Geriatric medicine curriculum standards

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• assess family and carers’ understanding about patients’ medical conditions, giving explanations, when needed, in easy-to-understand language without medical jargon
• explain the aim and purpose of rehabilitation, and its limitations
• manage disagreements and emotionally charged conversations
• explain the pros and cons of options to patients (taking ‘no action’ is an option)
• explore patients’ and family or carers’ expectations, concerns, and ideas about how the problem(s) are to be managed, and reframe where necessary
• respond to patients’ and family or carers’ emotions regarding the discussion
• offer patients and family or carers explicit opportunities to ask questions during the decision‑making process
• consider family or carers’ distinct information needs, which may require a separate meeting (provided patients, if have capacity, give consent)
• optimise communication aids as required, e.g. use of interpreters or hearing aids where applicable, and ensure patients are mentally capable of taking part in the discussion
• implement consistent, clear communication aids, whether short notes on a white board, written notes, or electronic case records
• check patients, families, and carers understand the information
• manage own nonverbal communication skills in difficult situations
• ensure accurate documentation of meeting is kept
• discuss meeting outcomes and outline expectations for all present following meetings
• ensure the outcomes of family meetings are communicated to wider team members who were not present in the meeting

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• outline standard approaches for planning, leading, and concluding difficult family meetings
• communicate clearly with patients and others in the setting of ethical dilemmas
• detail strategies for navigating conflict in family meetings
• use communication models such as SPIKES when delivering bad news
• tailor the information given according to the patients’ or carers’ level of understanding, concerns, and information needs
• respond to identified needs but defer proposing solutions until a team discussion is held
• inadequately respond to verbal and nonverbal cues or distress from patients, families, or carers

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• consider health promotion strategies in assessments, such as:
  • support patients by creating a safe environment to explore and discuss plans or goals during family meetings
  • formulate accurate meeting outcomes and follow up on agreed actions

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• explain to, and negotiate with, patients, families, and carers regarding goals, expectations, prognosis and follow-up plans

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• facilitate discussions with patients, families and carers in a way that is respectful, non-judgmental, and culturally safe
• be aware of cultural differences in information preferences and attitudes to discussing prognosis and dying
• clarify with patients, families, and carers their cultural background or norms

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• recognise that the values, biases, or perspectives of patients, physicians, or other health professionals may have an impact on the quality of care, modifying the approach to patients accordingly
• intervene when behaviours undermine a respectful environment
• disclose patient safety incidents to patients and families or carers accurately and appropriately

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• recognise the potential for perspectives of patients, physicians, or other health professionals that may have an impact on the quality of care

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• identify decision points in care pathways, and monitor the quality of shared decision making
• use a joint decision-making approach that takes patients’ preferences into account, even when they do not have capacity to fully participate in decision making Judgement and decision making
• recognise limitations of what can be achieved during family meetings, e.g. it is unlikely that longstanding family dysfunction can be resolved
• incorporate the family meeting process into the broader treatment episode or goals of care
• work with the multidisciplinary team to maintain mobility, independence, and continence while in hospital

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• identify key preferences of all parties

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• gather the necessary information prior to meetings, and identify issues from all parties that may require discussion
• clarify the purpose of meetings
• use a structured approach to guide meetings
• provide opportunities for contributions from all attendees, as needed
• identify shared goals and areas of difference
• identify causes of areas of difference, such as information gaps, treatment goal confusion, emotions, family dynamics, and team dynamics
• help resolve areas of difference and be prepared to make recommendations
• lead initiatives that promote respectful work environments
• debrief after difficult and/or emotionally charged meetings
• provide effective and constructive feedback to the multidisciplinary team and/or individual team members
• respond to feedback from the multidisciplinary team and/or individual team members
• manage the implementation of the meeting outcomes and follow up as required

Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

• contribute, as a member of the team, to joint decision making
• outline the purpose of meetings without facilitating other members of the team to contribute to the shared understanding

Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

• ensure parties rights have been respected
• advocate to ensure patients have the right help and/or resources in their home environment