During the three year residency training program in Internal Medicine, residents can choose to have an elective rotation in Geriatric Medicine. During this rotation, the resident is exposed to the diagnosis and management of health care issues in the elderly - functional assessments, social assessments, the health care system, various living arrangements for persons with decreased autonomy, delirium, dementia, depression, polypharmacy, urinary incontinence, health maintenance and prevention and many others. A multidisciplinary team approach is used involving nurses, physiotherapists, occupational therapists and social workers. The settings for the rotation differs depending on the base hospital:
Jewish General Hospital
The Jewish General Hospital McGill Division of Geriatric Medicine offers residents elective opportunities which include the Emergency Room and in-patient consultation services, and out-patient clinics which include Geriatric Assessment Clinic, Memory Clinic, Mobility Clinic, and Geriatric Oncology Clinics.
Residents have the opportunity to assess geriatric patients in a consultative model. This would include :
- Consultation and co-management of in-patients on medical and surgical wards with multiple medical comorbidities and frailty who are at risk for functional decline and prolonged hospital stay
- Patient assessments in Emergency Departments
- Out-patient clinical assessments of frail community dwelling geriatric patients in the ambulatory Geriatrics Clinic
- Consultation at a Nursing Home for management of patients with complex medical comorbidities
Topics to be covered include:
- Assessment and management of polymorbidity and functional status
- Evaluation of polypharmacy and approaches to deprescribing
- Diagnosis and management of Cognitive and functional decline
- Assessment of frailty in oncology patients
- Evaluation and treatment of delirium
- Assessment of capacity in vulnerable patients
- Evaluation of gait patterns and mobility in the elderly patient
- Identification and approach for elder abuse
The elective experience includes 2 weeks of in house and ER consults and 2 weeks of clinics
Elective learning objectives:
- Provide an intensive clinical experience in specific aspects of GM, with emphasis on the differences in medical care of the frail elderly.
- Learn to work effectively in an interdisciplinary team setting.
- To be familiar with performing all aspects of the comprehensive geriatric assessment, including cognitive and functional assessments.
McGill University Health Center (MGH and RVH)
Residents rotating through the MUHC spend 3 weeks on the acute geriatrics ward (MGH-13E, RVH-8M) and one week on inpatient consultation service. Outpatient geriatric clinics are also available. Home visits can be arranged in conjunction with the Geriatric Day Hospital at the RVH. Weekly rounds on geriatric topics are given by invited speakers weekly and held in conjunction with faculty from the MGH. The resident usually presents a half hour long talk towards the end of the rotation on a topic of interest in geriatrics.