Medical Director Education Belongs in a Geriatrics Fellowship Curriculum

Abstract

In this issue of the Journal, Dr Higuchi and colleagues1,2 report on the evaluation strategy for their curriculum in medical direction that was published in an earlier issue of this journal. Higuchi et al1,2 used a framework developed by the American Medical Directors Association (AMDA) on the roles and responsibilities of the medical director to assist learners in developing a systematic approach to problem solving in the nursing home. In this framework, the medical director steps out in 4 directions: (1) provides leadership and guidance to the clinical providers within the facility, (2) guides clinical care within the facility from a process and policy perspective, (3) participates in quality improvement endeavors, and (4) champions education and effective communication. Within this framework, learners are encouraged to operate in a manner that promotes partnership among the professionals who must work together in the nursing home, and encourages the other professionals to view the medical director as a valued consultant and leader who moves care in the direction of person-centered and person-directed care. The content provided in 7 sessions included (1) roles and responsibilities of the medical director, (2) infection control, (3) physician documentation, (4) federal regulations and state surveys, (5) quality improvement, (6) culture change in nursing homes, and (7) transitions in care. Similar curriculum could be easily incorporated into most geriatric fellowship programs. It should not be difficult to find at least one certified medical director among the faculty of each geriatrics fellowship program, given the long-standing requirement that geriatrics fellows receive part of their training in a skilled nursing facility and follow patients longitudinally in this setting throughout their clinical year of training. Although Higuchi and colleagues’ first article1 was outstanding, leading the direction toward well-developed medical director curriculum, the article in this issue2 is even more pivotal because it provides a validated means of learner assessment. I am not concerned that they did not find much change in attitudes on their assessment. I think this has more to do with how the questions were asked than whether attitudes were changed. I suspect these fellows actually came to realize that being a well-trained clinical geriatrician is not enough, specific knowledge and skills are needed that they would not have acquired except for this new curriculum. Also, they clearly began to realize that effective medical directors are