Geriatric Medicine – Program Details

Rotational blocks will be structured in such a way as to meet the new Royal College Geriatric Medicine Training Requirements for residents beginning training on or after July 1st 2019. However there will remain a significant amount of flexibility in scheduling, and the program is extremely responsive to the needs of the resident.

Transition to Discipline

The Transition to Discipline stage of training aims to introduce the resident to the subspecialty of Geriatric Medicine, as well as to verify the competencies acquired in Internal Medicine. Academic Half Day will focus on core Geriatric content, and residents will attend a 2-day Geriatric Psychiatry boot camp. Residents will meet with their research supervisor and begin to consider options for their scholarly project.
 
It is anticipated that this stage will be completed within the first 6-8 weeks, which are set up to allow the resident the maximum opportunity for being observed and will comprise 2 or more of the following:

Geriatric Inpatient Consultation ServiceThe resident will form part of a team providing comprehensive geriatric assessment (CGA) to older adults in acute care. The focus will be on understanding and performing the core components of the CGA.
Acute Geriatric UnitThe resident will work with a Geriatrician providing inpatient care on an Acute Geriatric Unit. The focus will be on the acute management of co-morbid general medical conditions in the hospitalized older adult.
Day HospitalThe resident will work with a Geriatrician providing Day Hospital services to older adults requiring outpatient multidisciplinary rehabilitation and management. The focus will be on the outpatient management of common general medical conditions and geriatric syndromes in the older adult.
Ambulatory CareThe resident will work 1:1 with a Geriatrician providing CGA to older adults in outpatient care. The focus will be on direct observation of the skills embedded within performing a CGA, including a focused neurological examination and cognitive testing.

Foundations of Discipline

The Foundations of Discipline stage of training aims to focus on providing care to older adults presenting with common geriatric medical conditions and syndromes, and related functional issues, presenting in different practice settings. Academic Half Day continues to focus on core geriatric content, as well as on teaching skills, discussion of ethical issues and critical appraisal of the literature. Residents will initiate their scholarly project and sign a Research Prescription outlining time course and outcome expectations. The resident should present their research proposal and methods at their first (formative) resident research day. Residents will also identify a quality improvement or patient safety project and be mentored through the process with the aim of completing this over the course of the training program.
 
It is anticipated that this stage will be completed in 6-8 months, and training experiences will comprise a minimum of 3 of the following:

Geriatric Inpatient Consultation ServiceThe resident will form part of a team providing CGA to older adults in acute care. In addition to working on the medical expert skills required to synthesize diagnoses for common geriatric syndromes, the resident will work on supervisory skills and teaching of junior members of the team.
Acute Geriatric UnitThe resident will work with a Geriatrician providing acute inpatient care on an Acute Geriatric Unit. They will be expected to take on an increasing patient load as they become more experienced in the acute care of frail and complex older adults, and will be expected to participate in RAPID rounds, case conferences and family meetings. The resident will provide out of hours coverage for the units on a rotational basis depending on the schedule of the attending Geriatrician.
Day Hospital
Geriatric Psychiatry ServiceThe resident will work with a Geriatric Psychiatrist in a variety of settings, including acute inpatients, consultation services, ambulatory care and long term care.
Physical Medicine and RehabilitationThe resident will gain experience in a variety of rehabilitation services to include stroke rehabilitation, amputee rehabilitation and pain services.
Falls, Fractures, Ambulation and Balance BlockDuring this 1-month ambulatory rotation residents will focus on develop skills in the assessment and management of falls, fractures, difficulties with ambulation, and balance problems (or dizziness). Residents will perform in-home & clinic-based falls assessments, participate in interdisciplinary fall rounds, develop skills in vestibular assessment & rehabilitation, become adept in the prescription of exercise for fall prevention, and participate in the Fracture Liaison Service.
Longitudinal ClinicResidents will begin their own outpatient clinic, performing CGA on older adults referred from primary care, or in follow up from an acute hospital stay, with a variety of geriatric syndromes.
Ambulatory GeriatricsThe resident will have the opportunity to work with Geriatricians in a variety of settings including outpatient clinics, telehealth, falls clinics, Primary Care Network clinics, rural clinics, and home visits.
Mixed Subspecialty ClinicThe resident will have the opportunity to work in clinics with specialists providing care that is relevant to the older adult, such as movement disorders, stroke prevention, pelvic floor, conservative renal care, complex chronic disease and palliative heart failure clinics.

Core of Discipline

The Core of Discipline stage of training aims to focus on the provision of comprehensive management of older adults with functional decline and multiple co-morbidities, across the spectrum of frailty, in a range of care settings. Academic half day continues throughout the program, and covers the remainder of the curriculum over a rotating 2 year period. Residents will continue to work on their scholarly project, and on their QI/patient safety project. They will present a completed work at their second resident research day, and will be encouraged to submit their work for publication or presentation at national or international scientific meetings. They will take on more formal teaching opportunities, including teaching the undergraduate MD students in their Geriatrics and Neurology course, presentation at Division Rounds and Journal Club, and teaching of patient groups in the Day Hospital setting.
 
It is anticipated that this stage will be completed in 12-14 months, and training experiences will comprise a variety of the following:

Geriatric Inpatient Consultation ServiceThe resident will form part of a team providing CGA to older adults in acute care. The resident will take on an increasingly senior role with the expectation of leading the team, providing feedback and teaching to junior learners.
Acute Geriatric UnitThe resident will work with a Geriatrician providing acute inpatient care on an Acute Geriatric Unit. They will be expected to take on a junior attending role, and will be expected to lead RAPID rounds, case conferences and family meetings. The resident will provide out of hours coverage for the units on a rotational basis depending on the schedule of the attending Geriatrician.
Day Hospital
Geriatric Psychiatry ServiceThe resident will work with a Geriatric Psychiatrist in a variety of settings, including acute inpatients, consultation services, ambulatory care and long term care.
Longitudinal ClinicResidents will continue to run their own outpatient clinic, working on improving efficiency and time management, as well as practice management issues such as billing.
Long Term CareThe resident spends time at three different LTC facilities in the Calgary area. They will be supervised by physicians with special training in the care of the elderly medicine who practice in the long term care setting. The rotation will consist of weekly patient visits at each of the sites, leading care conferences, presentation at Frail Elderly Journal Club and experience working with interprofessional team members.
Geriatric Residents at Half-Day

Our residents are made welcome at the Physiatrists’ Academic Half Day

The remaining blocks can be selected by the resident depending upon their educational needs. Their schedule must be approved by the Residency Program Committee, but is extremely flexible. Electives away from the Calgary area are encouraged. Elective experiences include the following, but any experience that meets the RCPSC requirements for training will be considered:

  • Further experience in Geriatrics Consultation Service as a junior attending
  • Palliative Care
  • Medical Teaching Unit
  • Wound Care
  • Home Based Geriatric Consult Team
  • Neuropsychiatry
  • Behavioural Psychiatry
  • Outpatient Geriatric Psychiatry
  • Comprehensive Community Care
  • Rural Geriatric Medicine (Lethbridge)
  • Conservative Renal Care
  • Cognitive Neurosciences
  • Movement Disorders

Transition to Practice

The Transition to Practice stage of training aims to focus on the consolidation of skills required to manage the caseload of a practicing Geriatrician, including prioritization, time management, and the integration of all aspects of clinical care. In line with many programs, I suspect, this is less clearly structured at this time. We anticipate that this period of time will depend significantly on the exact staff role the resident is expecting to fulfil. It is expected that the resident will function at the level of a junior attending and will be expected to balance multiple competing priorities on the consults or AGU services with outpatient, administrative and teaching commitments.
 
It is anticipated that this stage will be completed in 2-3 months.

Please visit the following links for more information regarding the Royal College of Physicians & Surgeons of Canada’s training objectives and requirements:

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