Care of the Elderly

 

Introduction

The Care of the Elderly Training Program has been officially recognized by the College of Family Physicians of Canada since 1989. It represents elective, supplementary training in care of the elderly of 6 or 12 months duration, available after the two-year core Family Medicine Residency. The McGill University program has existed since 1990 and is fully accredited by the CFPC and the CMQ.

The Department of Family Medicine and the Division of Geriatric Medicine jointly organize the content of our comprehensive Enhanced Skills Program in Care of the Elderly.

The Care of the Elderly Training Program provides in-depth training for Family Physicians seeking any or all of the following:

  • to enhance their knowledge and skills in elder care;
  • to enhance their knowledge and management skills of the special needs of the frail elderly;
  • to act as resource persons in care of the elderly in the community, urban or rural;
  • to pursue an academic career in geriatric medicine;
  • to take on leadership roles including program development in settings such as Long-Term Care, Geriatric Assessment/Rehabilitation Units, or Home Care.

Specific Objectives


Family Medicine Expert

  1. Attain excellence in his/her chosen facet of caring for the elderly while maintaining competency in generalist medicine.
  2. Perform a patient-centered clinical assessment and develop a management plan appropriate for the elderly.
  3. Plan treatment and procedures appropriate for the elderly and the individual patient’s goals of care.
  4. Regularly assess medications in the care of the elderly to achieve appropriate prescribing.
  5. Appropriately prescribe and deprescribe medications in the elderly.
  6. Establish plans for ongoing care and foster continuity of care throughout the life cycle.
  7. Appreciate ageing as a stage in the normal life cycle and apply disease prevention strategies at middle age.
  8. Facilitate continuous quality improvement and establish a practice environment that insures the safety of the elderly.
  9. Establish a practice environment that is inclusive to different cultures and patient perspectives.
  10. Address the complex clinical needs of the elderly.

Communicator

  1. Effectively communicate with the elderly and appropriately compensate for potential barriers specific to the elderly.
  2. Effectively communicate with family members.
  3. Obtain collateral history from caregivers and other health professionals.
  4. Engage patients and families in developing care plans.
  5. Elicit and take in to account patient and family perspectives and expectations.
  6. Share health care information with patients and their families while maintaining patient confidentiality.

Collaborator

  1. Promote holistic, patient-centered care, using a team approach.
  2. Maintain a positive working environment with team members.
  3. Facilitate patient transitions and transfers through different care settings.

Leader

  1. Work closely with other health care professionals and health care service administration to develop an integrated and coordinated care system for the elderly.
  2. Facilitate the application of care of the elderly throughout the spectrum of community care, acute and sub-acute care, as well as institutional (ex. long-term care) settings.
  3. Contribute to ongoing improvement in the health care of the elderly.
  4. Utilise community resources in the care of the elderly.
  5. Judiciously allocate health resources in the care of the elderly.

Health Advocate

  1. Recognize elderly people as a vulnerable population and advocate for them within and beyond the clinical environment.
  2. As a resource to the elderly, assess and respond to their needs by advocating with them for system-level change in a socially accountable manner.
  3. Appropriately ensure patient autonomy in shared decision-making.

Scholar 

  1. Engage in ongoing learning in the care of the elderly.
  2. Effectively teach and disseminate skills in care of the elderly to colleagues and trainees.
  3. Apply the most recent evidence in care of the elderly to their own clinical practice and to their teaching.
  4. Contribute to the creation and dissemination of knowledge relevant to care of the elderly.

Professional

  1. Recognize and respond to societal needs in care of the elderly.
  2. Maintain a commitment to patients through clinical excellence and high ethical standards.
  3. Adhere to all professional and peer standards.
  4. Remain committed to personal health through self awareness and reflective practice.

Priority Topics

In addition to the program objectives, trainees must achieve competency in the domain specific priority topics of the care of the elderly as listed by the College of Family Physicians of Canada. These topics are as follows:

  1. Medical Conditions
  2. Cognitive Impairment
  3. Appropriate Prescribing
  4. Falls and mobility issues
  5. Teams
  6. Communication
  7. Frailty continuum/spectrum
  8. Decision making and capacity
  9. Family and informal care supports
  10. Care across different settings
  11. Organizing care using community resources
  12. Advance care planning and goals of care
  13. End -of-life care
  14. Depression/anxiety
  15. Delirium
  16. Urinary incontinence
  17. Driving issues
  18. Pain

The full listing of the competencies for each priority topic can be found in Appendix IPriority Topics and Key Features for the Assessment of Competence in Care of the Elderly.” All priority topics may be encountered at any moment during training. Some learning experiences are more likely to encounter certain priority topics as outlined in Appendix II,Priority Topics most likely to be addressed by rotation”.

*For Rotation-Specific Objectives, click here.

Program Description

Duration

Six or Twelve Month Program

The McGill Care of the Elderly Training Program is of six or twelve month duration. The six-month program focuses on clinical skills. Those trainees interested in pursuing an academic or administrative focus are encouraged to apply for the twelve-month program.

The rotations done in the six and twelve months programs are outlined in Appendix III “Care of the Elderly Rotations Structure.” Below is a brief description of each rotation.

Rotation 12 months (13 periods) 6 months (6 periods)
Geriatric Day Hospital X X
Long Term Care X X
Geriatric Psychiatry  X X
Geriatrics Ward X X
Geriatric Clinics (1) X X
Elective (1) X X
Research  X  
Geriatric Consultations  X  
Geriatric Clinics (2) X  
Elective (2) X  
Elective (3)  X  
Elective (4)  X  

Longitudinal Schedules

  • Identical for both six and twelve month streams
  • 0.5 day per week of longitudinal family medicine clinic
  • 0.5 day per week of geriatrics clinics divided between:

o Geriatrics Assessment Clinic (1 per period)

o Memory Clinic (1 per period)

o Home Care (2 per period)

Rotations / Learning Sites

Home Care

The trainee will participate in the evaluation and treatment of patients in the home care program. S/he will also learn about community resources, as well as the application process for placement in long term care institutions.

The trainee will be the primary care physician for a number of homebound patients. To facilitate continuity of care, the trainee will have approximately two half days per month for the duration of their training program to care for those patients. This will involve regular and emergency home visits as well as being available to respond to questions and problems which arise.

Out-patient Geriatric Clinic & Specialty Clinics (i.e. Memory Clinic, Pain Clinic, Incontinence Clinic)

The trainee will participate in multi-disciplinary outpatient geriatric assessment clinics, which respond to referrals coming from physicians in the community or in the hospital. Our residents have the opportunity to join any other specialty clinic according to their interests.

Geriatric Day Hospital

The trainee is involved in the initial assessment and ongoing evaluation of the patients in the geriatric day hospital. The focus is on rehabilitation of the frail, community-based elderly; co-management of patients with primary-care physicians; and learning about community resources. A special focus of this rotation focuses is the dynamics of interdisciplinary team-work.

Acute Geriatric /Rehabilitation Ward

The trainee is actively involved in the care and responsibility of patients on the ward, including the discharge planning process. Conducting daily rounds together with the staff physician, the trainee will be involved in the teaching of the family medicine residents and medical students rotating on the ward. Multidisciplinary management is emphasized.

Long Term Care Ward

The trainee will jointly round with the attending physician in charge of a long-term care ward, and actively participate in patient care. The particular focus is on management of ethical issues, competency, and managing complex issues in a “care rather than cure” mode.

Geriatric Consultation (ER &Ward)

As a member of a multi-disciplinary team, the trainee will be involved in the evaluation of geriatric patients referred from the emergency room, and from medical, surgical and psychiatric wards. The trainee will be involved in decisions concerning admission and discharge from the emergency room or hospital.

Continuity of Care Clinics 

Residents will have a longitudinal component of two half days per week to participate in continuity of care in both a family practice and geriatrics settings. 

Geriatric Psychiatry

The trainee will participate in the evaluation of new problems and the ongoing treatment of patients, on both the geriatric psychiatry ward and the outpatient clinic or home setting. 

Electives

Clinical electives help the trainee achieve their particular goals in Care of the Elderly. Commonly chosen electives include palliative care, rheumatology, and neurology. Electives in teaching, research, and administration can be tailored to suit individual needs.

Scholarly Activity

Each trainee is responsible for completing a scholarly project on a subject of their choosing, with a view to presentation at the annual McGill Research Day, or at other national/ international conferences.  

Alternatively, the resident can elect to complete a literature search around a topic of choice/clinical case, with a view to publication in an appropriate journal, such as Canadian Family Physician.

A new research course is in the process of being developed to aid our trainees with this process.

Trainees actively participate in a Care of the Elderly Trainee Seminar Series, often conjointly with fellows in the specialty Geriatric Medicine training program, held approximately once a month, depending on the number of trainees in the program at one time.

Trainees are often involved in teaching activities (sometimes to family medicine residents and students, and members of the multidisciplinary team). They may be invited to give talks to community audiences.

Trainees in the twelve-month stream will have a month of protected time to devote to their scholarly project.

Evaluation Process

The evaluation process is the same as the process followed during the family medicine residency program.  Daily field-notes are used to collect feedback. There is a mid-term evaluation during each period (informally with the supervisor of that rotation) and a final evaluation at the end of each period (via ONE-45 system).

Each trainee will be assigned an academic advisor to review their academic progress throughout the training and to allow for further mentoring when needed.

Apply/Contact Us

For more information, please contact ben.albright [at] mail.mcgill.ca (Dr. Ben Albright)
Director, Care of the Elderly Program

For information regarding the application process
residency.geriatrics [at] mcgill.ca (Geriatric Medicine Residency)
Student Affairs Coordinator
Tel: (514) 399-9126

Applicants with strong English and French communication skills are encouraged.

All required documents need to be sent to:

Postgraduate Medical Education Faculty of Medicine McGill University
3655 Promenade Sir William Osler
Montreal, Quebec, H3G 1Y6

APPLY NOW!