Geriatrics Outpatient Clinic

• Rotation length: 12 months (longitudinal)
• Location: Swedish Medical Center (First Hill)
• Supervising Faculty: Ainsworth and Rubenstein
• Evaluation: direct observation, chart review, and written competency-based evaluation.

Practical details:

• Fellows have geriatric continuity clinic on Monday afternoons at Swedish Family Medicine.
• There is a dedicated faculty preceptor for this clinic, who discusses all fellows’ patients, sees and examines patients as necessary, and reviews and co-signs all chart notes.

Patient Care

• Improve diagnostic and therapeutic skills in a range of common geriatric medical conditions: heart disease, lung disease, neurologic disease, rheumatologic disease, cancer, infections, and dementia.
• Recognize acuity in frail elders: determine appropriate follow-up, determine need for hospital admission.
• Determine the appropriateness of labs and studies in the investigation of disease.

Medical knowledge

• Gain expertise in the geriatric syndromes: falls, dizziness, cognitive impairment, polypharmacy, urinary incontinence, vision loss, and hearing loss.
• Learn to recognize caregiver strain, evaluate patient safety, and determine the need for a higher level of care.

Practice-based learning and improvement

• Become proficient at using evidence to inform treatment decisions. Recognize the limits of evidence in the care of frail elderly.
• Learn to use preventive care principles (such as screening) in a manner appropriate to life expectancy and disability.
• Develop knowledge of community resources available to support this population.

Interpersonal and communication skills

• Communicate sensitively with patients and families, both face-to-face, and by telephone.
• Become expert in discussions of goals of care, including end of life care.
• Professionalism
• Establish the central role of the primary care physician/ geriatrician in the care of the elderly.
• Communicate and coordinate with other specialists in the development of appropriate care plans; that account for patient preference, life expectancy, and disability.

Systems-based practice

• Participate in the work of the multidisciplinary team (including nursing, therapy, and social work) to provide comprehensive care.
• Recognize the importance of care transitions, and the role for assisted living, adult family homes, skilled nursing facilities, home care, and long term care.