Learning objectives for your geriatric medicine placement
This page contains some learning objective suggestions from the BGS Trainees Council for your geriatric medicine placement, accompanied with examples of how they might be achieved and examples of evidence you could use in your portfolio.
Dear Doctor,
Welcome to your placement in geriatric medicine! For some of you, this will be a placement you have been looking forward to. For others, it will pass the time in foundation year before you start your training in paediatrics. Either way, you may be surprised at what you learn in geriatrics and will need to write a personal development plan (PDP) for your eportfolio. Especially if this is your first job of FY1, it can be difficult to know where to begin. Whilst your PDP will be personalised to you, as will hopefully be the care you provide to your older patients, we aim to give you some ideas about where to start. So please consider the suggestions of the British Geriatrics Society Trainees Council and work with your supervisor to design a PDP that will give you purpose during your placement, help you get the most out of the experience and equip you with skills which will be useful for your future roles. We also hope that achieving these objectives will show you what our specialty is all about and why we all decided to #ChooseGeriatrics.
Here are some of our top learning objectives for a placement in geriatric medicine, accompanied by examples of how they might be achieved during foundation year (FY) or internal medicine training (IMT) programmes and examples of evidence you could use in your portfolio to demonstrate you have achieved them. These have all been designed with your curriculum and portfolio framework in mind.
Objectives
Objectives
I will be a member of the multidisciplinary team (MDT) which provides comprehensive geriatric assessment and personalised care for older patients.
- FY1: Become familiar with members of the MDT that you will encounter during a geriatric medicine placement; seek to understand their role in assessment and treatment of a patient.
- FY2: Dedicate time to spend with members of the MDT in a single patient care journey, for example, attend initial speech and language therapy (SALT), pharmacy, physiotherapy, and occupational therapy assessment for a new stroke patient.
- IMT: Liaise with and coordinate the MDT, for example, lead discussions about a patient in a board round.
These competencies can be evidenced with CBDs from members of the MDT and also the 360-assessment tool or “TAB” feedback. You may also want to reflect on your experience of working as part of the MDT as a resident doctor.
I will be competent in the assessment and management of older patients presenting with frailty, falls and delirium.
- FY1: Identify and score frailty using relevant assessment tools. Complete an initial post-falls assessment for a patient who has had an inpatient fall. Recognise delirium and potential causes for your patients.
- FY2: Identify and score frailty using relevant assessment tools and understand the impact this will have on a patient’s hospital admission. Undertake an assessment of a fall in inpatients and community patients. Recognise delirium, potential causes and initiate a management plan.
- IMT: Identify and score frailty using relevant assessment tools and understand the impact this will have on a patient’s hospital admission and advance care planning. Undertake an assessment of a fall in inpatients and community patients. Recognise delirium and its potential causes. Initiate a management plan and be confident in explaining delirium and its trajectory to a patient and their caregivers.
These competencies can be evidenced with SLEs and also supported with the BGS frailty elearning module. Frailty, falls, and delirium are important presentations in older people, both in dedicated geriatric medicine placements and also other acute, medical, and surgical specialties. They are all impactful areas for quality improvement (QI) during your time in a geriatric medicine placement and then repeated in your next placement. For more information on doing a QI project in geriatrics, explore our QI hub.
I will work within a team to provide advance care planning for older people .
- FY1: Shadow a senior clinician during a discussion with a patient and/or their family about advance care planning opportunities such as a decision to feed at risk.
- FY2: Start to initiate “what matters most to you” discussions with patients and their families about their ongoing care and looking to the future.
- IMT: Consider advance care planning for each patient you see and initiate conversations with patients and their families about what their advance care plan might look like. Develop your independence in completing the relevant documentation.
These competencies can be evidenced with supervised learning events (SLEs) such as a case-based discussion (CBD) of the case you observed, a Mini Clinical Evaluation Exercise (MiniCEX) of a conversation you had and a reflection of your involvement in that patient’s advance care planning journey.
I will be familiar with the ethical and legal frameworks surrounding capacity, including being competent to assess capacity in common scenarios for older patients.
- FY1: Identify a patient who needs a capacity assessment for a decision, for example to consent to a procedure. Attend and observe a best interest meeting for a patient who does not have capacity to make a high stakes decision, for example discharge planning.
- FY2: Identify a patient who requires a Deprivation of Liberty Safeguards (DOLS) and work with a member of the multidisciplinary team (MDT) to submit the relevant paperwork.
- IMT: Lead a capacity assessment for a patient around a common decision for older patients such as a discharge destination and document your findings. Participate in a best interest meeting under supervision.
These competencies can be evidenced with SLEs: either a MiniCEX of an encounter that was observed or a CBD about a best interest meeting which should demonstrate your understanding of the ethical and legal principles that guided the decision-making process.
Beyond the service provision
We know that for many resident doctors, a placement in geriatric medicine can often feel like service provision because you do not get to see much beyond what is happening on your ward. We would encourage you to include in your PDP educational encounters that align with your specialist interests and work with your supervisor to facilitate these learning opportunities.
Examples of learning opportunities beyond the geriatric medicine ward
- Perioperative medicine: many geriatricians have a role in caring for surgical patients, either in orthopaedics or general surgery. Ask to shadow these ward rounds or attend pre-op assessment clinics with a geriatrician.
- Oncogeriatrics: there is an increasing role for geriatricians in oncology assessment and management planning. Ask to shadow a geriatrician who has this as part of their job role.
- Community and hospital at home: it is often easy to forget what happens before and after hospital. Seeing a patient in their own home gives a new perspective and will also show how we work with our colleagues in primary care. Arrange to spend some time with the community MDT.
- Continence: One of the often-overlooked elements of the comprehensive geriatric assessments. Especially relevant if your interests lie in general practice (GP), gynaecology, or urology. Attend a geriatrician-led continence clinic for a new perspective.
- Memory clinic: this will suit those who want to work in GP or psychiatry as you can see the steps that go in to making a diagnosis and the community services that are available to support patients and their caregivers.
Next steps and how the BGS can support you
For resources to support your learning during your geriatric medicine placement, ensure you use the BGS website to explore our elearning, information hubs or consider attending one of our events. Membership of the BGS is free for foundation doctors and unlocks further benefits including events grants. We would also encourage you to follow the BGS Trainees Council on Instagram for further placement and portfolio support as well as events and leadership opportunities in geriatric medicine. Find us by searching Instagram for “bgstrainees.”
Finally, we wish you all the very best during your new placement and hope that you find the experience of working with older people as varied, exciting, and rewarding as we do. Perhaps you will join us and #ChooseGeriatrics in your future career path.
