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

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8 Preparing All Physicians for the Care of the Aged: Medical Student Education Background The four-year curricula of U.S. medical schools are crowded with traditional content as well as many new and important areas of study, e.g., molecular biology, cost-effective medicine, nutrition, women’s health, end-of-life care, and ambulatory care. Consequently, organized curricula in geriatric medicine have been slow to develop in many medical schools. Both the 1993 IOM and the 1995 BHPr reports on geriatric education documented limited elective and required curricula in medical schools. In the early 1990s fewer than 15 allopathic schools required separate courses in geriatric medicine (BHPr, 1995). Osteopathic schools’ curricula were further ahead; a 1994 survey found that 31% had a required geriatric medicine course (Carlsen, Pfeiffer, Marx et al., 1996). As well as separate courses, topics in geriatric medicine can also be integrated into other subjects and courses. In the early 1990s as many as 85% of allopathic schools provided an average of 20 required hours of geriatric medicine. Elective geriatric medicine courses were common, but seldom chosen by medical students (only 2.9% selected these courses in 1992) (BHPr, 1995:155; Butler, Estrine, Honig et al., 2000). Surveys of geriatric education in 73 allopathic and 16 osteopathic schools were published in 1994 and 1996 respectively (Karuza, Katz, Rosh et al.; Carlsen, Pfeiffer, Marx et al.) (Table 8.1). These studies confirmed that in the mid-1990s many medical schools were still in the early stages of developing geriatric medicine curricula. Osteopathic schools typically developed separate courses; allopathic schools more often integrated geriatric content into existing courses. The AAMC and the Liaison Committee on Medical Education (LCME) conduct annual surveys to collect information on allopathic medical school curricula. Data from these surveys have been used to describe trends in geriatric medicine training in allopathic medical schools into the late 1990s. A July 1998 AAMC report summarized LCME curriculum data (Figure 8.1). Required courses remained rare, but 98% of schools reported some form of required geriatric medicine experience. A September 2000 report summarized recent results of the AAMC’s Medical School Graduation Questionnaire, administered annually to senior medical students. In 1998 and 1999 more than 40% of medical students felt that their medical schools’ geriatric medicine curriculum time was inadequate (Table 8.2). The AACOM also surveys osteopathic medical schools annually regarding their curricula. Analysis of the data for AY 1999-2000 revealed 5,250 osteopathic medical students at 18 of the 19 osteopathic medical schools received training in geriatrics that year (Personal communication, Lorrie S. Van Akkersen, AACOM, February 2002). The 2000 graduating class of osteopathic students (n=2,326) were surveyed regarding geriatric medicine curriculum. There were 1,911 respondents; 77.4% felt time devoted to learning about geriatrics was appropriate, 16.6% felt the time was inadequate, and 6.0% felt the time was excessive. Only seven people (0.4%) expected to work in or seek additional training in geriatrics (Personal communication, Lorrie S. Van Akkeren, AACOM, February 2002). In addition to medical school curricula in geriatric medicine, several foundation-sponsored student summer experiences have been available since the late 1980s. For example, the John A Hartford Foundation has been sponsoring such experiences at the Centers of Excellence (CoE) since 1989. Table 8.1 Teaching of Geriatrics in Osteopathic (1996) 1 and Allopathic (1994) 2 Medical Schools (Percent) Osteopathic Allopathic Medical Medical Approach Schools (n=16) Schools (n=73) Integrate geriatrics into the curriculum 31 77 Set aside time for geriatrics 63 25 Elective geriatrics clerkship 81 84 Required geriatrics clerkship 31 10 No geriatrics clerkship 13 6 Source: 1 Carlsen, Pheiffer, Marx et al., 1996 2 Karuza, Katz, Rush et al., 1994 Current Status of Medical Student Training To encourage student interest in geriatric medicine, the American Geriatrics Society (AGS) sponsors student chapters in medical schools and provides $200 annually to support these chapters. As of May 2002 there were 23 AGS student chapters. There is growing interest in these chapters as 6 new chapters started since November 2001 and three additional medical schools were seeking approval to start a 84
chapter. The goals of these student chapters include: • Encouraging interest in geriatrics among faculty and students in the various disciplines concerned with the care of the elderly. • Encouraging curriculum development in the medical schools to include geriatrics in the general curriculum, as well as in elective course offerings and multidisciplinary programs. • Developing educational programs in geriatrics open to the medical school faculty as well as to local health care professionals. • Promoting educational activities with in community facilities such as nursing homes. The American Medical Student Association (AMSA) is the oldest and largest independent association of physicians-in-training in the U.S. Founded in 1950 to provide medical students the opportunity to participate in organized medicine, AMSA began under the auspices of the American Medical Association. Today AMSA is a student-governed national organization of 30,000 medical students, pre-medical students, interns and residents advocating for the needs of physicians-intraining. AMSA has eight interest groups, including one in geriatrics. Interest Groups (IGs) provide a mechanism for students with similar interests to network. Each interest group has dedicated web pages and a list serv to facilitate communication. Interest groups can contribute to AMSA’s publications and generate project ideas for any of its six action committees. The current geriatrics interest group coordinators are Kathleen Tschantz at the Ohio State University College of Medicine and Tara Sanft, Medical College of Wisconsin. The number of geriatric interest group participants has remained steady at about 150 members for the last three years (Personal communication, David Hamilton, IG coordinator, February 2001). The American Federation for Aging Research (AFAR) currently administers several research enrichment programs for medical students. The AFAR’s Medical Student Geriatric Scholars Program began in 1993, with the first cohort of students selected in 1994. More than 550 students, representing 80 medical schools, have participated in the program. The John A. Hartford Foundation provides additional support to the program, and the Fan Fox and Leslie R. Samuels Foundation provides support for students in the New York Metropolitan area. This program funds medical students for an 8 to 12-week externship in clinical geriatrics and aging research. Students can train at one of four national training centers (Harvard, Johns Hopkins, UCLA, or University of Washington). Furthermore, CoE sites Figure 8.1 Trends in Geriatric Educational Opportunities for Allopathic Medical Students 120 100 80 60 40 20 0 7 10 9 Separate Required Course Source: AAMC, 1998 82 86 95 94 94 98 72 69 61 Part of Required Course Some Form of Requirement Separate Elective Course Part of Elective Course 1985-1986 1990-1991 1996-1997 Other Educational Experience may offer similar experiences to their own medical students. Students receive a $4,000 stipend; off-site students are also reimbursed for their living expenses. The Merck/AFAR Research Scholarships in Geriatric Pharmacology for Medical and Pharmacy Students, started in 1997, funded six students in its first year. This program pays medical or pharmacy doctoral students for mentored 8 to 12-week research experiences. In 2002, up to eight $4,000 stipends will be awarded. Students in this program may conduct their research in any academic setting. The Glenn/AFAR Scholarships for Research in the Biology of Aging began in 1994. This program, open to MD or PhD students, funds three-month mentored research experiences on subjects related to the basic sciences and aging. The program provides a $5,000 stipend, and the research may be conducted in any academic setting. The AGS’s Edward Henderson Student Award is presented yearly to one medical student interested in pursuing a career in geriatrics who has demonstrated excellence in the field. To be eligible for nomination, a student must have demonstrated: a commitment to the field of geriatrics through leadership in areas pertinent to geriatrics; initiation of new information or programs in geriatrics; or scholarship 29 40 37 17 14 Table 8.2 AAMC Medical School Graduation Questionnaire: Medical students responses to "Do you believe that the time devoted to your instruction in Geriatrics was inadequate, appropriate, or excessive" Schools Inadequate (%) Appropriate (%) Excessive (%) n All Schools 1998 44.7 52.5 2.8 13,887 All Schools 1999 43.6 53.9 2.6 12,684 All Schools 2000 38.6 57.5 3.9 14,103 Source: AAMC 2000 Medical School Graduation Questionnaire All Schools Report, 2001 85
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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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4 The Practice Of Geriatric Medicin
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participants. Geriatricians have be
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Table 4.8 Medicaid Recipients and P
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Figure 4.1 Distribution of Certifie
Page 35 and 36: Figure 4.3 Geriatric Caseload for P
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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
Page 51 and 52: Figure 5.6 Physician Faculty Vacanc
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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 and 78: General Internal Medicine The 1999
Page 79 and 80: Trends in GIM Residency Programs Re
Page 81 and 82: Nursing homes and home care experie
Page 83 and 84: Geriatric Education Retreats (GERs)
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Page 91 and 92: Conclusion This report summarizes r
Page 93 and 94: Bureau of Health Professions, HRSA,
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Page 97 and 98: APPENDIX A. Research Focus of Curre
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Page 101 and 102: APPENDIX E. SELECTED GERIATRIC MEDI
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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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