous semester visits. STUDENT TRAINING REQUIREMENTS Students are required to pass a background check, sign the SAGE policy & procedures as well as complete HIPAA & CITI Training online prior to new student orientation. The CITI and HIPAA training are educational training requirements of UNTHSC s Institutional Review Board on the protection of human research subjects. ASSIGNMENTS & FACULTY Students are assigned to a POD which is overseen by a faculty mentor and consists of senior clients and approximately students. Faculty mentors grade their assignments, provide feedback and support on their SAGE visits via a blackboard web based system. All assignments must be turned in on blackboard within 72 hours of the students visit with their senior in order to receive credit. Faculty grade assignments using a high pass, pass and incomplete. SENIOR MENTORS/CLIENTS Seniors are recruited into the program by Meals on Wheels, Inc. or they live in the surrounding community and express an interest in the program; and are encouraged to participate for at least 2 years. Seniors are recruited from various backgrounds, ethnicities, and socioeconomic status. Seniors interested in the program receive an Introduction to SAGE document and complete the SAGE Information form and sign the SAGE Consent Forms. When the signed consents are received in the office, the senior is placed on our waiting list in a database until they are paired with two students.

4 COORDINATION OF THE PROGRAM The Program Coordinator coordinates the program and assists faculty mentors, provide feedback, direction, and guidance to the students. The Program Coordinator is also responsible for the following: Ensuring students complete the required training Student Orientation Pairing, notification, and support to all students & seniors Recruitment of the seniors Database management Written and oral communication to seniors Training and support for faculty mentors Development of the blackboard classroom for SAGE SAGE ASSIGNMENTS TIED TO GERIATRIC COMPETENCIES AGS American Geriatrics Society - Areas of Basic Competency for the Care of Older Patients for Medical & Osteopathic Schools AAMC Association of American Medical Colleges - Geriatric Competencies for Medical Students AACOM American Association of Colleges of Osteopathic Medicine - Geriatrics Curricula for Undergraduate Medical Education in Osteopathic Medicine SAGE VISITS/SESSIONS SEMESTER 1/YR 1 Visit 1: Introduction to Senior Mentor/Client & Life Reminiscence This session allows the student to perform a life review with the senior mentor/client. Students learn to understand the benefits of life review, patient-centered interviewing, and assessing psychosocial issues, spiritual beliefs, and health perceptions in older adults. Attitude Competencies Addressed: GERI-A-1 Awareness of myths & stereotypes GERI-A-2 Recognition of Negative Aspects of Ageism on Optimal Care of the Elderly GERI-A-3 Recognition of the Heterogeneity of Older Persons GERI-A-4 Openness & Willingness to Work with Other Disciplines in Caring for Older Patients GERI-A-5 Aging Self-Awareness & Personal Attitudes GERI-A-6 Attitude of Compassion & Understanding for Care givers of the Frail Elderly GERI-A-7 Appreciation for Improving & Optimizing Functionality for Older People Visit 2: Home Environment/Safety Assessment This session allows the student to assess the home for environmental safety issues with particular attention for fall hazards. Students learn to prevent conditions that could result in falls or other injuries and to perform a comprehensive fall risk assessment for an older adult. Knowledge & Skill Competencies Addressed: GERI-K-11 Home Safety GERI-K-12 Falls GERI-K-13 Immobility & Gait Disturbances GERI-S-2 Mobility Assessment

5 SEMESTER 2/YR 1 Visit 3: Medication/ Pharmacology This session allows the student to perform a medication assessment on an older adult. Students learn to appreciate issues associated with prescriptions and multiple medications. Knowledge & Skill Competencies Addressed: GERI-K-2 Identify Drugs to be Avoided & Explain Potential Problems with Each GERI-K-3 Inappropriate Prescribing of Meds GERI-S-3 Document Patients Medication List Visit 4: Medical History & Physiology of Aging This session allows the student to obtain a medical history of an older adult. Students practice communication skills with special emphasis on physical changes of aging including questions about sexuality. Knowledge & Attitude Competencies Addressed: GERI-A-1 Awareness of Myths & Stereotypes GERI-A-2 Recognition of Negative Aspects of Ageism on Optimal Care GERI-A-3 Recognition of the Heterogeneity GERI-K-17 Physiology of Aging GERI-K-29 Normal Aging GERI-K-30 Anatomic & Histologic Changes of Aging GERI-K-31 Pathology of Normal Aging GERI-K-53 Sexuality & Aging SEMESTER 3/YR 2 Visit 5: Limited Physical and Structural Examination including OMM This session allows the student to perform a limited physical, structural and cognitive examination on an older adult. Students learn to adapt an examination to possible health conditions. Skills & Geriatric Assessment Competencies Addressed: GERI-S-2 Mobility Assessment GERI-S-8 Social Functioning Assessment GERI-S-4 Emotional Assessment GERI-S-9 Assessment of ADL s GERI-S-7 Cognitive Assessment GERI-S-9.1 Assessment of IADL s Visit 6: Community Resources and Functional Assessment This session allows the student to identify current use of community resources and potential services the senior client may find beneficial. The student will identify specific goals for the resources needed. A functional assessment will be completed. Knowledge & Attitude Competencies Addressed: GERI-A-4 Openness & Willingness to Work w/ other Disciplines GERI-K-56 Community Resources GERI-S-10 Development of Management Plan

6 SEMESTER 4/YR 2 Visit 7: Nutritional Assessment This session allows the student to perform a nutritional assessment on an older adult. Students will provide education to the older adult on nutritional balance and diet modifications related to selected health conditions. Prevention & Skills Competencies Addressed: GERI-K-58 Primary Prevention GERI-K59 Secondary Prevention GERI-S-9 Assessment of ADL s GERI-S-10 Development of Management Plan Visit 8: Advance Care Planning & Ending the Doctor/Patient Relationship This session allows the student to explore issues associated with advanced care planning (Power of Attorney, Living Will, etc.) and identify the process for terminating the physician/patient relationship. Students learn the legal and ethical processes that take place with these decisions. Knowledge & Attitude Competencies Addressed: GERI-K-14.2 Advance Directives GERI-K-19 Palliative Care Based on ID of Patient s Goals for Care GERI-K-65 End-of-Life Care Evaluations Senior mentors are given the opportunity to evaluate their student doctors by providing written feedback on attitude and skills to aid in feedback on the attitudes, knowledge and skills demonstrated by the student doctors during the SAGE visits. Medical student attitudes about health care and older adults are surveyed prior to entrance into the program and again during their second year of medical school to aid in program evaluation.