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

This program awarded 20 two-year, $100,000 grants in 2000
and another 20 in 2001 (see Table 5.9 in Chapter 5). The program
requires that each grantee implement a required experience for all
students in each year of training. The majority of these allopathic
medical schools are continuing the trend of integrating experiences
into existing courses, rather than creating a separate geriatric
medicine clerkship.
Each medical school in this program is developing an internal
evaluation plan. In addition, the AAMC has expanded the content of its
Medical School Graduation Questionnaire related to geriatric medicine.
In 2001, 42.3% of graduating medical students (14,164 respondents)
rated the time devoted to training in geriatrics as inadequate. This
compared with student ratings of the time devoted to care of hospitalized
patients (2.1% inadequate), primary care (5.1% inadequate) and
woman’s health (21% inadequate) (AAMC Division of Medical
Education, 2001). Figure 8.2 lists preliminary findings from this first
expanded survey for 2001 graduates. More than 50% of students
reported that they were exposed to expert geriatric care by the
attending faculty. Less than a third of the students reported geriatric
curriculum in all four years of their training. There is a trend toward
medical student participation in the Hartford/AAMC curriculum grant
program to describe a more positive geriatrics experience. The AAMC
is planning annual meetings of grantees and dissemination of the
newly developed curriculum materials.
Reynolds Foundation Initiative
The Donald W. Reynolds Foundation of Las Vegas launched a major
initiative in 2000 to strengthen geriatrics training for medical students,
residents, and practicing physicians. The Foundation issued a request
for proposals to all U.S. academic health centers and independent
residency training programs. The Reynolds Geriatric Training program
funds:
• Initiatives that are highly innovative and promise long-lasting,
value-added impact in institutions that do not yet have strong
medical student and residency training in geriatrics.
• To develop knowledge of fundamental biomedical aspects of
aging, geriatric assessment and care coordination, and to
train physicians to optimally manage the clinical conditions
and special problems of the frail elderly.
In the spring of 2001, after reviewing 64 applications, the
Foundation awarded ten four-year grants of $2 million each (see Table
5.9 in Chapter 5). If the progress of these initial grants is satisfactory,
the Foundation expects to issue additional calls for proposals in 2002
and 2004 and to award up to 20 new grants, totaling $40 million.
These grants will support a broad range of training activities, as
illustrated by the diversity of successful grant applications. The
University of Rochester will integrate aging as a prominent theme in
its new “double helix” curriculum that combines clinical and scientific
training throughout all four years of training. The University of
Michigan will require medical students and residents to prepare a
“Geriatrics Portfolio” that documents their required geriatric training
experiences. Virginia Commonwealth University will use a web site,
“Geriatric Quick Consult”, to offer practical advice on common
problems to students and community physicians. The University of
Iowa will develop a “geriatric virtual hospital,” offering web-based
teaching modules to students and practicing physicians covering ten
common geriatric syndromes. It will also prepare digitized lectures
on 40 core geriatric topics. Yale University will integrate into the
education of all medical trainees a model of care that reflects the
complex nature of the needs of the aging population and is scientifically
informed, culturally and ethically appropriate. Yale plans to develop
a case-based curriculum with multiple levels of complexity that will
integrate these concepts into medical education from the basic
sciences to continuing medical education for practicing physicians.
(See http://www.dwreynolds.org for a description of each project.)
Implications
Faculty implementing new geriatrics curricula in medical schools
confront challenges similar to those facing residency program directors:
the curriculum is crowded, there are numerous demands for new
topic area time, and traditional course content is not easily phased out
to make room for new material. A review of the new Hartford/AAMC
and Reynolds project proposals confirms several trends in medical
student education.
First, medical schools are integrating new geriatrics content into
existing courses and clerkships rather than developing new standalone
courses. The advantage of this approach is that it does not
require carving out new blocks of calendar time or displacing existing
courses. Integration also promises to create greater changes in
perspective throughout the medical school curriculum, adding
sensitivity to aging topics in many basic science courses and clinical
clerkships. Stand-alone courses have the advantage of focusing the
students’ attention on aging and allow faculty to structure a coherent
geriatric medicine experience.
Second, medical school educators have embraced technology.
Self-instructional computer-based exercises, simulated patients, and
on-line lectures and course syllabi are being widely developed and
utilized. Geriatricians are taking a lead in developing creative new
teaching materials. To review and disseminate these new electronic
products, both the AAMC and the Reynolds Foundation plan to develop
curriculum resource centers. The Association of Directors of Geriatric
Academic Programs (ADGAP) is developing a Geriatric Education
Coordinating Center (GECC) that would review and disseminate
educational strategies and materials for use in undergraduate,
postgraduate, and practicing physician education. The Reynolds
Foundation is funding this Center and the Director is Rosanne Leipzig,
MD. The goals for the proposed GECC are to:
1. Facilitate interaction among the Reynolds Foundation grantees
and others engaged in similar activities that encourages sharing
of curriculum materials, successes, and lessons learned;
2. Provide a forum for presentation of materials and teaching
methods developed by Reynolds Foundation grantees and others;
3. Provide a centralized mechanism for disseminating curriculum
materials, lessons learned, successes, overall program impact to
all geriatric medicine training programs and other interested
organizations;
4. Provide “one stop shopping” for a wide range of geriatrics
training materials that are currently available; and
5. Create a mechanism for providing feedback to curriculum
developers.
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