Geriatric Medicine Training and Practice in the United States at the ...

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Figure 7.1 Required Time (Half Days) Devoted to Clinical Instruction in Geriatric Medicine during 3-Year General Internal Medicine Residency % Programs 40 35 30 25 20 15 10 5 0 Source: IHPHSR ADGAP Database Project, 2002 29 0-12 13-24 25-36 37+ Half Days Figure 7.2 Required Time (Hours) Devoted to Didactic Instruction in Geriatric Medicine during 3-Year General Internal Medicine Residency % Programs 45 40 35 30 25 20 15 10 5 0 Source: IHPHSR ADGAP Database Project, 2002 28 the work from these conferences, the John A. Hartford Foundation awarded $2,041,931, starting July 2002, to the Society of General Internal Medicine. The SGIM is to work with the Association of Program Directors in Internal Medicine to enhance geriatrics curricula in general internal medicine residency programs by developing collaborative centers for research and education in the care of older adults. Ten center grants, each for a total of $100,000 over 2 years, will be awarded. Each center will provide a model for the collaboration of GIM and geriatrics in developing generalist leaders to improve the care of older Americans. Seth Landefeld, MD is the director of this three-year project. 31 39 40 23 0-12 13-24 25-36 37+ Hours 0 10 Survey of General Internal Medicine Program Directors In preparation of the present report, the IHPHSR conducted a survey of current efforts and trends in geriatric education for general internal medicine residents. This survey was completed in collaboration with the Society of General Internal Medicine (SGIM) in the spring of 2002. Characteristics of Responding GIM Residency Programs A total of 206 of the 390 surveys were returned, for a response rate of 53%. The size and census tract location of the responding programs were similar to those of the non-responders. Geriatric Medicine Curriculum in GIM Programs One hundred ninety one programs (93%) required geriatric medicine training; 15 (7%) did not. Six of the 15 programs without required geriatrics training did not offer any elective geriatrics experience. Forty percent (n=75) of the programs required between 25 and 36 half-days of geriatric medicine clinical training during the 3-year residency. Thirty-one percent (n=57) required between 13 and 24 half days, and 29% (n=55) required 12 half days or less of clinical training (Figure 7.1). Similarly, 23% (n=43) of the programs required between 25 and 36 hours of instruction, and only 28% (n=53) of the programs reported 12 hours or less of instruction (Figure 7.2). As could be expected, programs with more half-days of clinical instruction tended to have more didactic training (Spearman’s rho = 0.385, p
Trends in GIM Residency Programs Required lecture and seminar time dedicated to geriatric medicine had remained stable in 60% of the programs, had increased in 33% of the programs, and had declined in only 5% of programs (2% of programs did not require geriatric lectures or seminars). When asked to project whether the geriatric education curriculum time (clinical or didactic) would change over the next three years (July 2002-June 2005), directors anticipated substantial (8%) or modest (45.6%) increases, no change (44.6%) or a decrease (2%). Barriers to Implementation of Geriatrics Curricula in GIM Programs Residency directors were asked to rate seven potential barriers to implementing their geriatric medicine curricula using a five point Likert scale. Conflicting time demands with other curriculum was ranked as the most significant barrier (Figure 7.3). Residency directors were also asked to rate on a five-point Likert scale seven-curriculum topics as to their importance for training of internists. ICU/CCU, geriatrics, and palliative care were rated as the highest priorities (Figure 7.4). Family Practice In January 2000, there were 69,063 family physicians in the United States providing direct patient care (American Academy of Family Practice, 2001). Nearly one half of practicing family physicians work in communities with populations under 25,000 (American Academy of Family Practice, 2001). The 1999 National Ambulatory Medical Care Survey found that about 170 million office visits were made to family physicians. Visits to family physicians represented 22.5% of all ambulatory visits made to all physicians during that year. Since 1969 more than 470 family practice residency programs have been established and accredited by the RRC for family practice (American Medical Association, 1998). More than 3600 first-year positions are available in these three-year training programs; there were a total of 10,503 family medicine residents in 2000 (American Academy of Family Practice, 2000). Eighty-five percent of all family practice residency programs are based in community hospitals; although most are either affiliated with or administered by a medical school. The remaining programs are based at a medical school (12%) or the military (3%). AAFP Residency Assistance Program (RAP) Consultations The RAP was established in 1975 to provide consultative assistance to family practice residency program directors interested in enhancing the quality of their training programs (Hejduk, Kahn, & Ostergaard, 1997). Administered by the American Academy of Family Physicians Figure 7.3 Significant Barriers to Implementing a Geriatric Medicine Curriculum as Reported by General Internal Medicine Program Directors 1 IM Curriculum Conflicts Faculty Time Adequate Number of Faculty Clinical Faculty Availablity Hospital Administration Support Reimbursement Constraints Resident Attitudes Lack of Training Sites Faculty Attitudes Patient Availability % Programs Rating Barriers ≥4 1 Program directors were asked to rate each item on a scale of 1 to 5 where 1 = never a barrier and 5 = always a barrier. Source: IHPHSR ADGAP Database Project, 2002 Figure 7.4 Program Directors' Rating of the Importance of Residency Curriculum Areas to the Training of Successful General Internal Medicine Physicians 1 ICU/CCU Geriatrics Palliative Care Women's Health Community Medicine Occupational Environmental Medicine Genetics 0.5 6 11 (AAFP), the RAP program has provided over 1,000 consultations during the past 25 years. The AAFP conducted on-site geriatric medicine curriculum consultations for 40 community-based family practice residency programs between 1996 and 2001. Ten specially-trained family physician/geriatrician faculty conducted these one-to four-day consults. This project was developed as part of the Residency Assistance Program (RAP) in family practice, with funding from the John A. Hartford Foundation. 16 17 17 21 % Programs Rating Areas ≥4 1 Program directors were asked to rate each item on a scale of 1 to 5 where 1 = not at all important and 5 = extremely important. Source: IHPHSR ADGAP Database Project, 2002 17 23 65 35 41 81 85 85 46 90 77
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The Association of Directors of Ger
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The Association of Directors of Ger
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National Oversight Panel M. Brownel
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The American Geriatrics Society . .
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List of Tables and Figures Chapter
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Figure 7.4 Figure 7.5 Figure 7.6 Fi
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the fastest acceleration in 12 year
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esidency review committee provide a
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Project Methodology National Oversi
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Table 2.2 Secondary Data and their
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3 Historical Development of Geriatr
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$195.9 million NIA extramural suppo
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important political decision by the
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Page 29 and 30: participants. Geriatricians have be
Page 31 and 32: Table 4.8 Medicaid Recipients and P
Page 33 and 34: Figure 4.1 Distribution of Certifie
Page 35 and 36: Figure 4.3 Geriatric Caseload for P
Page 37 and 38: Table 4.19 Total Annual Compensatio
Page 39 and 40: panel felt were most important for
Page 41 and 42: 5 Academic Geriatrics Programs in U
Page 43 and 44: Table 5.1 Academic Geriatric Progra
Page 45 and 46: Table 5.1 Academic Geriatric Progra
Page 47 and 48: Figure 5.1 Number of Years as Acade
Page 49 and 50: Table 5.4 Women and Minority Facult
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Page 53 and 54: Table 5.7 Sources of Geriatric Prog
Page 55 and 56: Table 5.9 Allopathic Medical School
Page 57 and 58: Table 5.11 Allocation of Faculty an
Page 59 and 60: Table 5.12 Allocation of Faculty an
Page 61 and 62: Table 6.1 Geriatric Medicine and Ge
Page 63 and 64: Table 6.4 Sources of Financial Supp
Page 65 and 66: investigators receive $60,000 of su
Page 67 and 68: Table 6.7 Program Directors Reporte
Page 69 and 70: Table 6.10 Program Directors Report
Page 71 and 72: Fellowship Training Activities for
Page 73 and 74: Table 6.16 Fellowship-Trained Geria
Page 75 and 76: 7 Preparing All Physicians To Care
Page 77: General Internal Medicine The 1999
Page 81 and 82: Nursing homes and home care experie
Page 83 and 84: Geriatric Education Retreats (GERs)
Page 85 and 86: and GIM programs a mean of 2.8 avai
Page 87 and 88: chapter. The goals of these student
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Page 91 and 92: Conclusion This report summarizes r
Page 93 and 94: Bureau of Health Professions, HRSA,
Page 95 and 96: U.S. Centers for Medicare & Medicai
Page 97 and 98: APPENDIX A. Research Focus of Curre
Page 99 and 100: APPENDIX C. RESEARCH FOCUS OF NATIO
Page 101 and 102: APPENDIX E. SELECTED GERIATRIC MEDI
Page 103 and 104: Appendix F. Geriatric Medicine and
Page 109 and 110: Helen Hoenig, M.D., M.P.H., Duke Un
Page 111 and 112: APPENDIX H. RESIDENCY REVIEW COMMIT
Page 113 and 114: Appendix H. Residency Review Commit
Page 115: Association of Directors of Geriatr
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