Competencies of a subspecialist geriatrician - Philippine College of Geriatric Medicine - PCGM
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PHILIPPINE COLLEGE OF GERIATRIC MEDICINE

A component society of the Philippine College of Physicians

"Setting the standards in geriatric education, training and practice"

 

 

COMPETENCIES OF A SUBSPECIALIST-GERIATRICIAN 

The Philippine College of Geriatric Medicine Subspecialty Board

 

 

            The subspecialist geriatrician isa medical doctor who is specially trained to meet the unique healthcare needs of older adults. Illnesses, diseases and medications may affect older people differently than younger adults and older patients often have multiple health problems and take multiple medications. Geriatricians prevent, manage and develop care plans that address the special health problems of the elderly.

 

Geriatricians are diplomates or fellows in internal medicine who have completed the additional training necessary to become subspecialists in Geriatric Medicine. Diplomates in family practice may also qualify with similar credentials. Geriatricians often work as part of a team with other healthcare providers, including nurses, pharmacists and physical therapists — who may also have advanced training and hold special certifications in geriatrics.

 

            The competencies of a geriatrician will be described using the framework of settings of care and the roles of a subspecialist. The same will be classified under the educational outcomes of attitude, skills and knowledge. The geriatrician may practice the subspecialty in the settings of acute care, ambulatory care, long-term care and in transitions between and among the above. S/he may assume one or more of the following roles: as healthcare provider, manager, communicator-educator and researcher.

 

 

ACUTE CARE

Attitude

Skills

Knowledge

CARE PROVIDER

·         act as a care provider with self-confidence

·         prioritize patient safety

·         use a holistic approach which focuses on the person rather than the disease

·         be a team player

 

·         assess acute illness in the older person to triage to urgencies and  emergencies

·         perform CGA on inpatients (medical, special sensory, cognitive, psychosocial and functional status)

·         assess and manage elderly with multiple medical problems

·         assess and manage geriatric syndromes (delirium, constipation, falls and fracture, pain) in the acute care setting

·         manage urgent and emergency medical conditions in the older person

·         effectively facilitate a family conference

·         effectively manage medications in polypharmacy

·         discuss basic concepts of biology and physiology of aging

·         recognize atypical presentation of acute illness

·         distinguish urgent and emergency medical conditions in the older person

·         recognize risk factors for poor outcomes

·         in the presence of new symptom or geriatric syndrome, identify drug adverse events, drug-to-drug and drug-to-disease interactions

·         discuss appropriate and optimal drug prescribing for older patients

·         apply evidence-based approach to medical management

MANAGER

·         protect the rights of the patient, family and carers

·         prioritize patient in safety in decision-making

·         utilize multidisciplinary approach

·         ensure quality standards in service provision

·         practice efficient time management

 

·         assess capacity for decision-making, health care proxy

·         manage psychosocial aspects of care

·         regularly participate in quality improvement programs

·         reduce iatrogenic events by implementing patient-specific and system-wide strategies to prevent falls, pressure sores, restraints, DVT and functional decline

·         manage and allocate financial resources appropriately

·         apply relevant legislation based on the Expanded Senior Citizens Act, Universal Health Care, etc

·         apply principles of continuous quality improvement

EDUCATOR

·         give importance  to  patient's participation in acute care

·         educate other specialists and paramedical community on when to refer to a geriatrician

·         communicate bad news – prognosticate

·         use strategies to enhance oral and written communication in difficult patients

·         counsel on options in palliative and end-of-life care

·         conduct bereavement counseling for terminal illness and death

 

 

·         outline the course & prognosis of acute illness

RESEARCHER

·         demonstrate receptive attitude towards change

·         utilize the ethical principles in research

 

·         appraise and apply geriatric research findings to clinical care

·         design and conduct basic science researches, clinical trials, health services research, clinical epidemiology and other types of clinical investigation that will further the science of aging and healthcare for the older person

 

·         discuss demographic trends and implications for health and social services

·         apply outcome measures in continuous quality improvement

·         apply basic knowledge on research protocol development , conduct of research and research writing

·         apply basic knowledge of evidence-based medicine

 

  

 

 

 

 

AMBULATORY CARE

Attitude

Skills

Knowledge

CARE PROVIDER

·         Practice respect for older persons, and their wish for autonomy

·         Seek out and consider the observation and opinions of family and other concerned individuals in evaluating older persons

·         Provide compassionate care while establishing personal and professional boundaries with patients and families/caregivers

·         Must comply with the existing Code of Ethics of the medical profession

·         Perform  and interpret an outpatient geriatric assessment

·         Diagnose and manage acute and chronic illnesses in the outpatient setting

·         Assess and manage common geriatric syndromes in the outpatient setting:  dementia, depression, fall, delirium, incontinence, constipation,  malnutrition, pressure ulcer, sleep disorder, hearing and vision disorder, and pain

·         Manage psychosocial aspects of the care of older adults including interpersonal and family relationships, living situations, adjustment disorders, bereavement and anxiety

·         Assess caregiver needs and burden

·         Implement and monitor wellness plans for the elderly

 

·         Justify medication regimen and duration based upon:

a)      age-related changes in pharmacokinetics and pharmacodynamics;

b)      maximizing medication adherence

c)      common lists of medications that should be avoided or used with caution in older adults

d)      knowledge of drug interactions

·         Formulate a wellness (primary, secondary and tertiary prevention)  plan for older persons

 

MANAGER

·         Foster the development of positive attitudes about the importance of a multidisciplinary approach to caring for older persons, including appropriate respect for other health professionals and paraprofessionals and their roles in the provision of services

·         Coordinate rehabilitation with the multidisciplinary team if needed

·         Identify patient and family/caregiver needs and refer to appropriate local community resources

·         Regularly participate in continuous quality improvement programs

·         Apply principles of health care administration (planning, organizing, staffing, implementation,  monitoring and evaluation ) in practice management

·         Apply principles of continuous quality improvement

 

EDUCATOR

·         Demonstrate empathy and compassion to relatives and caregivers

·         Advocate for older adults’ rights and benefits within healthcare systems and settings

·         Communicate effectively with patient and family with regards to the nature of the illness, course, prognosis and treatment options

·         Use strategies to enhance clinician-patient oral and written communication in patients in difficult patients

·         Facilitate effectively  a family/caregiver meeting

·         Conduct lay forums on healthy aging, and other geriatric conditions as the need arises

·         Educate the medical and paramedical community on when to refer to a geriatrician

 

·         Apply the principles of creative teaching when conducting health education

RESEARCHER

·         Utilize the ethical principles in research

·         To design and conduct basic science researches, clinical trials, health services research, clinical epidemiology and other types of clinical investigation that will further the science of aging and healthcare for the older person

·         Critically appraise current evidence on geriatric research

·         Apply basic knowledge on research protocol development , conduct of research and research writing

·         Apply basic knowledge on evidence-based medicine

 

 

 

LONG-TERM CARE

Attitude

Skills

Knowledge

CARE PROVIDER

·         Practice respect for older persons, and their wish for autonomy

·         Seek out and consider the observation and opinions of family and other concerned individuals in evaluating older persons

·         Provide compassionate while establishing personal and professional boundaries with patients and families/caregivers

·         Must comply with the existing Code of Ethics of the medical profession

·         Perform  and interpret  geriatric assessment and triage patient to the appropriate level of care

·         Diagnose and manage acute and chronic illnesses in the long-term care setting

·         Assess and manage common geriatric syndromes in the long-term care setting:  dementia, depression, fall, delirium, incontinence, constipation,  malnutrition, pressure ulcer, sleep disorder, hearing and vision disorder and pain

·         Perform home visits, demonstrate modification of the physical exam for the home setting

·         Assess physical safety of the environment

·         Assess caregiver needs and burden

·         Skillfully discuss and document goals of care and advance care planning with elderly individuals and/or  their families/caregivers across the spectrum of health and illness

·         Manage psychosocial aspects of the care of older adults including interpersonal and family relationships, living situations, adjustment disorders, bereavement and anxiety

·         Regularly re-assess goals of care to recognize patients likely to benefit from palliative and/or hospice care, including those with non-cancer diagnoses (eg. CHF, COPD, Dementia)

 

·         Justify medication regimen and duration based upon:

a)      age-related changes in pharmacokinetics and pharmacodynamics;

b)      maximizing medication adherence

c)      common lists of medications that should be avoided or used with caution in older adults

d)      knowledge on drug interactions

·         Formulate a wellness (primary, secondary and tertiary prevention)  plan for older persons

·         Recognize indications for and availability of durable medical equipment

 

MANAGER

·         Foster the development of positive attitudes about the importance of a multidisciplinary approach to caring for older persons, including appropriate respect for other health professionals and paraprofessionals and their roles in the provision of services

 

·         Coordinate rehabilitation with the multidisciplinary team if needed

·         Refer patients to appropriate home health and support services to maximize ability to remain in their homes and provide durable medical  equipment

·         Effective coordination of transfer of care to receiving unit or area

·         Assess patients for capacity to make a specific medical decision and, if lack of capacity is determined, identify strategies and resources for decision-making, including guardianship

·         Regularly participate in continuous quality improvement

programs

 

·         Describe the role of a long-term care medical director , and the multidisciplinary care team

·         Apply principles of health care administration (planning, organizing, staffing, implementation,  monitoring and evaluation )in  a long term care facility

·         Discuss the principles, standard regulation and requirements of a long-term care facility

·         Apply principles of continuous quality improvement

EDUCATOR

·         Demonstrate empathy and compassion to relatives and caregivers

·         Advocate for older adults’ rights and benefits  within healthcare systems and settings

·         Counsel patients and families/caregivers about the range of options for palliative and end of life care

·         Use strategies to enhance clinician-patient oral and written communication in patients with hearing, vision, or cognitive impairment

·         Facilitate effectively  a family/caregiver meeting

·         Conduct lay forums on healthy aging, and other geriatric conditions as the need arises

·         Educate the medical and paramedical community on when to refer their patient to long-term care

 

·         Apply the principles of creative teaching when conducting health education

RESEARCHER

·         Utilize the ethical principles in research, eg, Ethical Guidelines in Geriatric Research by the DOST

·         To do or conduct researches on topics of interest concerning older persons in the outpatient setting

·         Critically appraise current evidence on geriatric research

·         Apply basic knowledge on research protocol development , conduct of research and research writing

·         Apply basic knowledge on evidence-based medicine

 

 

 

 

TRANSITIONAL CARE

Attitude

Skills

Knowledge

CARE PROVIDER

·         be a team player

·         prioritize patient safety

·         formulate and implement a discharge plan

·         triage patient to appropriate level of care

·         provide team leadership

·         effectively manage medications in polypharmacy

 

·         discuss risk factors for complicated care transitions

·         recognize indications for and availability of durable medical equipment

·         apply evidence-based approach to medical management

MANAGER

·         protect the rights of the patient, family and carers

 

·         effective coordination of transfer of care to receiving unit or area

·         liaison with primary & social services to facilitate transfer of care

·         discuss roles and rights of carers

·         discuss roles of geriatrician and multidisciplinary team in discharge planning

·         discuss structure & regulations on residential facility

·         identify financial support available to patient &carers

·         discuss end-of-life care issues in care transitions

·         identify agencies & resources involved in community care

EDUCATOR

·         advise/clarify guardianship issues

·         underscore importance of social support

·         prepare family and caregiver for transitions

·         empower patients consider patient preferences in treatment goal-setting

·         assess suitability for different levels of care with ease

·         discuss and apply legislation on intermediate care

RESEARCHER

·         demonstrate receptive attitude towards change

·         utilize the ethical principles in research

 

·         appraise and apply geriatric research findings to clinical care

·         design and conduct basic science researches, clinical trials, health services research, clinical epidemiology and other types of clinical investigation that will further the science of aging and healthcare for the older person

·         demonstrate good presentation skills

·         discuss demographic trends and implications for health and social services

·         apply outcome measures in continuous quality improvement

·         apply basic knowledge on research protocol development , conduct of research and research writing

·         apply basic knowledge of evidence-based medicine