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

Curriculum Retreats for Family Practice
Residency Program Directors
The AAFP and the Association of Family Practice Residency Directors
conducted three geriatric education retreats for FP program directors
during 2000 and 2001. The goals were to build recognition among the
residency directors of the skills future family physicians will need to
care for adults and to allow the residency directors to identify and
develop solutions to barriers to improving geriatric medicine training
for residents. Forty-six program directors participated in the three
retreats. The participants represented programs in all geographic
regions, small and large programs, and urban and rural settings. They
developed a consensus on the geriatric medicine knowledge, skills,
and attitudes that should be expected of all FP residency graduates.
They also developed a list of basic, required educational resources
for each FP residency program and proposed solutions to common
obstacles to successful geriatrics curriculum development. This
material was disseminated to all FP program directors in early 2002.
As described above, the last published comprehensive survey of
geriatric medicine training in family practice residencies dates back to
Reuben’s work in the late 1980s (Reuben, Fink, & Vivell et al., 1990).
At that time, 80% of family practice programs reported having some
geriatric medicine curriculum in place. The preferred training site was
the nursing home, with 93% of programs reporting they used this site.
Programs reported they had few faculty teaching geriatrics and would
need more in the future.
Survey of Family Practice Program Directors
In preparation of this report, the IHPHSR conducted a survey of current
efforts and trends in geriatric education for family medicine residents.
This survey was completed in collaboration with the Society of
Teachers of Family Medicine (particularly Ina Li, MD and Christine
Arenson, MD, of Thomas Jefferson University) and the Association of
Family Practice Residency Directors. The survey was mailed to the
residency directors of each U.S. family medicine program listed in the
American Academy of Family Physicians’ (AAFP) November 2000 list
of ACGME-Accredited Residency Programs in Family Practice
(American Academy of Family Physicians, 2000). Currently, there are
471 family medicine residency programs.
Characteristics of Responding FP Residency Programs
A total of 352 of the 471 surveys were returned, for a response rate
of 75%. The size and organizational type of the responding programs
were similar to those of the non-responders.
Geriatric Medicine Curriculum in FP
Residency Programs
Three hundred twenty one programs (92%) required geriatric
medicine training; 29 (8%) did not. Ten of the 29 programs without
required geriatrics training did not offer any elective geriatrics
experience, although some indicated they had some didactic
curriculum in geriatrics.
One third of the programs required between 25 and 36 half days
of geriatric medicine clinical training during the 3-year residency.
Twenty-three percent required greater than 36 half days, and 15%
required 12 half days or less of clinical training (Figure 7.5). Similarly,
Figure 7.5 Required Time (Half Days) Devoted to Clinical Instruction in
Geriatric Medicine during 3-Year Family Practice Residency
% Programs
35
30
25
20
15
10
5
0
15
30
Source: IHPHSR ADGAP Database Project, 2002
0-12 13-24 25-36 37+
Half Days
Figure 7.6 Required Time (Hours) Devoted to Didactic Instruction
in Geriatric Medicine during 3-Year Family Practice Residency
% Programs
45
40
35
30
25
20
15
10
5
0
10
42
Source: IHPHSR ADGAP Database Project, 2002
21% of the programs required more than 36 hours of instruction, and
only 10% of the programs reported 12 hours or less of instruction
(Figure 7.6). As could be expected, programs with more half days of
clinical instruction tended to have more didactic training (Spearman’s
rho = 0.252, p