Teaching Geriatrics to Gynecology Residents: Are American Congress of Obstetricians and Gynecologists Learning Objectives Being Met?

Abstract

To the Editor: By 2030, the proportion of Americans aged 65 and older will increase to 20% of the population.1 Training of new geriatricians is not keeping up, with only 6,756 U.S. geriatricians in 2010.2 The likelihood of meeting this demand, given current medical student and primary care resident attitudes toward and choices regarding careers in geriatrics, remains poor.3, 4 A better approach is to train specialists, including gynecologists, in geriatric medicine. Training in geriatrics develops expertise in the biology of aging and management of common conditions and geriatric syndromes, taking into account their effects on health, functioning, and independence. Geriatrics training also helps clinicians understand aging patients’ preferences regarding goals of care to best support quality of life, assure appropriateness of procedures, and decrease nosocomial outcomes and associated expenses. This is especially true in gynecology, with women continuing to live longer and many gynecological problems (e.g., gynecologic cancer, pelvic floor disorders) increasing as women age. Beginning in 1999, the Committee on Resident Education in Obstetrics and Gynecology (CREOG) incorporated geriatrics topics into its core curriculum (Table 1). Topics include health maintenance in older women and surgical and postoperative care.5 The current study was designed to evaluate whether the CREOG objectives have been integrated in residency programs and to identify gaps in knowledge of geriatrics in obstetrics and gynecology (Ob-Gyn) residents. An academic gynecologist and Reynolds Foundation Aging Scholar designed a questionnaire with the goal of assessing resident comfort, knowledge, and adequacy in caring for older adults using CREOG recommended core geriatric topics. Data were collected using an on-line survey of Ob-Gyn second- and fourth-year residents in all U.S. residency programs. Six percent responded, the majority female (87%) and from academic programs (74%). Overall, 77% felt only somewhat knowledgeable about gerogynecology. Fewer than 10% of residents were very comfortable when asked about their level of comfort explaining surgical options, assessing the effect of a surgical intervention on independence, summarizing complications of anesthesia, and assessing decision-making capacity. Sixty percent felt that their gerogynecology training was inadequate. Fourth-year residents were more comfortable with the geriatric topics surveyed than second-year residents. The last 10 years have proven difficult in incorporating geriatrics education into the Ob-Gyn residency curriculum. Most programs have made only minor additions in geriatrics topics. This is consonant with 2001 findings, in which 53% of Ob-Gyn programs did not have a formal geriatrics curriculum and instead “blended” geriatrics education throughout residency.6, 7 Program directors cannot agree on when and how to integrate geriatrics.7 The data show that residents do not believe that they are receiving adequate training in gerogynecology. Most of those surveyed felt only somewhat knowledgeable about important geriatric topics, and few were very comfortable explaining surgical options or assessing capacity. Although fourth-year residents had greater comfort, most felt that they were not receiving an adequate gerogynecology education and did not feel secure in their foundation of geriatric medical education. This is the first study to ask Ob-Gyn residents across national residency programs about their geriatrics training. The survey allowed comparison of residents across levels of training. The response rate was low, at 6%, not unusual for a survey performed in this fashion.8 Many articles have suggested ways to improve geriatrics education for specialists with a few common themes.6, 9, 10 To improve geriatrics education in specialty programs, focused teaching in geriatrics must occur. Ideally, a faculty leader gero-expert should guide each program.9 One way to achieve resident “buy in”10 is to make residents more integral to the care process and clinical decisions,9 focusing on patient function and how to ensure that older adults are in the best health for surgery.6 Residents in all surgical specialties should be knowledgeable about evaluating older adults undergoing surgery and appropriate preoperative examination. Finally, program faculty and residents need to be asked what they need to learn to be more competent in geriatrics. Ob-Gyn has a long way to go before residents begin to feel more confident in their knowledge and practice. Gynecologists need to know how to treat aging women. If we do not respond to this need, there is a risk of compromising medical care to our quickly growing geriatric population. Presented at the 2009 Council on Resident Education in Obstetrics and Gynecology and Association of Professors of Gynecology and Obstetrics Annual Meeting, San Diego, California. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Addis: study concept and design, acquisition of data, interpretation of data, preparation of manuscript. Nuño: analysis and interpretation of data, preparation of manuscript. Mohler: study concept and questionnaire design, preparation of manuscript. Sponsor's Role: None.