Clinical Decision-Making for Older Patients With Multiple Chronic Conditions: A Case-Based Exercise for Medical Students

Abstract

Abstract Introduction Over half of patients over age 65 in the US have multimorbidity, defined as having three or more chronic diseases, but most clinical research on chronic disease management focuses on single chronic diseases. An expert panel convened by the American Geriatrics Society has provided a framework of guiding principles for clinical decision-making in patients with multimorbidity. This resource describes a session for second-year medical students at the end of their preclinical curriculum, in which students practice using a framework for clinical decision-making for patients with multiple chronic diseases. Methods In this 90-minute small-group session, students work with faculty mentors to apply that framework to a hypothetical patient with multimorbidity. They consider patient preferences, review relevant evidence, estimate a prognosis, consider clinical feasibility, and devise a treatment plan that maximizes benefits, minimizes harm, and enhances quality of life. Results Approximately 180 students have completed the multimorbidity session. Outcomes data suggest that the session helps students master key concepts in management of the patient with multimorbidity. Discussion Prior to entering the clinical arena, medical students need to develop foundational skills that have not historically been part of preclinical curricula, such as accurately estimating prognoses, eliciting goals of care, and understanding the limitations of evidence regarding treatment outcomes in older patients. This session, one in a series of case-based exercises designed to train preclinical medical students in core competencies for care of the older patient, is a useful tool for medical educators looking to enrich the geriatric content in preclinical curricula.

Keywords

• Geriatrics
• Prognosis
• Multimorbidity