Residency | Department of Medicine | School of Medicine

Care of the Elderly

Caring for the elderly has always been an integral part of Family. Most elderly people have a close, long-standing relationship with their family physician. The role of the family physician in this changing scenario is becoming increasingly complex; a role that involves not only direct medical care, but also knowledge of community resources, health administrative issues, interdisciplinary team work at various levels, institutional care and so on. The College of Family Physicians of Canada has recognized this evolving role and stated its commitment to improving the health care of the elderly.

The Department of Family Medicine at Queen's University offers both a 6-month and a one-year program in Care of the Elderly, as recognized by the College of Family Physicians of Canada as a Category 1 residency program.

This program is currently directed mainly at family physicians completing the core two years Family Medicine Residency. Certified family physicians that are already in practice are also welcome. Out of country applicants or returning graduates applying to this program will be looked at individually. This document will review the training that will be provided to physicians through the Department of Family Medicine at Queen's University.

As of 2015, those who complete this program will be eligible for a Certificate of Added Competence as offered by the College of Family Physicians of Canada.

The program has full approval as an Enhanced Skill Program of the CFPC. This program is affiliated with the Department of Family Medicine at Queen’s University, Kingston, Ontario. The usual length of the program is six or twelve months depending on applicant’s career plans and funding availability.

Program Director - Dr. Chris Frank

Providence Care Hospital
Kingston, ON K7L 5A2
Telephone: 613 544-4900 x 53429
Fax: 613-544-4017

Program Assistant - Ms. Dana Doll

Department of Family Medicine
Haynes Hall, 3rd Floor
115 Clarence Street
Queen's University
Kingston, ON K7L 3N6
Telephone: (613) 533-9300 ext. 73005 Fax: (613) 533-9301
Email: pgy3programs@dfm.queensu.ca

Program Highlights

Dr. Chris Frank is the Program Director for Care of the Elderly at Queen’s University, and Dr. Meg Gemmill is the Program Director fort the Enhanced Skills Programs.

Residents are based primarily at Providence Care Hospital (PCH), which is a new hospital that opened in April 2017. Residents also spend time in acute care (Kingston General Hospital – KGH), in the community, in other clinics, and in long-term care facilities. While certain core experiences are best completed in a ‘block’ format (e.g. inpatient geriatric rehabilitation) the program has evolved to support a significant proportion of the core requirements as a longitudinal experience.

Admission

Deadlines for application can change yearly so please consult the Application Information page or write the Enhanced Skills Program Coordinator, Dana Doll at pgy3programs@dfm.queensu.ca.

Any graduate of a Canadian residency program may apply.

Re-entry candidates from Ontario should follow the directions on the Ministry of Health and Long-Term website.

They should apply through the Ministry of Health first. Once their application is received at Queen’s University, it will be reviewed, and applicants may be asked for further information.

Curriculum and Educational Activities

Twelve-month (13 blocks) program

This program permits residents to explore many aspects of a Care of the Elderly physician, with increased elective time, and more experiences with administrative, leadership, teaching, and scholarly work.

Block experiences (core)

Geriatric In-Patient Rehabilitation Unit (PCH) 2 blocks
Senior’s Day Rehabilitation (PCH) 2 blocks
Geriatric Consultation Team (Acute care - KGH) 1 block or equivalent longitudinal experiences
Geriatric Psychiatry (community-based) – 2 blocks

Longitudinal experiences (core)

Geriatric Clinics & Home visits (PCH)
Long-term Care
Academic Experience (focus on education, administration, scholarly work including required academic projects, and leadership skills)

Elective experiences – determined in discussion with the program coordinator

Residents have 12 to 16 weeks of elective time, depending on how their longitudinal experiences are structured
At least one elective must have a significant focus on comprehensive family practice
Examples: Palliative Care, Physical medicine and rehabilitation inpatients or clinics; sub-specialty clinics; other inpatient experiences;

Six block program

This program permits residents to expand and refine their skills in Care of the Elderly, with some additional focus on leadership and scholarly skills.

Block experiences (core)

Geriatric In-Patient Rehabilitation Unit (PCH) 1 block
Senior’s Day Rehabilitation (PCH) 2 blocks
Geriatric Consultation Team (Acute care - KGH) ½ block or equivalent longitudinal experience

Longitudinal experiences (core)

These 3.5 blocks are structured in a longitudinal fashion to meet the educational needs of the resident.

Geriatric Clinics & Home visits (PCH)
Long-term Care
Academic Experience (focus on education, administration, scholarly work including required academic projects, and leadership skills)
Geriatric Psychiatry (community-based)
Electives (of which at least one component must have a significant focus on comprehensive family - determined in discussion with the program coordinator)

Sample longitudinal schedule:

	Monday	Tuesday	Wednesday	Thursday	Friday
AM	Geriatric Psychiatry	Geriatric Psychiatry	LTC	Geriatric Psychiatry	Geriatric Psychiatry
PM	Geriatric Clinic	Geriatric Psychiatry	LTC	Family Medicine	Academic Half Day

Academic requirements – 6-block and 12-month programs

Each resident will be expected to complete a scholarly project for which there will be academic time provided throughout the year. The details of this timing will be discussed with the Program Coordinator and will vary depending on a resident’s needs and the rotations they are currently completing. As a minimum, the resident must complete an in-depth literature review with presentation at the end of training, but if the resident is interested in research, this can be supported.

In addition, residents will work on developing their leadership skills. This is accomplished through formal leadership teaching, “junior attending” roles, and a mini-administrative project, where they identify an administrative issue, and develop a plan to resolve it. In the past, residents have enhanced orientation materials, updated a website, or brought a suggestion through hospital committee processes.

Residents will participate in regular teaching offered to all residents during their geriatrics rotations; they will be responsible for teaching junior residents, and for supporting other residents during their own teaching sessions. Formal Care of the Elderly specific teaching is planned to address individual resident needs via an academic half-day format.

Goals and Objectives

The program’s overall goals and objectives are as described below. The detailed program objectives are available here.

PROGRAM Goals and Objectives

Family practice residents in this PGY3 Care of the Elderly program will learn special skills, knowledge and attitudes to support their future practice in Care of the Elderly that may include primary care and consultative work.

PROGRAMS GOALS:

In this program residents will:

Establish effective professional relationships with older patients, their family, caregivers and substitute decision makers within the primary care setting and specialized geriatric care systems.
Learn comprehensive and clinical assessment skills of the frail elderly, including assessment of mental function.
Become familiar with the atypical presentation of illness and the management of common geriatric and psychogeriatric problems.
Expand their clinical and administrative skills, knowledge and leadership abilities to work effectively with inter-professional team members in acute hospitals, long-term care facilities and the community, including the older patient’s home.

Residents will be encouraged to set personal learning objectives that may include perceived or previously identified areas of interest. Residents must demonstrate the requisite knowledge, skills, and attitudes for effective patient-centered care and service to an elderly population.

Assessment Portfolio

Candidates meet regularly (at least quarterly), during the course of their program for ongoing tutorial support with the Program Coordinator or their designate. An electronic portfolio assessment system is used to support regular feedback and assessment during the program, with carefully selected assessment tools used regularly to inform the end-of-rotation ITERs. At the mid-point of the program, all faculty members involved to that date will provide feedback to the Program Coordinator and candidate for a mid-program feedback session. As well, a final assessment meeting will be carried out at the end of the program.

Training Sites

Residents are based at Providence Care Hospital site for most of their program. They work closely with the Specialized Geriatric Services program, whose goal is to assist elderly persons to live as independently as possible in a variety of settings. It achieves this by providing multidimensional geriatric assessment services within the community, ambulatory care areas, acute care facilities and long-term care institutions.

In addition, residents will work in the following settings, although these are somewhat dependent on their learning needs:

A) Kingston General Hospital – for acute care consultations, palliative care, and geriatric psychiatry consultations, and for subspecialty clinics.

B) Hotel Dieu Hospital – for subspeciality clinics

C) Long term care facilities – for the horizontal long-term care experience

D) In the community – for the Geriatric Psychiatry rotation, palliative care, and some core geriatrics experiences

Rotations outside of Kingston may be considered for both core and elective rotations, provided that the rotation objectives can be met, but the resident will need to work with the program coordinator to arrange these.

Teaching faculty in geriatric medicine core rotations are family physicians with Care of the Elderly training and internist geriatricians. Although the residents are located at Providence Care Hospital and do the majority of their clinical work there, it is expected that they maintain links with the Department of Family Medicine, often by participating in core teaching there as an educator or as a learner. The program coordinator has a cross appointment with the Department of Family Medicine and is closely involved with the rotation planning, supervision and assessment of residents.

All other Queen's University resources that support residents are available to Care of the Elderly trainees also.

Care of The Elderly Practice

A candidate for this program will be a physician with a demonstrated interest and some clinical experience in care of the elderly. Through the educational experiences offered, candidates will further their knowledge of the aging process and the assessment and management of clinical problems so that they may provide:

A resource base for geriatric care in their communities
Support to outreach models in their communities
Consultation services in community hospitals as a liaison with consultant geriatricians in larger centres
Involvement at an advisory level to Home Care Programs, long-term care facilities, and governing agencies
Institutional care as Medical Director, advisory physician, attending physician long-term care or related settings
Palliative care services in community and institutional settings
Educational initiatives for other physicians and health care workers in the community or institutions
A service and educational resource in an academic Department of Family Medicine

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