Learning objectives for your geriatric medicine placement

• 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. 

• 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.

• 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. 

• 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.