Geriatrics Recruitment Resources

at the David Geffen School of Medicine at the University of California, Los Angeles

Program Overview

The UCLA Division of Geriatrics provides training in Geriatric Medicine to three affiliated residency programs in internal medicine. Since 1997, this training has included a four-week acute-care inpatient rotation in geriatrics for senior residents in Internal Medicine and Family Practice. All patients admitted to this inpatient hospital service are ambulatory care or nursing home patients of the UCLA Geriatrics Practice physicians who staff the service.

The goals of the Geriatric Medicine residency rotation are to:

• demonstrate competence in the comprehensive care of hospitalized geriatric patients, concentrating on issues more specific to older adults
• recognize differences in disease presentation in the elderly population
• learn how to apply evidence-based, cost-conscious strategies to diagnosis and disease management in older patients
• understand functional status and how it relates to outpatient and inpatient geriatrics and discharge planning
• learn how to function as a member of an interdisciplinary team caring for geriatric patients in both inpatient and skilled nursing facility settings
• participate in family meetings and be an effective communicator
• understand utilization of resources and appropriate levels of care in geriatric patients
• learn how to address end-of-life issues with patients and family members
• understand the multiple factors involved in effective and successful discharge planning in geriatric patients
• gain experience in working in a community hospital environment and a skilled nursing facility
• learn how to manage medical problems over the phone
• recruit primary care residents to advanced geriatrics training and careers in Geriatric Medicine.

Training is conducted at the UCLA-Santa Monica Medical Center and Orthopedic Hospital.

Program Operations

In addition to the clinical teaching that occurs during inpatient rounds led by the geriatrics attending physicians, residents attend a 30-minute lecture/discussion five days per week on 20 clinical topics in geriatrics such as: orientation to the geriatrics service, functional assessment, delirium, rehabilitation services, malnutrition, and pain management. The rotating attending geriatrician usually leads the lectures.

One of the most notable learning activities is the residents’ participation in the daily 30-minute geriatrics interdisciplinary team meetings. The team consists of the primary nurses; staff from physical therapy, occupational therapy, and speech therapy; a dietitian; a social worker; a discharge planner; and physicians. The medical residents lead the meetings, which provide unique opportunities for them to improve communication, clarify patient outcomes, and improve quality of patient care. The team reviews individual patient progress and does discharge planning. Moreover, there is continuous sharing of information and learning for all members of the team.

At the completion of the rotation, the residents are expected to:

• demonstrate baseline competency and improvement in medical interviewing and physical diagnosis
• formulate a differential diagnosis and plan for evaluating and managing patients admitted to his/her service
• recognize common geriatric syndromes and be able to manage them
• efficiently and effectively chart daily progress notes in the medical record
• effectively cross cover patients when other team members are not available
• demonstrate an understanding of appropriate utilization of consult services and diagnostic testing
• function effectively as a member of a multidisciplinary team to ensure proper care and welfare of patients
• participate in family meetings and communicate effectively to patients and their families
• determine appropriate level of care upon discharge

Rotating geriatric physicians receive standardized lecture materials, which include power point slides, handouts, and sample board review questions. Guest lecturers are provided with guidelines for their lecture content, with annual review and suggestions for improvement.

Staffing Requirements

Two full-time UCLA geriatrics faculty staff the rotations in one-week rotations. Outpatient clinic preceptors are provided largely by one or two of the geriatrics faculty in the geriatrics ambulatory care clinics.

Program Costs and Funding Sources

UCLA received a 1994 John A. Hartford Foundation grant to increase geriatrics content in primary care residency training. This funding provided leadership support and development for the curriculum and evaluation process. Today these ongoing and recurring costs are funded largely by the UCLA Department of Internal Medicine and the Division of Geriatrics. In addition, faculty contribute their time and effort to update and maintain educational activities, evaluation methods, and teaching skills.

Process and Outcomes Data

One of the most powerful outcomes of the program has been the opportunity to recruit geriatrics fellows from the primary care residents rotating on the inpatient geriatrics service. Since the rotations began in 1997,
17 fellows have been recruited from UCLA’s internal medicine residency programs and three fellows have been recruited from family practice residency programs. Some residents have also participated in research experiences with UCLA geriatrics faculty.

The Internal Medicine House Staff program conducts retreats and feedback sessions with the residents. These sessions are often attended and evaluated by members of the geriatrics faculty. Information from resident feedback is brought to the Geriatrics Division Executive Committee, where plans for improvement and updates in the program are discussed and implemented.

This activity is uniformly valued among the residents and they consistently report a high satisfaction with this activity on their evaluations.

Implementation Lessons

• The acute inpatient resident education program has been the most successful recruitment tool for new geriatrics fellows.
• A successful inpatient rotation for senior residents in internal medicine requires a balance of steady patient care responsibilities, learning opportunities, and inspiring role models.
• Advanced trainees require careful attention for "the teachable moment" and the opportunity to have a close working relationship with an experienced role model who can add value to their practice experience.
• The organization and function of the entire interdisciplinary team is important. Residents are most impressed by the team’s daily meetings, which result in timely and effective discharge placements as well as appropriate implementation of community-based resources.

Available Materials

Tools/Resources

• A list of topics covered in the 20 lectures given during the 4-week rotation
• A CD containing UCLA Geriatrics Division educational materials

  For the materials CD, contact:
  Ann Hu
  UCLA Donald W. Reynolds Program Coordinator
  David Geffen School of Medicine at UCLA
  10945 Le Conte Avenue, Suite 2339
  Los Angeles, CA 90095-1687
  (310) 312-0531
  achu@mednet.ucla.edu

For More Information

Bruce A. Ferrell, MD
Professor of Medicine and
Associate Chief of Education
Division of Geriatric Medicine
David Geffen School of Medicine at UCLA
10945 Le Conte Avenue, Suite 2339
Los Angeles, CA 90095-1687
(310) 825-8253
bferrell@mednet.ucla.edu

Download the program as a PDF file