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

“While our residents recognize that many of their patients will be
over age 65, they also have learned (due to Medicare reimbursement
levels and patient complexity) that they cannot afford to care for a
high percentage of older adults and maintain a financially viable
practice.”
Residency directors were also asked to rate on a 7-point Likert
scale seven curriculum topics as to their importance for training of
family physicians. Pediatrics, geriatrics, and inpatient medicine were
rated as the highest priorities (Figure 7.8).
Best Educational Practices in FP Residency Programs
Directors were asked to describe the best aspects of their geriatrics
curriculum. We grouped these open-ended responses into 11
categories. The program directors were most enthusiastic about
outpatient and community-based experiences and the overall design
of their curricula.
Other Initiatives in Internal Medicine
and Family Practice Residency
Education—The Stanford University
Geriatric Education Resource Center
The Stanford University Geriatric Education Resource Center (with
funding from the John A. Hartford Foundation) developed and
disseminates geriatric medicine educational materials for internal
medicine and family practice residents. These materials were created
with input from the AAFP and eight academic medical centers (Baylor,
Harvard, Johns Hopkins, Stanford, UCLA, Chicago, Connecticut, and
Rochester). The materials include packaged methods and stand-alone
aids for teaching geriatric knowledge and skills. (See
http://Sugerc.Stanford.edu/index0.html.)
In addition, each year up to six medical school faculty are selected
to attend the Stanford Faculty Development Center for training to
become Geriatrics in Primary Care (GiPC) seminar facilitators. The
one-month facilitator-training course gives participants the knowledge
and seminar leadership skills they need to deliver a series of eight
2-hour seminars to faculty and residents in their communities. The
seminars are designed to help primary care faculty enhance their
ability to care for older patients as well as teach this information to
medical trainees and others who teach.
Participants are encouraged to explore their attitudes, knowledge,
and skills related to geriatrics during a variety of instructional activities
including: case studies, didactic presentations, role play exercises,
brainstorming sessions, and personal and institutional goal setting.
During the eighth seminar, participants develop a set of recommendations
for improving their institutions’ educational environments for
geriatrics.
Psychiatry
As with internists and family physicians, the number of psychiatrists
with certification in geriatric medicine is small, and recruitment into
fellowship programs is weak. General psychiatrists without advanced
training in geriatric mental health will continue to provide the majority
of psychiatric care to older adults (see Chapter 4). The psychiatry RRC
requirements provide a basis for developing residency curriculum in
geriatrics (see Appendix H). However, little is known about how these
requirements are being implemented.
A combined neurology and psychiatry Geriatric Education Retreat
(see below) was held in March 2001. The most tangible outcome was
interest in developing a combined Geriatric Neurology/Psychiatry
geriatrics fellowship program. While psychiatry already has a fellowship
program in place, neurology does not.
Obstetrics/Gynecology
The Council on Resident Education in Obstetrics and Gynecology
(CREOG) estimates that by the year 2030, 20% of women cared for
by obstetrician-gynecologists (OB-GYN) will be older than age 65.
(CREOG Geriatric Education Task Force, 1999). In 1999, CREOG
published educational objectives for training residents in OB-GYN.
Since 1996, the RRC for OB-GYN has required specific training in
geriatrics and geriatric gynecology (see Appendix H). To date no
studies have been done to determine the methods currently being
used by OB-GYN program directors to implement this new curriculum.
Internal Medicine Subspecialties
Physicians practicing in internal medicine subspecialty have completed
two to three years of general medicine training and additional years of
training in their chosen subspecialty. The practice activity of these
physicians includes primary care as well as clinical activities specific
to the chosen specialty. Most of these physicians will care for large
numbers of older adults (see Chapter 4).
Integrating Geriatrics Into the Subspecialties of Internal Medicine
is a comprehensive project of the American Geriatrics Society aimed
at defining the basic knowledge, attitudes and skills every subspecialist
must possess to care for the older patient appropriately and efficiently.
This project was launched in 1994 with a $1.5 million grant from the
John A. Hartford Foundation and a smaller amount of support from
Merck, Pfizer, and Warner-Lambert pharmaceutical firms. In 1997, the
project received a two-year $1.9 million grant extension from the
Hartford Foundation. In 1999, the AGS received another extension
grant ($2 million) from the Foundation to carry out more Geriatric
Education Retreats (GERs), including an expanded focus outside of
internal medicine with a GER for neurologists and psychiatrists. This
third phase of the project includes collaboration with the Association
of Subspecialty Physicians (ASP) and will have an emphasis on junior
faculty development.
The project is being administered by The Wake Forest University
School of Medicine, with Nancy Woolard as the project coordinator.
William R. Hazzard, M.D. (University of Washington) is the project
director.
The specific aims of this project are to:
• Assist leading subspecialists as they redirect their attention
to the geriatric aspects of their disciplines.
• Identify opportunities for geriatrics-related teaching and
research within the subspecialties of internal medicine.
• Foster leadership roles for, and professional satisfaction
among, the subspecialists who pursue geriatrics-related
teaching and research.
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