Parkwood site: group of physicians who have regular clinics in the Aging Brain and Consult clinics on main level, and rotate weekly coverage of the geriatric rehabilitation inpatient ward. Geriatric rehab unit accepts admissions/referrals of patients requiring rehab in order to return home post-admission. High proportion of post-op orthopedic patients. St.Joseph's hospital: group of physicians who have regular clinics at St. Joseph's hospital and also consult on St. Joseph's and University hospital inpatients. No inpatient admissions under this site of the geriatrics service
Teaching to Service ratioEdit
very high. Patient volumes in clinics and inpatient unit are quite low, offering extensive time for clinic based and bedside teaching
Each site will have 2-4 residents assigned to it, and they may be assigned to different or the same clinics on a given day.
Community - London, Ontario
Week in the Life of...Edit
What does a typical work week look like on this rotation? Edit
Parkwood Hospital: If you do your rotation at Parkwood, your "home base" is on the Geriatric Rehab Unit (GRU), with a few half days a week at various outpatient clinics.
Time on the GRU is pretty slow, and there are usually 2 residents assigned to the GRU at one time. Your main responsibility is seeing the new admissions (range from 4-12 new admissions per week). New admissions usually take between 1-2 hours to complete. There is a nurse practitioner who is responsible for the day-to-day care of the GRU inpatients and you will round with him each morning on the inpatients. Most don't have many active medical issues; usually tinkering with BP meds and blood sugars. The NP does a little bit of teaching around med choices appropriate for geriatric patients. Half of the patients are assigned to one geriatrician and half to the other. The geriatricians themselves usually drop in a couple of times a week and see the more acute patients and make management decisions.
The rest of the time you will go to clinics. These include Aging Brain (MCI and dementia assessments), Wound Care, Osteoporosis, and Incontinence Clinic. Another opportunity that might be available is to attend the Geriatric Outreach Clinic with Dr. Joel Hurwitz. He will pick you up and drive you out to Dashwood, a small town near Grand Bend, where they have a clinic. They see patients there referred from the South Huron area. Most of the patients have been pre-assessed by a team of social workers, OTs, and nurses, so there is an idea coming if of what problems they need addressed. Dr. Hurwitz is a good teacher and it's kind of a fun experience.
St. Joseph's/University: weekly schedule of clinics with residents assigned to see inpatient consults as they arrive. Clinics similar to those at Parkwood.
You may be asked to cross-cover to do 2-4 overnight call shifts for Acute Care of the Elderly (ACE) team at Victoria Hospital as junior resident. Start at 5pm and end following handover the next day. Most of the time they don't seem to have residents do any call. In general, family medicine residents do not cover call; internal medicine residents will likely cover call.
I did not have any call.
Other Things to addEdit
Rotation offers opportunity for extensive practice of MMSE and MOCA cognitive assessments, thorough physical exam (esp. Neuro and MSK exams) and assessment of global patient issues (home situation, family situation, etc.). Dr. Borrie, based out of the Parkwood site, is an especially great person to learn the knee and neuro exams from!
Each resident is expected to do a presentation on a topic of his or her choice at Journal Club, which happens every other Tuesday of the rotation. Date of Last Edit: November 2010\
This was an excellent rotation for learning medications in the elderly. Each admission required a med review.