The John A. Hartford Foundation/Geriatrics Education for Specialty Residents-Funded Geriatric Didactic Lecture Series strives to develop clinically competent trainees in the care of the older patient.  Residents in Obstetrics and Gynecology, General Surgery, and Urology will attend monthly didactic session lasting 30 minutes in duration. 

Program Goal: The Geriatrics Curriculum is designed to improve patient care by advancing surgical residents’ knowledge of the care of older adults in the pre-, peri- and post-operative period.

The lecture series topics are guided by the designated competencies of the Accreditation Council for Graduate Medical Education (ACGME).  These competencies include:

• Patient care
• Medical knowledge
• Practice-based learning and improvement
• Interpersonal and communication skills
• Professionalism
• System-based practice

Teaching Methods

Didactic, discussion, and case-based instruction will be used.

Individual Course Learning Objectives

1. Aging and the Surgical Patient
2. Describe the fastest growing segment of the US population
3. List the main health issues posed by the growth of older adults
4. Compare the clinical presentation and management of the older patient to the younger patient
5. Identify surgical needs of older patients that younger patients do not need
6. Developing attitudes toward and communicating with the elderly; age bias

1. Pre-operative Medical Evaluation in the Older Patient:  A Stepwise Approach
2. Present an algorithm approach for the evaluation of surgical risk in the older patient
3. Define the term functional status as it related to cardiovascular risk and surgery
4. Compare and contrast this approach for determining surgical risk in 3 different older patients (case presentation)
5. . Establish lines of communication with health care team: personal physician/geriatrician, social worker
6. Understand rights regarding competence and advance directives: informed consent, surrogate decision making, long-term care, extent of care, living wills, and decisions about death

1. Common Cardiovascular Complications in Older Adults*
2. Review common valvular abnormalities in older adults
3. Describe the management of post-operative arrhythmias
4. Identify when consultation with cardiology is needed to co-manage chronic cardiac disease in older adults

1. Inpatient Geriatric Assessment and Potential Need for Consultation:  Cognitive and Function Status
2. Describe geriatric assessment tools that can be used in the inpatient setting
3. Diagnose delirium in the older adult post-operatively
4. Identify when functional limitations may limit discharge planning options
5. Identify the potential need for consultation with geriatrics/inpatient acute care unit
6. . Establish lines of communication with health care team: hospitalist/geriatrician, social worker

1. Acute Renal Failure in the Post-operative Period:  A Focus on Older Adults*
2. Identify renal impairment in the older adult
3. Define levels of chronic kidney disease
4. Identify potential reversible causes of acute renal failure
5. List potential reasons that hemodialysis may be needed
6.  Establish communication with nephrology consultants

1. Peri-operative Nutritional Demands for the Older Adult*
2. Identify the older persons at risk for poor nutrition in the perioperative setting
3. Identify potential causes of  poor nutrition
4. Delineate treatment for nutritional deficits in the acute care setting
5. Discuss and communicate with nutritional specialists, such as pharmacists and dieticians

1. Treatment of Pain in the Peri-operative and Post-Operative Period in Older Adult
2. List and describe classes of medications used to treat pain in the peri- and post-operative period
3. Utilize reference cards to determine drug dosing equivalents for pain medications
4. Identify difficult pain management issues in older adults and when to seek consultative care services
5. Communicate needs effectively for consultation with palliative and pain management teams

1. Hospice Care Principles
2. Describe regulations for hospice care financing
3. Describe types of services provided by hospice
4. Define the role of the hospice physician in the acute care setting
5. Contrast different hospice diagnoses for older adults on surgical services
6. . Establish lines of communication with health care team:  hospice physicians, nurse coordinators, social workers
7. Communicate with the patient and family regarding quality of life issues

1. Discharge Planning for the Older Adult Patient after Surgery
2. Identify different types of care transitions for older adults after surgery
3. Compare and contrast limitations on financing for these transitions
4. Identify older patients who may need services upon discharge
5. Describe acute care processes for discharge to a specific level of care
6. Establish lines of communication with health care team: personal physician/geriatrician, rehabilitative physicians and facilities, nursing homes, and social workers