Teaching Geriatrics to Clinical Medical Students: Introducing Complexity and Subtlety and Teaching Clinical Reasoning

One of the keys to teaching Geriatric Medicine is teaching clinical reasoning skills, specifically how to address complexity and subtle illness presentations common in older patients. The geriatric medicine educator can do this by teaching broader and more nuanced illness scripts which reflect the heterogeneity of aging and other geroscience principles such as age-associated physiological changes, homeostenosis, and frailty. Another approach is to teach about management of the typical geriatric patient with multiple concurrent conditions and goal-concordant care, using the Geriatrics 5Ms as a framework. Clinical reasoning pearls and aphorisms can be used to teach principles in each of these areas, such as “Start low, go slow, but get there” to discuss an approach to titrating medications. Trainees can be taught to used structured approaches, such as systematically addressing physical, social, psychological, and cognitive function. Finally, trainees can be taught explicitly how various aspects such as clinical reasoning related diagnosis and treatment decisions differ for the older patient.