Geriatrics Windsor

Contact person: Dr. Reema Ray, Windsor

As stated in the core principles, the rotation will follow the 4 principles of Family Medicine:

A. FOUR PRINCIPLES

THE DOCTOR-PATIENT RELATIONSHIP IS CENTRAL TO THE ROLE OF THE FAMILY PHYSICIAN
The resident must develop and demonstrate appropriate attitudes toward the elderly in providing care. The resident should be familiar with the role of and impact on the families/caregiver in the management of the elderly and be able to recognize and effectively manage the problems of the family/caregiver caring for the elderly. The resident should demonstrate knowledge of and insight into common ethical and legal issues in the care of the elderly.

THE FAMILY PHYSICIAN IS AN EFFECTIVE CLINICIAN
The resident must have theoretical knowledge of and practical experience in common clinical problems and approaches in the elderly.

FAMILY MEDICINE IS COMMUNITY-BASED
The resident must actively use and interact with community resources to enhance patient management.
Identify local resources that can assist in the provision of care for the elderly

THE FAMILY PHYSICIAN IS A RESOURCE TO A DEFINED PRACTICE POPULATION
The resident must be able to access appropriate materials and resources and apply them in the practice to the patient's benefit. The resident will understand the unique position of the family physician to promote research that respects patient involvement. The resident will be able to select and access evidence from the medical literature to answer patients' questions.

B. PROGRAM GOALS

  1. Defining the discipline in terms of knowledge and attitudes
  2. Refining and extending clinical skills appropriate to the discipline
  3. Creating an awareness of the services available in the community with utilization of a team approach
  4. Creating the skills for community leadership in the development of geriatric services and health promotion

C. OBJECTIVES

KNOWLEDGE

  1. The physician shall be able to discuss the aging process.
  2. The physician shall be able to discuss the disorders of old age.
  3. The physicians shall demonstrate a high index of suspicion for treatable disease and dysfunction.
  4. The physician shall demonstrate expertise in the medical, functional, social, ethical, psychological dimensions of ill health in the elderly.
  5. The physician shall demonstrate skill in working cooperatively with other health professionals.

 

SKILLS

  1. The physician shall demonstrate the special skill required to take an accurate, relevant history from the patient and/or relative or friend.
  2. The physician shall demonstrate a physical examination technique modified to an appropriate scheme for the elderly patient.
  3. The physician shall demonstrate knowledge of the use of functional assessment methods in routine practice.
  4. The physician shall demonstrate expertise in risk assessment and management.
  5. The physician shall demonstrate expertise in diagnosing and treating the common disorders of old age, aiming for realistic goals.
  6. The physician shall assess the mental function and competency of the elderly patient.
  7. The physician shall demonstrate expertise in diagnosis and a management of psychogeriatric disorders.
  8. The physician shall accurately assess the required levels of care for any patient.
  9. The physician shall manage the patient with multiple disorders and rank these in order of priority.
  10. The physician shall discuss the special problems of retirement.
  11. The physician shall discuss the special problems of the terminally ill patient and the family.
  12. The physician shall discuss the special problems of drug therapy for the aging patient.
  13. The physician shall assess the patient’s suitability, for care at home against the background of family, mental capabilities, physical status, economic feasibility, and home facilities.
  14. The physician shall demonstrate expertise in managing the problems of the family in relation to elderly people.
  15. The physician shall use the team approach to the geriatric patient. (Experience at levels of team leader, team participant and as group facilitator shall be included. Post-meeting follow-up and evaluation of team function are to be emphasized).
  16. The physician shall appropriately utilize rehabilitation therapy.
  17. The physician shall demonstrate expertise in the recognition and management of elder abuse.

 

USE OF COMMUNITY RESOURCES

  1. The physician shall list and appropriately utilize the services offered in the community, e.g. legal advice, home care, nursing home, voluntary services, day hospital, etc.
  2. The physician shall list and appropriately utilize the facilities available in the hospital for the elderly patient, such as physiotherapy, speech therapy, pastoral counseling, and social services.
  3. The physician shall demonstrate knowledge of the administrative role of a medical director of a Geriatric Unit. The physician shall be able to discuss the role of attending physicians and consultant physicians in such facilities.

 

DESCRIPTION OF PROGRAM

The program will be primarily based at Hotel Dieu Grace Healthcare (HDGH). The Resident will have opportunity to work at a variety of settings in geriatrics. There will be placement for two weeks at the inpatient programs of Complex Medical and Rehabilitation. Also, there will be placement at outpatient setting including geriatric assessment program at HDGH, nursing home rounds and Alzheimers’ Society. The other two weeks will include geriatric consult services of Windsor Regional Hospital (WRH) and HDGH.

The Complex Medical Unit assignment is based at the Y. Emara building. Patients at this unit have complex medical needs such as complex wounds, feeding regimen, fractures, delirium, dementia, responsive behaviors, multi-morbidity, etc. The inpatient rehabilitation program is considered for patients who are eligible for more intensive rehabilitation. The geriatric rehabilitation unit located on the first floor of the Y. Emara building, and the general rehabilitation program is located at Tayfour building.

The resident will have an opportunity to work in a team-based model consisting of nurse practitioner, staff nurses, wound care nurse, social worker, dietitian, clerical staff, pharmacy, physiotherapy, occupational therapy, etc. Formal family care conferences with patients and families at the unit are held with various members of the allied team to provide patient centered care.

There are opportunities to work with geriatricians for inpatient consult services at both WRH and HDGH. Geriatric psychiatry consultations are available, and the resident can be provided an opportunity to discuss cases with clinical psychiatrist. Pharmacists are on-site and offers a great learning opportunity through medication reconciliation, addressing polypharmacy, identifying medication interactions, geriatric dosing of medications, etc.

The current preceptors are:
Dr. W. Liang, Family physician at Amica retirement home.
Dr. Robert Biswas, Internal medicine and geriatric medicine
Dr. Harman Virk, Internal medicine and geriatric medicine
Dr. Reema Ray, family physician and hospitalist
Dr. Michele Askew, family physician and hospitalist
Dr. Priya Sharma, Psychiatrist
Geriatrics Mental Health Outreach Team
The primary preceptor is Dr. Reema Ray - rray7@uwo.ca

Scheduling: Can take 2 residents/block.