In addition to a slightly different schedule, residents on a geriatrics track would also have other unique experiences to facilitate the additional training in care of older adults that they are seeking.
Quality Improvement Project
Residents interested in care of the older adults will often find themselves in medical directorships of nursing homes and other institutions once in practice. By choice or obligation, they will likely be deeply involved in quality improvement. A resident in the geriatrics track would design and implement a quality improvement project at either Wellbrooke nursing home or within the E. Blair Warner Clinic (directed at older patients) executed in either their second or third year. The results could likely be published or presented as research at a conference. For residents interested in fellowship, this will strengthen their application. Additionally, the residency at large could benefit from fresh focus on quality metrics aimed at older adults.
Patient Assignment
While every resident at Memorial Hospital Family Medicine Residency should have older patients on their panel, regardless of interest, an effort would be made to reassign a higher proportion of patients greater than age 65 to residents on the Geriatrics Track. Additional opportunities would include a greater reassignment of nursing home residents, including assisted care residents that are not traditionally assigned.
House Call Clinics
An innovative approach to specialize the training of residents interested in geriatric care would be the opportunity for house calls to mobility-restricted older patients. Many doctors in practice still do occasional house calls, generally for older, home-bound patients. These visits not only allow them to provide needed medical care to vulnerable patients but also allow for the assessment of a patient’s environment and support network. The ability to discern what patients are most appropriate for house calls, how to maximize that efficacy of the visit and document/bill appropriately are all skills that are worthwhile to learn in residency. Because these patients will likely have Medicare, a faculty would likely need to accompany the resident. To minimize the burden on faculty, these clinics could be limited to a resident’s third year as infrequently as bimonthly. These would be in addition to the two home visits led by the behavioral health team, which is primarily socially focused.
