ThefollowingslidescontainatemplatethatillustratesthegeneralformatusedforaY3orY4clerkshipreview.Inthe“notes”sectionofsomeslidestherearefurtherinstructionstoclarifywhatisneededforaparticularsectionofthereview.

Thecomponentsoftherevieware:1. revisitprioractionplanandinvestigateprogress2. assesscourseobjectivesincludingessentialskills/diagnoses3. evaluateplanned/unplannedredundancy4. assesspedagogy5. evaluateassessmentofcourseobjectives6. reviewmeasuresofquality(e.g.courseevaluations)

TheDeansoftheappropriateyear,ortheiragents,willserveastheteamleaderforeachcoursereview.Theresponsibilitiesoftheteamleaderare:

1. Assigntaskstothefacultyandstudentteammembersandconveydeadlinesforwhentheworkneedstobedone.

2. Recruitmembersforthereviewteamifnecessary(typicallyteammemberswillbeassignedbytheMEC).

3. Contacttheclerkshipdirectortoarrangeameetingwiththeteamtodiscusstheclerkship;informtheclerkshipdirectorofthedatethereviewwillbepresentedattheMECmeetingsotheycanputitontheircalendar/indicateavailability.

4. CollectalltheworkcompletedbytheteammembersandcollateintoonePowerPointpresentation;collecttheactionplanfromtheclerkshipdirectorandinsertitattheendoftheslides;sendtheslidestoRachel2weeksbeforetheMECmeeting.

5. PresentthefinalrecommendationsofthesubcommitteeattheMECmeeting(lastfewslides)

ReviewofYear4GAMClerkship

• ClerkshipoccursinYear4• ClerkshipDirectors

– RoshiniPinto-PowelandGinaFernandez• ClerkshipCoordinator

– HollyHarrison• ClerkshipLength– 4weeks,9cycles• Sitesused

– MultiplethroughoutNHandVT• ClerkshipwaslastreviewedinAug2014• ReviewDate/Team:5/9/16:Dr.Dick,Dr.Kieffer,LynnSymonsMS4(MEC),Alison

Ricker

ActionPlanfromPriorReview• Addressstudentconcernsregardinghowtostudyforyournon-NBMEexam- Done• ClarifyGradingrubricgiventhat40%ofgradegivenbyclerkshipdirectorsbut

breakdownnotclearlydelineatedincoursematerial- Done• EssentialSkills/Conditions

– ChangeCHFto“CompensatedCHF”– MoveMedicationadjustmentfromConditiontoSkill– RemovechronicpainasalreadycoveredinFM– AddADLtoIADLsurveyforessentialskill– Thesedidn’tappeartogetchangedinOASISafterthelastreview

• Objectives– Droporincorporate“Contributeconstructivefeedbackduringpeerreview.”– Modifyobjective20tostate“Applytheconceptsofimprovingqualityofcare,patientsafety,and

valueofcareintheambulatorysetting.”– Modifyobjective23tostate“Identifytheroleofthephysicianinaddressingthemedical

consequencesofcommonpublicpolicyandpublichealthfactors…– Thisdidn’tappeartogetchangedinOASISafterthelastreview

CourseObjectivesLearningObjective Assessment LearningActivity

1Applyevidencebasedknowledgetodiagnosisandtreatmentquestionsinambulatoryandgeriatricpatientcare.

2Applycurrentclinicalandtranslationalsciencestodiagnosisandtreatmentquestioninambulatoryandgeriatricpatientcare.

3Applycurrentknowledgeofdiseaseprevention,riskfactormodification,end-of-lifecareandqualityimprovementtoclinicalproblemsinambulatoryandgeriatricpatientcare.

4Applyknowledgeabouttheimpactofsocial,economic,culturalandpersonalfactorsonhealthtoclinicalproblemsinambulatoryandgeriatricpatientcare.

5Establishcomfortableandmutuallyrespectfulstudent-patientandstudent-familyrelationshipswithadiversepopulationandtoestablishthebasisforafuturedoctor-patientrelationship.

6 Interviewpatientsskillfully,utilizingeitheracomprehensiveorafocusedhistoryrelativetothepresentingissuesinambulatorycare.

7Examineambulatorypatientsskillfullyandrespectfullyandrelativetoanypotentialsensoryorcognitivedeficitsespeciallyinthegeriatricpopulation.

CourseObjectivesLearningObjective Assessment Learning

Activity

8 Identifyandprioritizeacuteand/orchronicproblemsinambulatorycarewithaccuracy,usingappropriatedifferentialdiagnoses.

9Correctlyidentifyabnormalitiesonroutinelaboratoryworkandradiographscommonlyutilizedinambulatorycare.

10Communicateeffectivelywithpatientsandfamilieswhenspecialbarrierstocommunicationexist,includingculture,language,educationandgeriatricsensoryandcognitivedeficits.

11Assistpatientsandtheirfamiliesinunderstandingtheirtreatmentoptionsandprognosis.

12Communicate,bywayofpatientpresentationstopreceptors,patientencounternotes,phonecallsand/oremails,effectivelyandrespectfullywithphysicianpreceptorsandothermembersofthehealthcareteam.

13Behaverespectfullyandresponsiblytowardspatients,families,colleaguesandothermembersofthehealthcareteamwhileacknowledgingindividualconcerns,opinionsandculturalperspectives.

14Meetprofessionalresponsibilitiescompletely.

CourseObjectivesCourse Objectives Assessments Learning

Activities

15Adheretohighethicalandmoralstandards,acceptresponsibilityforpersonalactions,acceptconstructivefeedback,andrespectpatientconfidentiality.

16Takeresponsibilityforcontinuedmedicaleducationandtoidentifyandcritiqueevidencebasedliteraturethatguidesambulatorycarepractices.

17Describebarrierstoaccesstobasichealthservicesanditseffectonvulnerablepopulations.

18Contributeconstructivefeedbackduringpeerreview.

19 Identifyandcriticallyevaluaterelevantinformationaboutevidencebased,costconsciousstrategiesinthecareofpatientsintheambulatorysetting.

CourseObjectivesCourse objectives Assessments Learning Activities

20Assesstheeffectofsocialenvironmentonclinicalcareandoutcomesandtoapplytheconceptsofimprovingqualityofcare,patientsafetyandthevalueofcareintheambulatorysetting.

21 Identifyappropriateresourcestosupportpatientcareandtocollaborateeffectivelywithallmembersofthehealthcareteamintheambulatorysetting.

22Describehowhealthcareiscurrentlyorganized,financedanddeliveredandthelargerenvironmentinwhichhealthcareoccursandtheimpactonambulatorypatientcare.

23Identifytheroleofthephysicianinaddressingthemedicalconsequencesofcommonsocialandpublichealthfactorsandtoadvocateforoptimalcareinambulatorysettings.

CourseObjectives– Comments• Appropriatenumber,understandable• Coversover-archingGeiselcompetencies• UpdatesforIlios required

FormatofCourse&SessionObjectives• Courseobjectivesarenotprovidedinthesyllabus• Courseobjectivesarewritteninthecorrectformat• Sessionobjectivesaremostlyprovidedinthecoursematerials

andareprovidedinIlios• Sessionobjectivesaremostlywritteninthecorrectformat

– Needverbchangestofocusonwhatskillthelearningobtainsratherthanwhatinformationisbeingdelivered• Example“Introduceasimple5stepmodelfordeliveringhighvaluecare”

HowdoY1/2coursesprepareforY3• Questionsaskedatendofclerkship– 1=poorand5=excellent

Results:Overall

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

FM MED OB PEDS PSYCH SURG GAM NEURO

13-14 14-15 15-16

Results:Communication

00.51

1.52

2.53

3.54

4.55

FM MED OB PSYCH SURG PEDS GAM NEURO

13-14 14-15 15-16

Results:PE

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

FM MED OB PED PSYCH SURG GAM NEURO

13-14 14-15 15-16

Results:MedicalKnowledge

00.51

1.52

2.53

3.54

4.55

FM MED OB PED PSYCH SURG GAM NEURO

13-14 14-15 15-16

IssuesofRedundancy• Aretheremajorissuesofredundancywithothercourses?– SomeoverlapwithFamilyMedicineintermsofpopulationseen,essentialconditions.

– SomestudentshavecommentedonFMandGAMseemingverysimilarintermsoftheclinicalexposure

– Givenwhatisstillarelativelyinpatientheavyclinicalcurriculum,subcommitteefeltthatrepetitionwasacceptable.

– CDsencouragedtofurtherclarifytostudentsatstartofclerkshipacknowledgmentofthisfact

EssentialSkillsAbdominalExam Yes(MEDI) PerformwithSupervisionBackExam PerformwithSupervisionCardiacExam Yes(MEDI) PerformwithSupervisionCounseling:Diseaseissues Yes(MEDI) PerformwithSupervisionCounseling:Exercise Yes(CFM) PerformwithSupervisionCounseling:Medications Yes(MEDI) PerformwithSupervisionCounseling:ScreeningTests PerformwithSupervisionCounseling:Smokingcessation PerformwithSupervisionCounseling:WeightChange Yes(CFM) PerformwithSupervisionDermatologyExam PerformwithSupervisionFootExam PerformwithSupervisionHPIrelevanttoclerkship PerformwithSupervisionIADLsurvey(ADL) PerformwithSupervisionOralpresentation,ambulatory Yes(CFM) PerformwithSupervisionPulmonaryExam Yes(MEDI) PerformwithSupervisionSocialHistory PerformwithSupervision

• Aretheseappropriateforthisclerkship?Yes

• Wouldyouaddorsubtractany?Possibleadds- Counseling:advancedirectives,immunizations;Exam:kneeandshoulder;Other– cardiovascularriskassessment,fallriskassessment,substanceusescreening/riskassessment/counseling;consider“healthrelatedhabits”inadditionto/separatefromsocialhistory.Areteam-basedinterpersonalskillsandprofessionalbehaviorsincludedasskills?

• Aretheremajorissuesofredundancywithotherclerkships?No

EssentialProblemsAnemia yes (MEDI) ManagewithAssistanceArrhythmia yes(MEDI) ManagewithAssistanceBalanceProblems ManagewithAssistanceChestPain yes (MEDI) ManagewithAssistanceCHF(Compensated) ManagewithAssistanceChronicPain yes(CFM) ManagewithAssistanceDementia yes(NEURO) ManagewithAssistanceDizziness ManagewithAssistanceDMTypeII yes(CFM) ManagewithAssistanceFatigue ManagewithAssistanceFrailty ManagewithAssistanceHyperlipidemia yes(CFM) ManagewithAssistanceHypertension yes(CFM) ManagewithAssistanceIschemicHeartDisease ManagewithAssistanceJointPain yes(CFM) ManagewithAssistanceMedicationAdjustment ManagewithAssistanceObesity yes(CFM) ManagewithAssistanceGERD ManagewithAssistanceChronicKidneyDisease Yes(MEDI) ManagewithAssistanceSkinLesionorRash yes(CFM) ManagewithAssistanceUrinaryIncontinence/frequency ManagewithAssistance

• Aretheseappropriateforthisclerkship?Yes

• Wouldyouaddorsubtractany?PerhapsArrhythmiashouldbemorespecificallyatrialfibrillation;possiblyadd:diarrheaand/orconstipation(especiallythelatterincontextofgeriatrics);acuteinfections– UTI,pharyngitis/URI;somatization;depression;(low)backpain

• Aretheremajorissuesofredundancywithotherclerkships?No(thoughI’msurprisedthatmoreofthesedon’toverlapwithMEDI)

ExplorationofEthicsandCulturalCompetencies

• FOSS(FromtheothersideoftheStethoscope)– Ethicalissuessometimesarisebuttheseareorganicdiscussionsandcannotbeensured

• HighValueCareSessionandMedicare/Medicaidsessions– Discussresourceallocation

CourseLearningOpportunities• Clinicalexperiences

– 4weeksatoutpt clinic

• Conferences– ElderFOSS(reflectonelderpt encounter/eldermentorsreflectontheirexperiences)

• Assignments– CasePresentation– Powerpoint presentation(fromGAMcorelist)ORJournalClubArticle

– DischargeSummaryCritique

• OASISclinicallogs– 2pt encountersperhalfdayclinic

CourseLearningOpportunities• SmallGroup– QIsessionatorientation– Journalclub101– Medicare/Medicaid101– HighValueCostConscienceCare

Assessment

• Midclerkshipfeedback– selfassess,reviewskills/conditions• Studentperformanceevaluationform(Filledoutbypreceptors)• Skillsform

• Grading– PreceptorEval – 60%ofGrade– CDeval – 40%ofGrade

• Casepresentation10%(BreakdownGiven)• PP/JC10%(BreakdownGiven)• Professionalism10%• Exam10%(50questions)- ComefromCoretopicslist

MeasuresofQuality– StepIICK

*valuesdepictedareSDabovetheUS/CanmeanforGeiselmeanscores

Measuresof

Quality–AAMCGQ

Clerkships OverallSatisfactionAY2014-2015

PEDS 4.5

MED 4.5

CFM 4.5

PSYCH 4.3

SURG 4.2

GAM 4.2

OBGYN 4.2

NEURO 4.0

MeasuresofQuality– CourseEvaluation

scale[1=poor;2=fair;3=good;4=verygood;5=excellent]

scale[1=poor;2=fair;3=good;4=verygood;5=excellent]

MeasuresofQuality– CourseEvaluationGAM

2014-15 2015-16*

OverallExperience 4.18 4.13

Objectiveswelldefinedandclearly presented 4.47 4.6

Ability forY1and2topreparemeforthisclerkship

4 4.19

Expectationswelldefinedand clear 4.46 4.6

Volumeadequate forlearning 4.36 4.35

Varietyofdxadequateforlearning 4.07 4.13

Quality ofteachingbyattendings 4.23 4.36

SiteDirectors responsivetoconcerns 4.64 4.7

Methodsusedto eval studentperformancemadeclear 4.3 4.49

Qualityof mid-clerkshipfeedback 4 4.03

MeasuresofQuality– StudentComments

Strengths:• Manystudentsfoundthedidacticssessionsuseful

– “Usefuldidacticsthatwereparticularlyrelevanttopracticingmedicineintherealworld”– “OfalltheclerkshipsI'vedonesofar,Ienjoyedtheformatofthisclerkship'sdidactic

sessionsthebest.Theywerefun,interesting,andvaried--andIlearnedalotfrommyclassmates.”

– “Thedidacticsessionswereengagingandcoveredusefultopicssuchasmedicare/medicaid,introductiontobilling,studentpresentations."

• Minimalbusywork/reasonableworkload– “Ialsoappreciatedthatalotofthe"busywork"thatclutterssomeoftheother

clerkshipswasnotpresentonthisclerkship”– “Reasonablework-loadintermsofclinicdays&clerkshipassignments.”– “Ilikednothavingtoomanyadditionalclerkshipassignments(i.e.writeups,reports,etc)

otherthanthe2presentations.Feltlikeitallowedmetoconcentratemoreontheclinicalexperienceaspectandgetmoreoutofitratherthanhavingtoworry.”

• Manystudentsappreciatedhavemoreautonomy– “Independenceintheoutpatientareaofmedicine- treatedmorelikeaninternthanI

havebeeninallmyY3clerkships”

MeasuresofQuality– StudentComments

Strengths:• Manystudentsfeltitwasauseful/relevantculminatingexperience

– “Greatexposuretoambulatorymedicineinthe4thyear,nowthatwearemoreabletomanagepatientsindependently.Inaway,itfeelslike'comingfullcircle'andtakingallwehavelearnedthusfarandapplyingitholistically."

– “Revisitingoutpatientclinicalmedicineafterathirdyearandsub-Icompletelyfocusedonainpatientmedicinewasrefreshingandremindedmeofthechallengeofcreatinganassessmentandplanwithinafiniteperiodoftime."

• ThemajorityofstudentsenjoyedElderFOSS– “Ilearnedalotabouthigh-valuecareandgeriatric-specificissueslikeagingina

community,performingIADLsandcare-takers.IalsolikedthatthissessionwasinthemiddleoftherotationbecauseIusedwhatIlearnedformylasttwoweeksinclinic.”

– “Providedavaluableplatformforopendiscussiononissuesrangingfromchangesinthemedicalsystemtoassistedlivingvs.nursinghomecare,tosuggestionsforhowwemightbettercarefortheelderlyinourcareers."

MeasuresofQuality– StudentComments

SuggestionsforImprovement:• Mostsuggestionsforimprovementwereminorandverysitespecific• Whilestudentsfelttheclerkshipfunctionedwell,somequestioneditsutilityinthebroader

curriculumorfeltitmightbemoreusefulifincorporatedintoIM– “Theutilityofasecondaryoutpatientmedicineclerkship,inthesettingofalready

dedicating5weekstofamilymedicine,and4weekstooutpatientpediatrics,seemsexcessive.”

– “Therearemanyaspectsofthisrotationthatoverlapwithfamilymedicineand,althoughIfeelthatmyexperienceonGAMwasimportant,itfeltsomewhatredundantasapost-matchfourthyear.”

– “In3rdyeartheIMshelfis50%outpatientyetwehavenooutpatientIMexposureduringthatrotation.GAMshouldbeincorporatedintothe3rdyearclerkship,notasastandalonecourseduringthe4thyear."

• SomestudentsfoundcommutingforFridaysessionstobedifficult– “SuggestFridaylecturestoberemotesopeopledon'thavetocommuteasmuch”

SummaryregardingMeasuresofQuality

• Summary:– Commentswerelargelypositiveandstudentslikedhavinggreaterautonomy,

feltdidacticsessionswerewellrunandinformative,enjoyedtheFOSSsession,andappreciatedthereasonableworkload

– Studentsfeltliketheclerkshipfunctionedwellandwasaniceculminatingexperiencethatchallengedthemtothinkabouthowtheywillbefunctioningaspartofthehealthcaresystem

– Themajoritysuggestionsforimprovementwereverysitespecific– Inthe“bigpicture”ofcurriculumredesign,anumberofstudentsquestioned

whetherthecontentofthisclerkshipwasredundantorwhetheritshouldbeincorporatedintootherclerkships(familymedicine,IMetc)

Recommendations• Objectives

– AssurethecourseandsessionobjectivesareprovidedinCANVAS– RevisechartshowingAssessmentandLearningActivitiesforeachObj.– Obj 20:Dropphrase“Assesstheeffectofsocialenvironmenton

clinicalcareandoutcomes”fromthefollowing:Assesstheeffectofsocialenvironmentonclinicalcareandoutcomesandtoapplytheconceptsofimprovingqualityofcare,patientsafetyandthevalueofcareintheambulatorysetting.• Thisisnotuniformlycoveredorassessedinthisclerkship

– Obj 23:Remove“social”fromthefollowing:Identifytheroleofthephysicianinaddressingthemedicalconsequencesofcommonsocialandpublichealthfactorsandtoadvocateforoptimalcareinambulatorysettings.• Coursefocusedmoreonpublichealthfactorsthansocialfactors

Recommendations• SessionObjectives

– Needverbchangestofocusonwhatskillthelearningobtainsratherthanwhatinformationisbeingdelivered• Example“Introduceasimple5stepmodelfordeliveringhighvaluecare”

• EssentialConditions– ChangeCHFtocompensatedCHF– ChangeArrhythmiatoAtrialFibrillation– AddConstipationandUrinaryTractInfection– RemoveAnemia(coveredinIM)– MoveMedicationAdjustmentfromconditiontoskill

Recommendations• EssentialSkills

– ConsideraddingAssessforAdvancedDirectives– ConsideraddingCVriskassessment– ConsideraddingFallRiskassessment– ConsideraddingScreenforsubstanceabuse(screeninghasnototherwise

beencovered,managementisinPsych)• Pedagogy

– Removerequirementtolog2patientsperhalfdayintoOASIS(otherclerkshipsnotdoingthis);simplysticktohavingstudentslogthosethatmeetessentialconditions/skills

– FurtherdiscussandcontemplatehowGAMisdifferentfromFM• Sincein4th year,shouldthisbebrandedasan“advancedambulatoryexperience”with

emphasisplacedonefficiencyinclinic,increasedautonomy• ConsidernamingparadigmgiventhatmanyclinicalsiteswillnotbeGeriatricsfocused,yet

curriculumis

ActionPlan• CourseObjectives20and23weremodifiedassuggested.AddedHealthandValuesobjectives

• SessionObjectiveswererewritten(slideattached)• Course/SessionobjectivesandAssessmentsposted• EssentialConditionsmodified(slideattached)• EssentialSkillsmodified(slideattached)• Pedagogy:changedtosinglelogofconditionsandskills

• ContinuetoreinforcedifferencesbetweenFMinYear3andGAMinYear4,highlightingpositiveaspectsofbothdisciplines

SessionObjectives• SessionName:ClerkshipDirectorSessions1,2and3;2hr casebased

andcriticalthinkingdidactics• Analyzeambulatorypatientcasesusingcriticalreasoningandpresent

evidencebasedinformationforaspecificteachingpointhighlightedbythecases.

• Synthesizeacurrent,evidencebasedanalysis,onaspecifictopicingeriatricandambulatorymedicinechosenfromalistofcoretopicsinthesyllabus,inaPowerPointformat.

• AppraiseacurrentorsentineljournalarticlerelevanttogeriatricandambulatorycareusingpreceptsofEBM,inaPowerPointformat

• SessionName:Orientation: QualityImprovementwithMr.PotatoHead• DescribethehistoryandreviewconceptsofQualityImprovement

includingthePDSAcycle,wasteandmedicalerror.• ApplytheconceptofaPDSAcycleaninteractivegame

SessionObjectives• SessionName:ClerkshipDirectorSession2;HighValueHealthCareandChoosing

WiselyCampaign• AnalyzeambulatorypatientcasesfromtheAAIMusingcriticalreasoningand

evidencebasedinformationtovalidatetheprinciplesofHVHC• ExamineandinterprettheChoosingWiselyrecommendationsofeachstudent’s

individualspecialtychoice.• Identifytheethicalimperativetoreducewasteinhealth-care.

• SessionName:AgingCenter: ElderFOSS• Engageinaninteractivedialoguewithcommunityelders(mentors)toreflecton

andsharehealthcareexperiencesandtheirimpactonpatients,familiesandcaregivers.

• Discoverthespectrumofhealth,cognitiveabilitiesandhealthcaredesiresamongstthegeriatricpopulation.

• Identifytheeffectofsocial,culturalandeconomicfactorsonaging.

SessionObjectives• SessionName:ClerkshipDirectorSession3; MedicalInsuranceBasics

• ExplainthemedicalInsurancecoveragesystemsincludingMedicare,MedicaidandPrivateInsurance

• Debatetheimpactofsocial,economicandculturalfactorsonhealthcareforalladults,especiallytheelderly

AmbulatoryClinicExperience• Choosepersonallearninggoalsforthemonthonthefirstdayandreviewthese

withtheclinicpreceptor• Establisharespectfulstudent-patientrelationshippayingattentiontocultural,

socioeconomicandotherfactors• Interviewandexaminepatientsskillfullyandrespectfully• Collectandprioritizethepatient’sproblems• Formulateanappropriatedifferentialdiagnosisandbeabletoretrieveandapply

evidencebasedknowledgetopatientcare• Listenandcommunicateeffectivelywithpatients,families,colleaguesand

consultantsbothinpersonandthemedicalrecord• Exhibitprofessionalbehaviorintermsofinitiative,interest,punctuality,

appropriatedress,patientconfidentialityandexpectedduties• Demonstrateawarenessofclinicandcommunityresourcesandcostawarenessas

partoftheassessmentandplan

SessionObjectives• Learnandapplyknowledgeintheareasofdiseaseprevention,riskfactor

modification,polypharmacy,specificgeriatriccoretopicsandendoflifedecisionmakingcare.

• Advocateforoptimalcareforeachpatient• Receivemidclerkshipfeedbackfromtheclinicpreceptorattheendofweek2

usingaformthatbeginswithself- reflection• Receivesummativeevaluationandfeedbackfromtheclinicpreceptorattheend

ofweek4

• CommunityExperience:ElderFOSS,HomeBasedPrimaryCare/Homevisits,NursingHome/Skillednursingfacilityvisits

• SessionObjectives:• Interactwithpatientsinavarietyofsettingsoutsideofaclinicsettingtobetter

understandsocialandculturaldeterminantsofhealthcare.

EssentialConditions• AtrialFibrillation• BalanceProblems/Falls• CompensatedCHF• Constipation• ChronicDiarrhea/IBS• Chestpain(typical/atypical)• Dementia• DepressioninChronicDisease• Dizziness• DMTypeII• Fatigue• Frailty• Hypertension• Hyperlipidemia• IschemicHeartDisease• JointPain– unspecified• Obesity• RenalInjury/Insufficiency• SkinLesions(NOS/composite)• UrinaryIncontinence• UTI

EssentialSkills• HPIrelevanttoclerkship• SocialHistory• PhysicalExamskills:

– Cardiacexam– Pulmonaryexam– Abdominalexam– Backexam– Extremity/Footexam– Dermatology/Skinexam

• GeriatricAssessments– FunctionalStatus(ADL/IADL)– AdvanceCarePlanning/Advancedirectives– FallRiskScreening

• ScreeningTestsCounseling• DiseaseIssuesCounseling(e.g.DM,HTN)• WeightManagement,Diet,ExerciseCounseling• MedicationReconciliation/Counseling• SubstanceUseScreening/RiskAssessment/Counseling• SmokingCessationCounseling• InterprofessionalCareCollaboration(Workingwithmembersofthecareteam)