Geriatric Core Competencies for General Psychiatry Residents
Adapted from Proposed Geriatric Psychiatry
Core Competencies
for Subspecialty Training (1)
Patient Care:
- Residents will adapt interview style, to communicate effectively
with older adults, compensating for hearing, visual and
cognitive deficits. Residents will demonstrate respectful
and caring behaviors in interactions with patients and their
families.
- Residents will gather accurate key information from the
patient, collateral sources, and other health care professionals
as needed to complete:
- History
- Mental Status Exam
- Structured cognitive assessment (vascular, frontotemporal,
Diffuse Lewey body dementia spectrum, Alzheimer’s)
- Functional assessment
- Medical/Neurological Assessments
- Abuse assessments
- Caregiver issues
- Community and home assessment
- Residents will develop a multiaxial diagnosis, incorporating
the bio-psychosocial formulation as it relates to the elderly.
- Treatment planning will incorporate a bio-psychosocial
model, and enlist a multidisciplinary approach as relevant
to the illness and circumstances.
- The medical/psychiatric interface will be examined developing
a comprehensive and organized approach to the evaluation
of geriatric individuals with multiple medical co-morbidities.
- Pharmacotherapy of geriatric psychiatric and cognitive
disorders will be prescribed with particular attention to
principles of geriatric psychopharmacology.
- The resident will inquire about herbal/non-regulated medication
use, and be aware of drug interactions.
- The resident will become familiar with the benefits, risks
and indications for ECT in older adults.
- The resident will incorporate a developmental perspective
in the formulation of geriatric cases as well as understanding
the indications for the various psychotherapies and modifications
required for elderly individuals.
- The resident will be knowledgeable about social/community
resources and support systems available to the geriatric
patient.
Medical Knowledge:
- Residents must demonstrate knowledge of the following
geriatric psychiatry subject areas:
- Biomedical
- Normal aging changes in organ systems, sensory
systems, and cognition
- Principles of pharmacology and aging with attention
to:
- Pharmacokinetics and pharmacodynamics
- Psychotropic use in older adults
- Side effect occurrence in older adults
- Risks of polypharmacy, and recognition and
prevention of drug interactions - pharmacokinetic
and pharmacodynamic
- Appreciation of the various presentations of psychiatric
disorders in the elderly, and the impact on functional
status, morbidity and mortality, including: mood
disorders, psychotic disorders, anxiety disorders,
cognitive disorders, personality disorders, and
other illnesses
- Risks, prevalence and presentation of cognitive
disorders
- Recognition of the interplay between general medical
conditions and psychiatric illness
- Investigation and detection of delirium in patients
at risk
- Recognition of maladaptive response to psychosocial
changes
- Familiarity with psychological and behavioral
therapeutic techniques
- Sociocultural
- Appreciation of cultural and ethnic differences
among older adults
- Familiarity with family and caregiving issues
- Ethical issues in the care of older adults
- Policy issues in the care of the elderly, including
health insurance and prescription drug costs
- End of life issue
Interpersonal and communication skills:
- The resident will create and sustain a therapeutic and
ethically sound relationship with geriatric psychiatric
patients and their families from a spectrum of available
ethnic, racial, cultural, gender, socioeconomic, and educational
backgrounds.
- The resident will use effective listening skills and adapt
communication to accommodate sensory, cognitive and functional
deficits of patients and provide information appropriately,
with adequate accommodations for deficits.
- The resident will communicate with other members of team.
- The resident will facilitate learning of other residents
and students.
Practice-Based Learning and Improvement:
- Residents are expected to:
- locate, critically appraise, and assimilate evidence
from scientific studies and literature reviews related
to their geriatric patients’ mental health problems
to determine how quality of care can be improved in
relation to practic;
- facilitate the learning of students and other health
care professionals, such as other residents, medical
students, nurses, allied health professionals and other
members of the multidisciplinary team; and
- obtain and use information about their own population
of geriatric psychiatric patients and the larger population
from which their patients are drawn.
Professionalism:
- Residents must demonstrate a commitment to carrying out
professional responsibilities, adherence to ethical principles,
and sensitivity to a diverse geriatric psychiatric patient
population.
- Residents are expected to:
- demonstrate respect, compassion, and integrity; a
responsiveness to the needs of geriatric psychiatric
patients and society that supercedes self-interest;
accountability to such patients, society, and the profession;
and a commitment to excellence and on-going professional
development;
- demonstrate a commitment to ethical principles pertaining
to provision or withholding of clinical care, confidentiality
of patient information, informed consent, competence,
guardianship, advance directives, wills, elder abuse,
and business practices;
- demonstrate sensitivity and responsiveness to patients’
culture, age, gender, disabilities, ethnicity, socioeconomic
background, religious beliefs, political leanings, and
sexual orientation; and
- demonstrate responsibility for the care of geriatric
psychiatric patients by responding to patient communications
and other health professionals in a timely manner, using
medical records for appropriate documentation of the
course of illness and treatment, coordinating care with
other members of the team, and providing coverage if
unavailable.
Systems Based Practice
- Residents are expected to:
- become familiar with the diverse systems involved
in the care of older patients and their families, and
how to use and integrate these resources into a comprehensive
psychiatric treatment plan;
- become aware of community systems of care and know
how to help patients access appropriate care and other
support services such as the area agencies on aging,
social work, etc,; and
- practice cost effective care without compromising
quality of care.
References
- Lieff S, Kirwin P, Colenda C. Proposed geriatric psychiatry
core competencies. In Curriculum Resource for Subspecialty
Training. http://www.aagponline.org/prof/gerpsych_cc.asp.
- CAGP Draft core competency guidelines for resident training
- rotation specific objectives. September 7, 2004. http://www.cagp.ca/downloads/residentCoreCompetencies.pdf
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