MedEdPORTAL (Mar 2015)
Treating Older Adults with Hypertension: When Are the Guidelines Not Applicable?
Abstract
Abstract Introduction Health care planning and promotion is one of 26 minimum geriatrics competencies for all medical students in accredited medical schools in the United States. Under this domain, all medical students should be able to accurately identify clinical situations where life expectancy, functional status, patient preference, or goals of care should override standard, evidence-based, clinical practice guidelines for the treatment of hypertension and other conditions in older adults. However, there are no current resources on teaching a holistic approach to health care planning and promotion to the third-year medical students. This team-based learning (TBL) workshop uses hypertension as an example for helping learners achieve this competency using active learning. Methods This TBL workshop consists of a recommended prereading list, readiness assurance tests (RATs), a group application exercise involving three case vignettes regarding the treatment of hypertension in older adults. The workshop is administered over a 95-minute period. Results All students were engaged during this workshop, and a grasp of the big picture of geriatrics was seen in student formative feedback. Further, the workshop was given an average score of 4.1 on a 5 point Likert scale survey, and antihypertensive medication was stopped for some nursing home patients based on direct clinical observation. Discussion The evidence-based guidelines in treating chronic diseases are often not specific and less applicable to older adults who often have multiple co-existing conditions and complex needs. As a result, the adherence to, and application of, evidence-based clinical practice guidelines on hypertension is often poor. This resource teaches a new approach to help learners understand how to apply the appropriate guidelines to this vulnerable population.
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