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Innovations in Surgical Education: A Geriatric Surgical Fellowship Hugh Willcox, MD; Richard Bell, MD, FACS; James Nottingham, MD, FACS; G. Paul Eleazer, MD University of South Carolina Department of Surgery Defining the Problem: The Solution: The Academic Geriatric Surgeon The United States is Aging Educational Modules to Develop an Academician They will need operative interventions An improvement is needed Educational Modules to Develop a Geriatric Surgeon 1. Statistics Primer 1. Preoperative Evaluation of the Elderly - Basic Statistics - Functional status - Application of appropriate methods - Comorbidity Evaluation - Critical Analysis of published data - Specific organ assessment 2. Epidemiology Basics 2. Acute Pain Control for the Elderly - Factors influencing the health of the elderly - Pathophysiology of pain - Descriptive and analytic techniques applied - Options for pain control to the study of the geriatric population - Evaluation of side effects requiring surgical services 3. Polypharmacy 3. Clinical Trial Designs - Assessment of medications - Fundamentals of designing trials - Methods to minimize medications - Navigating the IRB - Understanding the Beers Criteria - Human research subjects training 4. Nutrition in the Elderly 4. Grant writing - Risks for malnutrition in the elderly - NIH - Physiologic changes in body composition - How to find grants - Assessment of nutritional status - Writing and budgeting grants - Potential interventions 5. Evidence Based Medicine 5. Basic Science of Aging - Techniques - Theories of Aging - Methodology - Assessments of true age – chronology vs - Applications physiology 6. Economics, Accounting and Budgeting - Specific organ changes with aging - Economics of health care in the aged 6. Delirium in the Elderly Surgical Patient - Maximizing beneficial spending - Risk factors - Principles of accounting for - Evaluation of cognitive awareness department/division leaders - Interventions 7. Legislation and Ethics 7. Beyond the Hospital - Understanding relevant South Carolina - Advanced discharge planning legislation and how it applies to the - Home visitation elderly 8. Trauma in the Elderly - Evaluating ethical issues of the elderly - Demographics 8. Palliative Care Training - Prevention - Hospice options - Interventions - Operative palliative techniques 9. Anesthesia in the Elderly - End of life issues – communication, - Normothermia symptom management - Fluid and blood management 9. Evaluation and Education Techniques - Anesthetic options - Theories of adult education 10. Surgical considerations in the elderly - Strategies to evaluate students, residents - Common surgical diseases of the aged References: - Application of these principles - Exploring intraoperative techniques 1. Polanczyck CA; Marcantonio E; Goldman Let al; Impact of Age on Perioperative Complications and Length of Stay in 10. Curriculum Development Patients Undergoing Noncardiac Surgery; Annals of Internal Medicine; 2001; 134: 637-643 - Defining the problem 2. Data from CDC Advance Data No. 329, June 19, 2002 - Developing a solution 3. Cox SS, Pofahl WE, Pories WJ; Surgical Residency Curriculum, 4th edition, 2003 - Evaluation of success 4. Rosenthal RA; Zenilman ME; Katlic MR; Principles and Practice of Geriatric Surgery (1st edition); Springer Verlag: New York, 2001