The Diploma in Geriatric Medicine is written for doctors caring for older people in general practice, in community services and in general hospital settings rather than in specialist geriatric units, and that perspective shapes every question. You are not being asked to make a rare diagnosis. You are being asked whether the change in front of you is new and reversible, what it means for this person's function, whether the care they have is adequate, and whether this can be managed where they are or needs to go somewhere else. That is a different skill from the medicine, and the diploma is built on it.
Key takeaways
- Use the comprehensive geriatric assessment as your organising framework: it is the spine of the diploma.
- Ask first whether the change is new and reversible, because delirium and its causes dominate the acute questions.
- Function and goals determine the answer more often than the diagnosis does.
- The carer and the home environment are clinical information and are examined as such.
- Deprescribing is an active intervention, and the correct answer frequently involves stopping something.
The comprehensive geriatric assessment is the framework
If you take one structure into this exam, take this one, because it is what the specialty uses and what the questions are built around.
The assessment has domains, and running through them systematically will answer most questions. The medical domain: the diagnoses, the medications, the nutrition. The functional domain: activities of daily living, mobility, and what has changed. The psychological domain: cognition and mood. And the social and environmental domain: who is at home, what support exists, what the housing is like, and what the person actually wants.
Candidates who reason only within the medical domain get a substantial proportion of these questions wrong, not because they mis-diagnose but because the answer lay in one of the other three.
Is it new, and is it fixable?
This is the question that dominates the acute presentations in this diploma.
An older person is brought in confused. The temptation, and the error, is to reach for dementia. The diploma wants you to ask first whether this is new, because a new confusion is delirium until proven otherwise, and delirium has a cause that is frequently reversible: infection, pain, constipation, urinary retention, dehydration, hypoxia, a metabolic disturbance, and, very often, a drug.
The same question applies across the presentations. A fall may be a new medical problem rather than a chronic frailty. A decline in function may be an untreated depression, an undetected anaemia, a hypothyroidism, a new visual impairment, or a drug that was started three weeks ago.
Ask what has changed and what changed at the same time, because the answer is often in the medication list, and the exam knows it.
The four domains that carry the exam
The specialty has a core, and it is where the questions cluster.
Falls. The multifactorial assessment, the drugs that cause them, the interventions that actually have evidence, and the consequences including the fracture risk that follows.
Cognition and delirium. Distinguishing delirium from dementia from depression, the reversible causes, and what to do and specifically what not to do, since sedation is frequently the wrong answer and the exam tests it.
Continence. Common, under-revised, assessable, and treatable more often than candidates assume.
Polypharmacy. Which is not a background feature but a topic, and which produces more examinable material than most single diseases.
Around these sit nutrition, pressure care, bone health, stroke, Parkinson's disease, and end-of-life care.
The carer and the home are clinical data
This is where the diploma differs most from a hospital-facing exam, and where candidates who read the social history as scene-setting lose marks.
A plan that a frail person cannot execute is not a plan. A medication regimen requiring four administrations a day, in a person with cognitive impairment and no carer, will not happen, and prescribing it is a clinical error rather than a triumph of evidence-based medicine.
So the questions supply the social context deliberately: who is at home, what the carer can manage and whether they are coping, what the housing is like, whether there are stairs, whether the person can get to the toilet in time, and what services are already involved.
When the vignette tells you the daughter visits twice a week and the patient lives alone with poor mobility, that is not colour. It is determining what discharge, what treatment and what follow-up are actually possible.
Deprescribing is an intervention
Doctors are trained to add. This diploma frequently rewards subtraction, and it rewards it as an active clinical decision rather than as a failure to treat.
Know the drugs that reliably cause harm in older people: the ones that cause falls, the ones that cause confusion, the ones that cause postural hypotension, the anticholinergic burden that accumulates across a medication list. Know the logic of stopping: what to stop first, in what order, and what to monitor for afterwards.
And know the concept that runs underneath it: a treatment whose benefit accrues over years is of no use to someone whose remaining time is measured in months, and continuing it is a burden without a purpose. We explore that reasoning further in multimorbidity and competing priorities.
Manage here or refer?
Finally, the scope question, which this diploma shares with the other primary care diplomas.
Much of geriatric medicine can and should be managed in the community, and a referral is not automatically the safe answer. The exam tests whether you know what a GP or a general physician can competently do, what needs a specialist service, and what needs the person to be in hospital today.
Comprehensive assessment, medication review, falls assessment, continence assessment and the management of most chronic disease in frailty belong where the patient is. The acutely unwell, the rapidly declining, the person whose home situation has collapsed, and the diagnostic uncertainty that needs specialist input do not.
Where iatroX fits
iatroX's DGM bank is built around whole-person decisions in the settings where older people are actually cared for, rather than around specialist diagnosis, which is the perspective the diploma uses. Explanations are grounded in current guidance, the adaptive engine targets the domains where you are genuinely weak, and missed questions can be opened in the Socratic Tutor, which asks you to reason before it explains and names the domain of the assessment you failed to consider, which is very often the functional or the social one. Try it with free sample questions at iatroX.
Frequently asked questions
What framework should I use for DGM questions? The comprehensive geriatric assessment, with its medical, functional, psychological and social domains. Candidates who reason only within the medical domain get questions wrong because the answer frequently lies in one of the other three.
How should I approach a confused older patient in an exam question? Ask first whether the confusion is new. New confusion is delirium until proven otherwise, and delirium has a reversible cause: infection, pain, constipation, retention, dehydration, hypoxia, a metabolic disturbance, or, very commonly, a drug.
Why does the social history matter so much in this diploma? Because a plan the person cannot execute is not a plan. Who is at home, what the carer can manage, and what the housing allows determine which treatments and follow-up are actually possible, and the exam supplies this information deliberately.
Is stopping a drug ever the right answer? Frequently. Deprescribing is an active clinical decision in older people, particularly for drugs that cause falls, confusion or postural hypotension, and for treatments whose benefit accrues over a longer period than the patient's likely remaining time.