Welcome to the Geriatrics Component of Family Medicine!
The next two weeks will be an exciting time for you. Your time will be spent as part of the UT Medicine Geriatric inpatient team. We love and respect our patients and take pride in being able to improve the quality of life for each of them. We have gathered information, instructions and tips we hope will help you succeed in this challenging rotation. Please familiarize yourself with the contents before your rotation begins.
We are constantly striving to improve, so if you have any questions, concerns, or suggestions, please contact Dr. David Espino (358-3888, firstname.lastname@example.org) or Dr. Neela Patel (513-0639, email@example.com). We hope you enjoy your time with us and will join us again in your fourth year.
On the Friday before you start, call the geriatrics office (358-3200) and find out who is on the inpatient service beginning Monday. Call the resident on the service on the first day for details on what time you should show up. If you can not find the resident, show up at 8am at the ACE Unit located on the 10th floor of Christus Santa Rosa, City Centre, located in downtown San Antonio and ask them to page the geriatrics resident.
**Prior to your first day:
- Familiarize yourself with the Inpatient Acute Care for the Elderly (ACE) Unit information.
- Review the Meditec EMR and Discharge Summary Tutorial listed in the Orientation Info area of this page.
- Familiarize yourself with the various Geriatric Assessment Instruments listed on the Assessment Tools & Guidelines section of this site.
- Review the various articles on geriatric syndromes & inpatient care of the elderly listed in the Virtual Library.
- Request a copy of the Geriatrics At Your Fingertips handbook from our attending OR
Download the PDA and electronic versions of the "Geriatrics at Your Fingertips" handbook, available online: http://www.geriatricsatyourfingertips.org.
How to Find Us & Parking
The Christus Santa Rosa City Center is located at 333 N. Santa Rosa St., San Antonio, Texas 78207 in downtown San Antonio. Please park at the Christopher Columbus Church, 607 Columbus Street, San Antonio, Texas 78207 (MAP) and take a shuttle over to the hospital. IMPORTANT: Please contact Cari Cesaro, GME Coordinator for Christus Santa Rosa (firstname.lastname@example.org), 210-704-4822, PRIOR to your first day for additional instructions on parking and to obtain a CSR badge, if needed.
Medical Team Support
There are usually six to eight patients on the ACE unit at any one time. You will be assigned to help the attending and the third year family medicine resident care for these patients. Medical students will assist with activities such as writing discharge prescriptions, tracking down lab and imaging results and other assigned duties in a helpful and pleasant manner.
This rotation is designed to allow the student to co-manage elder patients with the guidance and help of both the attending and the resident physician. As such, 3rd year medical students rotating on inpatient should be present when the third year (PGY3) resident is present. Students should focus on initial and comprehensive inpatient geriatric assessments, including using the MMSE and/or Mini Cog (see assessment instrument area of web site). Students are dismissed when the work is done based on the service load and patient needs. This decision will be up to the team leaders, either the attending and/or the third year (PGY3) resident physician.
Students need to round on one weekend day while on the rotation to provide continuity of care for their assigned patients. This is usually preferably Saturday, but faculty can decide on an individualized basis which day. If the student has plans for one of the days of the weekend he/she should tell the attending no later than Thursday AM rounds.
Medical Record Charting
In addition you will be responsible for two key pieces of medical charting on your patients during your rotation. You will be responsible for a written History & Physical and Discharge Summaries on patients going to long term care. The H&P must be available within 18 hours of admission and the discharge summary on the date of discharge. Copies of your drafts may be stored in the outpatient office on the 11th floor. Copies of the discharge summary should accompany the patient to the long term facility.
Formats and information on completing the written H&P and the discharge summary are available in the Orientation Info area on this page (left tool bar).
Resident evaluation will be weighed towards three (3) distinct areas: Attitude & Behavior, Medical Records Review, and Didactic Participation.
Attitude & Behavior
Absences & Tardiness - Students will have no absences. Two or more absences, excused or unexcused, may result in you needing to repeat a portion of your rotation which usually involves after hours call support. Excused absences due to an illness must be accompanied by an practicing physician (not colleague) note. Absences on the weekend day are treated the same as a weekday absence. The student should always call when he/she anticipates an absence. The phone number on weekends is 210-271-1800. Pre-rounding with the resident usually starts at 7:30am. Ask your resident at what time he/she prefers you in house. Call (210-568-5600 or the resident beeper) if you anticipate that you are going to be tardy. Tardiness of more than 30 minutes will be treated as an absence.
Dress - Be dress appropriately. As our patients represent a unique cohort with preconceived notions of how physicians should interact with them it is requested that students dress respectfully. Men should wear ties and women dress modestly. No open toes sandals. Failure to dress appropriately, in and of itself, is a basis for a sub par evaluation.
Professional Behavior - Professional students should be actively concerned about others, including patients, families, resident physicians and attendings. Professional students maintain a positive outlook toward others and toward assigned tasks including remaining until all patient care activities have been completed for the day. A professional student also recognizes and admits mistakes. They both seek and accept criticism and use it to improve their performance. Behavior indicating a "shift work" mentality will result in a failing grade for unprofessionalism.
Medical Records Review
The student is responsible for the completion of both the written H&P and discharge summary in a responsible and complete manner. It is expected that the student will present the attending with at least three patient charts for review during the two week period for a total of six documents to review (three H&P's and three discharge summaries).
Students who get honors for this content area will have been expected to have all elements of the H&P and the discharge summary on the patient complete on ALL three new patient charts reviewed. Students who fail will either: (1) not have presented the three charts for review to an attending or (2) will have missed basic elements such as the medical problem list or the geriatrics instrumentation list on at least two of the H&Ps or discharge summaries presented.
Student participation in both rounds and geriatric didactic portion (Monday geriatrics grand rounds) will count towards the final evaluation. This will done in an honors, pass, fail format with students who participate actively scoring higher than those who are not attentive. Honors students will be expected to contribute new or recent inpatient elder care knowledge to the discussion on a regular basis.