Teacher’s
Manual
Natural Language Question Activity
Write Your Own Medical Adventure
provided by:
2012 Reynolds Grantee
10th Annual Meeting
TEXAS
Training Excellence in
Aging Studies
Division of Geriatric and
Palliative Medicine
The University of Texas Health
Science Center at Houston
School of Medicine
The First Decade
and funded by:
The Donald W. Reynolds Foundation
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Natural Language Question Structure
Response
Critical
Thinking
Question
Evaluation
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Step 1: Write a Critical Thinking Question:
Write your question here
Example Question:
How does a comprehensive geriatric assessment differ from a standard adult medical exam? Why is it
important to complete a comprehensive geriatric assessment of an older adult?
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Write your response here
Step 2: Write your expert response below.
Example Response:
A comprehensive geriatric assessment (CGA) exam goes beyond the standard adult history and
physical examination. It is a more extensive evaluation that includes elements of special
significance in older adults. A CGA ensures that you are providing the highest quality healthcare for
this population. The comprehensive geriatric assessment differs from a standard medical
evaluation in four important ways.
(1) It focuses on elderly individuals with complex conditions. As older adults age, it is often the
case that older patients will develop groups of related medical problems. These conditions
are referred to as “Geriatric Syndromes." Common geriatric syndromes include falls,
cognitive impairments, polypharmacy (conducting regular medication review for all overthe-counter, as well as prescribed, drugs or supplements), delirium, depression,
incontinence, impaired homeostasis and iatrogenic disorders. The CGA assists clinicians in
uncovering such problems.
(2) Obtaining an in-depth social history helps to fully understand overall health. Often, the
concerns or problems of an older adult will not present themselves as purely physical
ailments. A thorough social history includes questions about living environment, social
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support, social activities, and advanced directives. These questions can reveal problems
such as caregiver stress, elder abuse and mistreatment and financial concerns that would
not be evident from a routine physical exam.
(3) It emphasizes functional status. A comprehensive geriatric assessment addresses the most
prevalent issues that affect functionality faced by an older adult patient. It involves a
thorough evaluation of:
a. Cognition: dementia and delirium;
b. Mobility: fall risk, gait and balance, instrumental and basic activities of daily living
(IADL and ADLs);
c. Affect: depression and other mood disorders;
d. Pain;
e. Vision;
f. Hearing; and,
g. Nutrition.
(4) It frequently takes advantage of an interprofessional team of providers. The
interprofessional team can help with the comprehensive geriatric assessment, allowing for
more expert assessment of and advice for the patient, and allowing the geriatrician more
time for other patients. The interprofessional team provides the patient with more
resources from other professionals (social workers, case managers, physical and occupation
therapists, registered dieticians, and nurses). Using a team offers a holistic approach to
healthcare.
The CGA is a critical tool that geriatricians and geriatric interprofessional teams rely on to
formulate an individualized plan of care for older patients. It is important because it is
comprehensive and the approach is holistic. It utilizes an array of assessments that address issues
faced by older adults with complex comorbidities. The CGA provides an integrated picture of older
adult health, taking into account all the multifaceted domains that impact an older adult’s health,
well-being, independence, and quality of life.
Step 3: Circle keywords in your response that are critical to the overall
concept you are trying to convey and that you want the students to grasp and
retain.
In the example above, the keywords/short phrases are highlighted.
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Step 4: Put keywords in table.
Natural Language Table
Grp
Rubric Level:
Rubric Level:
Rubric Level:
Point range:
Point range:
Point range:
Keyword
Synonyms
Alternatives
Step 5: Identify suitable synonyms.
Step 6: Identify acceptable alternatives (other potential words or phrases
that are not synonyms, but would still be related and acceptable).
Step 7: Assign grouping if needed.
An example of a completed natural language table is on next page.
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Example: Natural Language Table
Natural Language Table
Rubric Level:
Point Range:
Grp
Keyword
1
complex
1
social history
1
functional
1
interprofessional
1
individualized
1
plan of care
1
1
quality of life
independence
Rubric Level:
Point Range:
Rubric Level:
Point Range:
Synonyms
complex problems, interrelated, complexity, many
problems, challenging,
social activities, social support, social environment
functioning, functional, ability, capacity, able,
useful, purposeful,
interdisciplinary, expert, specialist, team,
multidisciplinary
customized, tailored, personalized, specified,
specific, particular, self-care, self
care plan, assessment and plan, therapeutic plan,
therapeutic alliance
life of older adult, quality, value, worth, good life
individuality, individualism
Alternatives
comorbidities, varied,
multiple, diverse
friends, community,
background
efficient, thriving,
maintaining
care team, holistic
unique, thorough
regiment, routine
health, wellness
maintenance
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Step 8: Determine rubric categories, levels and rubric points
Level A
Level B
Level C
Trait 1
Trait 2
Trait 3
Trait 4
Example: Critical Thinking Rubric
Trait
KNOWLEDGE
(geriatric
terminology)
Novice=1
Incorrect Response
Demonstrates no
knowledge of geriatric
terminology and/or
strategies
COMPREHENSION Response is stated
(grasp of geriatric without clarification or
essentials)
description.
Advanced=2
Not applicable to this this
level
Response is stated but
description leaves some
terms undefined,
ambiguities unexplored,
undetermined,
and/or unknown.
Mastered=3
Correct Response
Demonstrates
thorough knowledge of
geriatric terminology
and/or strategies
Response is stated
clearly, insightfully, and
described
comprehensively,
delivering all relevant
information necessary
for full understanding.
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APPLICATION
AND ANALYSIS
(Evidence,
perspective and
Influence of
geriatric concepts
and context )
Response is minimally
developed, simplistic and
obvious with limited
degree of clarity and with
little confidence
Response is partially
developed with some
clarity and confidence
Response is fully
developed, taking into
account the
complexities of
Response with some
geriatrics with a high
interpretation/evaluation, degree of clarity and
Response without any
with confidence
but not enough to
interpretation/evaluation. develop a coherent
analysis or synthesis.
Response with enough
Shows an emerging
interpretation/
awareness of geriatric
Identifies several relevant evaluation to develop a
concepts and geriatric
geriatric concepts when
comprehensive analysis
context
responding.
or synthesis or
application
Begins to identify some
geriatric contexts when
Thoroughly
responding
(systematically and
methodically) analyzes
responses in relation to
geriatric concepts.
Carefully evaluates the
relevance of geriatric
contexts when
responding.
SYNTHESIZING
AND
EVALUATING
(Discover
meaning or
significance, draw
conclusions, and
make an
assessment)
Conclusion is
inconsistently tied to
some of the information
discussed; related
outcomes (consequences
and implications) are
oversimplified.
Conclusion is logically tied
to information; some
related outcomes
(consequences and
implications) are
identified clearly.
Conclusions and
related outcomes
(consequences and
implications) are logical
and reflect informed
evaluation and ability
to place evidence and
perspectives discussed
in priority order.
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Step 9: Add rubric level to your table on page 6
Step 10: Assign point range for question per rubric level to your table on
page 6
Example: Completed Natural Language Table
Natural Language Table
Rubric Level: Novice
Point range: 0-2
Grp
Keyword
Rubric Level: Advanced
Point range: 3-5
Rubric Level: Mastered
Point range: 6-8
Synonyms
1
complex
complex problems, interrelated, complexity,
many problems, challenging,
1
social history
1
functional
1
interprofessional
1
individualized
1
plan of care
1
quality of life
1
independence
social activities, social support, social
environment
functioning, functional, ability, capacity, able,
useful, purposeful,
interdisciplinary, expert, specialist, team,
multidisciplinary
customized, tailored, personalized, specified,
specific, particular, self-care, self
care plan, assessment and plan, therapeutic
plan, therapeutic alliance
life of older adult, quality, value, worth, good
life
individuality, individualism
Alternatives
comorbidities,
varied, multiple,
diverse
friends, community,
background
efficient, thriving,
maintaining
care team, holistic
unique, thorough
regiment, routine
health, wellness
maintenance
Step 11: Alpha and beta test your natural language questions to fine tune
your system. It is best completed as an iterative process. At each iteration,
modifications can be made thereby enhancing the evolving versions until
you are satisfied with the system implemented.
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The Training Excellence
in Aging Studies
(TEXAS) program
promotes geriatric
training from medical
school through the
practicing physician
level. This project is
funded by the
Donald W. Reynolds
Foundation to the
division of Geriatrics
and Palliative Medicine
within the department
of Internal Medicine at
the University of Texas
Health Science Center
at Houston (UTHealth).
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