Skin and chronic wound problems are common clinical challenges for physicians and trainees who provide care for older patients. Appropriate assessment and wound care management decisions require focused, specific knowledge of the unique characteristics of older patients’ skin and predisposition to chronic wounds. However, this topic is not routinely and adequately covered in most residency training curricula. This is unfortunate, as chronic wounds can be problematic not just for the patient, but also to facilities, as failure to heal or prevent them can lead to litigation and reimbursement issues. To address this challenge, we developed a web-based, interactive virtual patient program that aims to educate clinicians on the multi-modal management of skin and chronic wounds in geriatric patients. The module consists of five cases representing common clinical scenarios that highlight the principles of assessment and treatment of common chronic wound conditions: normal aging skin, skin tears, foot ulcers in persons with diabetes, venous stasis ulcers, and pressure ulcers. At the end of the module, the learner will be able to describe the normal changes of aging skin, identify risk factors for the development of chronic wounds, prevent skin tears and common types of chronic wounds, and compose a treatment regimen for these wounds. Videos, including how to properly dress a skin tear, perform compression wrapping, and probe and swab a chronic wound, are included. Questions are interspersed within each case and text feedback is provided to reinforce learning. References are provided with links to full PubMed abstracts.

NUMBER OF CREDIT HOURS: The Harvard Medical School designates this educational activity for a maximum of 2 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

COST: $40.00
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OVERALL LEARNING OBJECTIVES:

1. To acquire knowledge and skills in common chronic wound care conditions in older adults.

CLINICAL LEARNING OBJECTIVES:

1. Describe the changes in skin that occur with normal aging.
2. Identify risk factors for the development of chronic wounds.
3. Prevent skin tears and common types of chronic wounds (including foot ulcers in persons with diabetes, venous stasis ulcers and pressure ulcers).
4. Compose a treatment regimen for skin tears and common types of chronic wounds.

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FOY WHITE-CHU, MD Course Director

Dr. White-Chu chose to specialize in geriatric medicine due to the patients’ medical complexity and opportunity to provide quality care to those in need. After completing her internal medicine residency at Oregon Health & Science University in Portland, OR, Dr. White-Chu served as a primary care provider in a Program for All-Inclusive of the Elderly. She elected to move to Boston, MA for a two-year geriatric fellowship at Harvard Medical School. She quickly realized her geriatric background lent itself to a holistic approach to chronic wound care. Furthermore, she appreciated there was a lack of chronic wound care education for health professionals. As of January, 2009, Dr. White-Chu is completing her second year of geriatric fellowship. She is an International Interprofessional Wound Care Course candidate, a senior fellow in the Hartford Center of Excellent in Geriatric Medicine, and a student in the Harvard Macy Institute Program for Educators in the Health Care Professions. She hopes that her dual interests of chronic wound care and education will promote wound care education for all members of the healthcare team. DISCLOSURE:

GRACE HUANG, MD Course Contributor

Grace Huang, MD, is the Director of the Office of Educational Technology at the Carl J. Shapiro Institute for Education and Research, a joint venture between HMS and Beth Israel Deaconess Medical Center (BIDMC) in Boston. She also works as a hospitalist at BIDMC. She has spent a number of years designing web-based modules on clinical skills, including computer-based case simulations (“virtual patients”), physical diagnosis tutorials, interactive pathophysiology diagrams, and procedure-based instruction. She serves as a consultant to the Association of American Medical Colleges in their initiative to promote scholarship and sharing of educational materials through MedEdPORTAL. Her clinical research interest is in the impact of a formal hospital-based procedure service on complication rates among internal medicine residents. DISCLOSURE: Dr. Huang's spouse works at Pfizer, Inc., and she holds stock options and shares in the same company.

MADHURI REDDY, MD Course Contributor

Dr. Reddy is an Instructor of Medicine at Harvard Medical School and Medical Director of the Wound Healing Clinic at Hebrew Rehabilitation Center in Boston, MA. She is the past Director of the Wound Healing Clinic in the Division of Plastic Surgery at the Lahey Clinic in Massachusetts. Dr. Reddy completed Internal Medicine training in 1999, and Masters of Science in Clinical Epidemiology and subspecialty training in Geriatric Medicine at the University of Toronto in 2001, followed by a fellowship in Skin & Wound Healing in the Division of Dermatology at the University of Toronto 2001-2002, and was Faculty of the annual International Interdisciplinary Wound Care Course. Dr. Reddy is Assistant Editor of the Journal of Geriatrics and Aging, has published several papers on chronic wounds and textbook chapters, speaks frequently at educational events and has recently completed a book for patients and families on caring for chronic wounds. DISCLOSURE:

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ANGELA BOTTS, MD Reviewer

Throughout her career thus far, Dr. Botts has demonstrated an ongoing commitment to geriatric medical education. Following her internal medicine residency at the Beth Israel Deaconess Medical Center, Dr. Botts completed a geriatric medicine fellowship at Harvard Medical School. She is currently active as a geriatrician at the Beth Israel Deaconess Medical Center and is an Instructor in Medicine at Harvard. Dr. Botts is the recipient of a Hartford Center for Excellence Research Fellowship Award and Geriatric Academic Career Award. Her teaching interests include the development, implementation, and management of an inpatient geriatric pain management curriculum for interdisciplinary housestaff and nurses. In addition, she has been selected as a Rabkin Fellow for the 2008-2009 academic year. DISCLOSURE:

FRANK DOMINO, MD Reviewer

Dr. Frank J. Domino is an Associate Professor and Family Medicine Clerkship Director at the University of Massachusetts Medical School. He was the Associate Editor for Family Medicine to the Up To Date medical database, and is currently the Editor in Chief of Lippincott, Williams and Wilkins’ "5 Minute Clinical Consult" series. Dr. Domino’s major areas of focus include educating all levels of learners (students, graduate and post graduate) in a variety of subjects including Evidence Based Medicine, Sports Medicine, and common ambulatory controversies (Vitamin D Deficiency, Medical Ethics, Non-Pharmacologic Treatment of Depression and Anxiety). Dr. Domino’s areas of faculty development training include Problem Solving, Needs Assessment, Ambulatory Medical Ethics, Presentation Skills, and Fluency/Professional Development in the Medical Literature. Dr. Domino has received numerous teaching awards, including multiple Outstanding Medical Educator Awards and the Outstanding Achievement "Star" Award for Curricular Contribution to the University of Massachusetts Medical School. Dr. Domino is the Family Medicine representative to Harvard Medical School’s Continuing Medical Education program "Current Clinical Issues in Primary Care" Pri-Med committee as well as the University of Massachusetts Medical School’s Continuing Education Committee. He is a regular contributor to and holds an appointment in the Community Faculty Development Center at the University of Massachusetts. His areas of clinical research include Vitamin D Deficiency, and the translation of medical research into practice. DISCLOSURE: Wolters Kuhler Publishing, Editor in Chief, 5 Minute Clinical Consult, Primary Care Medicine; no direct financial payment RxPalm, Incl., President; Medical Editing company

RICHARD HODIN, MD Reviewer

Richard Hodin MD is Professor of Surgery at Harvard Medical School and Attending Surgeon at the Massachusetts General Hospital. His clinical interests are in GI and Endocrine Surgery. He is Surgical Director of the MGH Crohns and Colitis Center and Chief of the MGH Endocrine Surgery Unit. Dr. Hodin runs an NIH-funded research laboratory that is focused on the gut mucosal barrier dysfunction that accompanies a variety of disease states, including starvation, IBD, and severe sepsis. DISCLOSURE:

IFAT KAMIN, MD Reviewer

Bio and Photo Coming Soon. DISCLOSURE:

SIOBHAN RYAN, MD Reviewer

Dr. Siobhan Ryan is an assistant professor in the Division of Dermatology, Department of Medicine of the University of Toronto. She works in the Wound Healing Clinic of Women’s College Hospital, Toronto Canada. Dr. Ryan is Chair of the Education Committee of the Department of Medicine of Women’s College Hospital and has been involved in the design of many continuing medical education programs related to both wound healing and dermatology. DISCLOSURE: Company: ARTEC Type of Relationship: Scientific Advisory Board (no renumeration) Content Area: Tissue Engineering Research Advice on Clinical Applicability Company: Astellas Pharma Candada, Inc. Type of Relationship: Clinical Trial Content Area: Psoriasis

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NUMBER OF CREDITS: 2 

Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Harvard Medical School designates this educational activity for a maximum of 2 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Upon completion of the course you will get a certificate via e-mail within 2 weeks.

Click the image to view a sample of the certificate

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