Instructor Guide

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Older Patient with Multiple Co-Morbidities

Goals:

A PGY-2 resident will be able to incorporate components of the patient-centered clinical method into the care of older patients and will be able to incorporate components of functional assessment into the care of older patients.

Patient Care

  • Demonstrate an ability to identify an older patient’s goals of care
  • Develop a prioritized list of functional assessment tools to administer to an older patient

Medical Knowledge

  • Describe the patient-centered clinical method
  • Describe the components of comprehensive geriatric assessment
  • Identify domains of function and instruments to assess each domain

Professionalism

  • Demonstrate compassion and empathy in the care of the older patient with multiple medical problems

Systems-based Practice

  • Identify other health professionals that can aid the family physician in assessing an older patient’s function and in addressing functional defects

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Session Guide

 

Time Needed: Two separate sessions. First session focuses on introduction of the patient centered clinical method and requires 60 to 90 minutes. The second session focuses on comprehensive geriatric assessment and requires 2 hours.

Session 1: Introduction to Patient Centered Clinical Method

Total time: 90 minutes

Equipment needed:

  • Large note pad
  • Markers

Instructor Preparation

  1. Review chapters 2, 3, 4, 5, 6, 7, 8, 9 and 10 in Patient Centered Clinical Method, 2nd Edition, Stewart, M, Brown, JB, Weston, et al., Radcliffe Medical Press, 2003.
  2. Be familiar with the diagrammatic representation of the Patient Centered Clinical Method.

Session

  1. The instructor’s objective for this session is to describe the Patient-Centered Clinical Method.
  2. Intro: Ask participants to think of a patient interaction they have had in the past several months that had a very good outcome. This could be a single interaction in the clinic, a hospitalization or a patient seen over several visits in the clinic. Write down a brief description of the patient, the situation and what factors contributed to the positive outcome
  3. Discussion: Ask participants to share stories about their patient. Instructor acts as scribe, writing down key information. It is important to write down this information on a white board so that the information is laid out in the same arrangement as the Patient-Centered Clinical Method
  4. Hand out diagram of patient-centered clinical method. Using the information provided by the residents, describe the components of the patient-centered clinical method.
  5. Briefly describe the positive outcomes associated with the patient-centered clinical method

Handouts

  1. Diagram of patient-centered clinical method
  2. Article: Brown JB, Stewart M, McWilliam CL. Using the patient-centered method to achieve excellence in care for women with breast cancer. Patient Education and Counseling 38 (1999) 121-129

Session 2: Comprehensive Geriatric Assessment

Total time: 90 minutes

Equipment needed

  • Computer and LCD projector
  • Geri-Cards Assessment Game
    • Instructions (provided below)
    • Geriatric Assessment Cards – 1 set for each participant
    • Patient scenarios

Instructor Preparation

  1. Review Presentation
  2. Review Instructions for Geri-Cards Assessment Game

Session

  1. Introduce the format for the session – a brief lecture followed by an interactive exercise.
  2. Present “Comprehensive Geriatric Assessment” – 30 minutes
  3. Take a brief (5 minute) break
  4. Geri-Cards Assessment Game (50 minutes)
  5. Wrap-up session – whip around with each participant stating one important take-away point gleaned from the session.

Handouts/Suggested Reading

  1. Gazewood, JD. Assessment of the older patient, in Reichel’s Care of the Elderly, 6th ed., Arenson et al, ed., Cambridge University Press, 2009.
  2. Elsawy, B, Higgins, KE. The geriatric assessment. Am Fam Physician. 2011 Jan 1;83(1):48-56.