U of M MedStudents

Mission Statement
Every graduating UM medical student will have a meaningful educational experience in geriatrics and will demonstrate competency in providing medical care for older individuals

Intended Learning Outcomes
These intended learning outcomes (attitudes, knowledge and skills) are derived from a listing of proficiencies recommended by the American Geriatrics Society.

I. Attitudes

A. Awareness of the various myths and stereotypes related to older people.
B Recognition that ageism, like racism, affects all levels and aspects of society including health professions and can adversely affect optimal care of elderly patients.
C. Recognition of the heterogeneity of older persons--a diverse group with different personalities, different values, different functional levels, and different medical illnesses. Thus, each person needs to be viewed as an individual regardless of chronological age and to be cared for in a unique fashion.
D. Openness and willingness to work with other disciplines in caring for older patients.
E. Self-awareness of the students’ personal attitudes towards their own aging, disability, and death.
F. Compassion and understanding attitude on the part of the physician for care givers of the frail elderly and the difficulties they face.
G. An appreciation of the need for improving and optimizing function for older people, rather than just focusing on diseases
II. Knowledge

A. Related to Basic Sciences

1. Demography and Epidemiology of aging including the growth in numbers of older people and heterogeneity of the older population.
2. Theories of aging including biochemical/molecular, cellular, genetic, and biopsychosocial.
3. "Normal" aging versus diseases at the molecular, cellular, tissue, and organism levels.
a. "Normal" aging is heterogeneous affecting different tissues and organs in different individuals at different rates.
b. Preventable, reversible, and treatable aging processes need to be identified by practicing physicians and managed accordingly.
c. Loss of homeostatic control mechanisms may account for much of the aging process.
4. Anatomic and histologic changes associated with aging.
5. Pathology associated with normal aging and age associated disease processes.
6. Physiology of aging in various organ systems.
7. Pharmacologic changes in aging and relevance to therapeutic decisions

B. Related to Clinical Practice

1. Geriatric Syndromes and Conditions. Students should be familiar with common geriatric syndromes and conditions and have a basic understanding of risk factors, causes, signs, symptoms, differential diagnosis, initial diagnostic evaluation, and preventive strategies. Conditions of these Geriatric Syndromes and Conditions include:
a. Dementia
b. Inappropriate prescribing of medications
c. Incontinence
d. Depression
e. Delirium
f. Iatrogenesis, include consequences of hospitalization & bed rest
g. Falls
h. Osteoporosis
i. Alterations in the special senses including hearing and vision impairment
j. Failure to thrive
k. Immobility and gait disturbances
l. Pressure Ulcers
m. Sleep Disorders
n. Non-specific presentation of disease

2. Knowledge of diseases and disorders that are more common or have particular features in older people. Although student’s individual clinical experiences may provide greater or lesser exposure to these disorders, students should have at least "broad" knowledge of pathophysiology, presenting signs and symptoms, differential diagnosis, and initial diagnostic evaluation for common diseases older people, including:
a. Rheumatological diseases (e.g. osteoarthritis, rheumatoid arthritis, temporal arteritis/polymyalgia rheumatica)
b. Genito-urological diseases (e.g. benign prostatic hyperplasia, sexual dysfunction)
c. Neurological diseases (e.g. Parkinson’s disease, stroke and transient ischemic attack, dizziness/syncope)
d. Cardiovascular diseases (e.g. congestive heart failure, atrial fibrillation, valvular heart disease) Hypertension (Diastolic and Systolic)
e. Endocrinological diseases (e.g. type II diabetes mellitus, hyperosmolar non-ketotic coma, hyper- and hypothyroidism, Paget’s disease of the bone)
f. Cancer of various organs, including: breast; lung; colon; prostate; and hematologic malignancies
g. Infections, including: pneumonia; tuberculosis; and urinary tract
h. Renal diseases (e.g. fluid and electrolyte disturbances)
i. Gastroenterological disorders (e.g. constipation, malnutrition, diverticulitis, diverticulosis)
j. Psychiatric diseases (e.g. depression)
k. Others, such as fractures, amyloidosis

3. Knowledge of psychosocial issues. Students should be familiar with identification, presenting signs and symptoms, and appropriate referral of common psychosocial problems and issues, including:
a. Normal behavioral late life changes, including retirement
b. Psychopathology, including: affective disorders, psychotic disorders, anxiety disorders, responses to medical illness, depression, and substance abuse
c. Under-reporting of symptoms and illnesses
d. Sexuality and aging
e. Elder abuse and neglect
f. Suicide
g. Home safety
h. Community resources, including those used to prevent institutionalization
i. Adaptation to care in alternative living situations, including long-term care facilities

4. Knowledge of Prevention, including:
a. Primary prevention (for example, exercise, nutrition, and psychosocial interventions designed to maximize function to allow independent living);
b. Secondary Prevention with age appropriate screening for diseases and identification of geriatric syndromes;
c. Tertiary prevention strategies; for example, rehabilitation and chemoprophylaxis in the post-myocardial infraction patient.
5. Knowledge of Ethical Issues in Geriatric Care
a. Advance Directives
b. Decision-Making Capacity
c. Euthanasia, Assisted Suicide
d. Health Care Rationing
e. Pain Management
f. End-of-Life Care
6 Health Care Financing
a. Mechanisms and Implications
(Medicare, Medicaid, Managed Care, Capitation)
7. Cultural aspects of aging. Students should be familiar with the influence of culture and ethnicity on the aging process, health and disease perception, and access to medical care, with emphasis on:
a. Demography of ethnic elders in the United States
b. The heterogeneity of the federally designated minority elder groups
c. Risk Factors and disease prevalence in these elders
d. The components of providing culturally competent medical care

III. Skills

A. Students should be competent in performing the basic elements of geriatric assessment with standardized methods for assessing physical, cognitive, emotional and social functioning as appropriate. Specific examples include: screening examinations for mental status, geriatric depression, and functional status including activities of daily living and instrumental activities of daily living.
B. Students should be competent in physical diagnosis skills, including: mobility assessment, gait and balance assessment, and recognizing normal versus abnormal signs of aging, and pre-operative assessment.