Medical Student Education

Clinical Years

Third-Year Integrated Medicine-Geriatrics Clerkship

The Integrated Medicine-Geriatrics Clerkship was designed to combine two previously independent clerkships with the goals of fostering third year medical students skills in the care of all adult patients, addressing age related changes in pathophysiology and the differences in the approach to and treatment of patients dependent upon age, gender and genetic factors. This is a truly integrated clerkship with common goals, objectives, evaluation and final grade as well as co-Directors from both departments. The change was designed to enhance integration of specialties with common goals, objectives and competencies for their clinical experiences. The overall goals and objectives of the clerkship are as follows:

Goals

Develop refined data gathering skills with a variety of patients including those in pain, with disabilities, with difficulty communicating, or with altered mental status
Develop the ability to organize and prioritize data
Develop the ability to generate complete differential diagnosis for common symptoms or abnormal labs, with a focus on age and gender
Develop familiarity with the approach to the diagnosis and management of complex medical problems
Understand the associated changes in physiology, anatomy, organ systems and global functioning that result from aging, lifestyle and disease
Understand the appropriate use and interpretation of laboratory investigations, including the experience for the patient, cost, benefit and risk
Understand the role of biologic, cultural and social influences on patients (with relationship to their symptoms, compliance with therapeutics, etc.)
Develop an awareness of the financing and reimbursement of medical care (including the type of insurance, coverage for visits, tests and medications and ordered services) with relationship to various health plans
Develop a framework for understanding professionalism in your relationship to your patients, this institution, and your team (including honesty, self-directed learning, respect, tolerance and cultural awareness)

Objectives

Demonstrate a high level of proficiency in history taking and physical examination skills for adult and geriatric patients, including cognitive and functional evaluations and clarifying patient/family goals of care
Demonstrate problem solving skills
Demonstrate the ability to present a case, both written and oral, including a plan of care
Demonstrate the ability to interpret a chest x-ray, electrocardiogram (EKG), Mini-Mental Status Examination (MMSE), Geriatric Depression Scale (GDS) and arterial blood gas in the context of various clinical scenarios
Demonstrate proficiency in technical skills (venipuncture, IV placement, EKGs)
Demonstrate the ability to recognize when and how to adjust medication doses based on gender, age, disease, and other medication use
Demonstrate an awareness of the epidemiology and variation in presentation of various diseases with respect to age, gender and ethnicity
Demonstrate excellent communication skills with patients, families and other professionals and colleagues, including discussion of sensitive issues (such as sexuality, abuse, bad news, functional and cognitive impairments)
Demonstrate the ability to work with non-physician interdisciplinary team members and to participate in an interdisciplinary approach to patient care
Demonstrate the ability to use information technology to research questions related to patients symptoms, lab results or management (including drug-drug interactions and drug side effects)
Apply the principles of EBM and critical analysis to patient management

The Clerkship is divided into three 4 week "pods". Two of these pods concentrate on inpatient Medicine/Geriatrics care at Mount Sinai Medical Center and at one of Mount Sinai School of Medicine's affiliate hospitals (Elmhurst Hospital, Bronx VA Medical Center, Cabrini Medical Center, Maimonides Medical Center or Englewood Hospital Medical Center). Until this Clerkship, the only geriatrics training students received during their Mount Sinai in-patient experience occurred if they were assigned to the ACE (Acute Care for the Elderly) Unit, where a geriatrician and an internist share teaching and patient care responsibilities. No student precepting was done by geriatricians. Now, during the in-patient pod at Mount Sinai, every student is assigned to a geriatrics preceptor with whom she/he meets once each week with 2 other students for 1.5 hours to discuss patients and learn the basics of inpatient care for older adults, including concerns about the "hazards of hospitalization."

The third pod is Outpatient Geriatrics at Mount Sinai. This ambulatory pod consists of weekly experiences caring for older adults in the following sites: nursing home (Jewish Home and Hospital, Manhattan Division and the Bronx VA Nursing Home), sub-acute rehabilitation care (also at JHH), home care (Mount Sinai's Visiting Doctors Program), ambulatory practice (Coffey Geriatrics Associates) and assisted living residences. This block focuses on well-elderly and chronically ill community-dwelling adults in various clinical settings. Geriatric assessment, interdisciplinary team care and communication, following patients throughout the continuum of sites where medical care is provided, and individualizing the benefit/burden ratio for medical care with older adults by taking their wishes, life expectancy, and co-morbidities into account.

Course Directors

Peter Gliatto
Assistant Professor, Medicine / General Medicine