University of Cincinnati College of Medicine.

Abstract

Curriculum Management and Governance Structure Administrative governance originates from the dean through the associate dean for medical education to the curriculum committee and to its Task Force on Geriatric Medical Education. The faculty of the University of Cincinnati (UC) Office of Geriatrics Medicine (OGM) has overall administrative responsibility for the development, implementation, and evaluation of all elements of the gerontology and geriatric medicine curriculum content throughout all four years. With oversight from the associate dean for medical education and the curriculum committee, this faculty makes up the Task Force on Geriatric Medical Education. The OGM is a freestanding entity of the UC Health Sciences Center, created in 1980 by a mandate from the State of Ohio legislature that all Ohio medical schools are required to maintain a geriatrics medicine office. The OGM director reports to the dean. Course directors and others from each department in the College of Medicine (both the preclinical and clinical years) were recruited as advocates to work with their faculties to enhance existing, and add new, curricular content in gerontology and geriatrics medicine. THE AAMC/HARTFORD GERIATRICS CURRICULUM PROGRAM Institutional Involvement in Curricular Change During 2001, when the Hartford/AAMC grant was initiated, overall curricular changes were being planned, especially for the preclinical years. Although these plans did not directly affect the efforts of the Geriatrics Medicine Task Force, they did create an environment that was receptive to the goals and objectives of the geriatrics program. Theme for the Geriatrics Program We did not develop a theme in the traditional sense for our geriatrics program. Rather, we chose to build a foundation in geriatrics by integrating enhanced and new programs throughout all four years of the curriculum. Learning Outcomes for the Geriatrics Curriculum The overall project goal was to develop a longitudinal undergraduate medical curriculum in gerontology and geriatrics medicine, to give our medical students a defined set of attitudes, knowledge, and skills that would help them provide competent, compassionate care for older people. To that end, we established an effective curriculum implementation structure (including a task force and planning committee and the appointment of course advocates) to support the successful development and integration of new geriatrics/gerontology content into the medical school curriculum, organized and implemented specific new required content into each of the four years of the medical school curriculum, and conducted an internal evaluation of our medical students to determine the extent to which the specific competencies are achieved and to participate in the AAMC-organized evaluation. The outcomes are summarized in Table 1. Also highlighted are experiences with older adults, community partnerships, standardized patients, student interest groups, palliative care, and end-of-life care.TABLE 1: OutcomesResulting Pedagogical Changes The use of older well adults as teachers during the medical school orientation week and the use of standardized patients during the third-year family medicine clerkship are new teaching techniques that have been effective. Application of Computer Technology All gerontology and geriatrics content for lectures, clerkships, internships, and selectives have been placed on Blackboard, the e-learning site for UC students. Students’ Clinical Experiences in Geriatrics In addition to the required experiences (see Table 1), two electives in Years II and IV are available to the students: The Year II elective is a longitudinal experience. Students elect to participate in a monthly clinical experience with one of our geriatricians and in a monthly discussion group on gerontological and geriatrics medicine topics. An average of five students per year participates in this Year II elective. The Year IV elective is a four-week rotation. Students have a minimum of 20 hours of clinical time, weekly, with several different geriatricians at various clinical sites, such as the geriatrics evaluation center, nursing homes, medical day care, and inpatient medical/inpatient psychiatric services. Students also spend approximately 20 hours per week observing and participating in community-based services such as senior centers, home-delivered meals, adult protective care, in-home services, and day care. An average of seven students per year elect this rotation. The Program’s Assessment and Evaluation Instruments During the grant period, a range of data was collected on students from the first, third, and fourth years of the medical curriculum. These data were collected primarily to assess the baseline knowledge and attitudes of medical students throughout the curriculum. Two standardized instruments, the Facts on Aging Quiz (Palmore EB. Facts on Aging Quiz, 2nd ed. New York: Springer, 1998) and the UCLA Geriatrics Curriculum Survey tool (Reuben DB, Lee M, Davis JW, et al. Development and validation of a geriatrics attitudes scale for primary care residents. J Am Geriatr Soc. 1998;46:1425–30), were administered during the first year of the grant. These tools were also used in the second year, along with a new, self-assessment tool, Application of Geriatric Principles (see Table 2), which was developed to assess some of the practice behaviors of our clinical students during their fourth year.TABLE 2: Application of Geriatrics Principles: Self-Assessment ToolRequirements to Sustain the Program The program is being sustained with the same high level of cooperation that was demonstrated throughout the two years of project funding. The dean of medical education and the curriculum committee remain committed to infusing gerontology and geriatrics medicine content into the curriculum. Most importantly, the presence of the geriatrics medicine office in the College of Medicine is a valuable asset as a catalyst for curriculum development and as a collaborator with all departments. Resources Required Many hours of in-kind services were dedicated by faculty members, as well as the associate dean for medical education, to developing the geriatrics medicine component of the curriculum. These services included advocacy, curriculum development, teaching, and evaluation. There were no financial incentives offered, nor was there any additional financial support for the faculty. Unanticipated Outcomes Because of the level of competition from other specialty areas for time in the curriculum, the unprecedented advocacy and cooperation from the faculty was a most welcome but unexpected outcome. Impact of External Funding Funding from the John A. Hartford Foundation/AAMC grant minimized the need to compete for the dwindling funds available from the dean for new initiatives in the curriculum. As previously mentioned, because of OGM, the dean, associate dean for medical education, and the curriculum committee recognized that a structure was in place to maintain and build our curriculum in gerontology and geriatrics medicine. A subtle but important impact was the increased status that gerontology and the geriatrics medicine curriculum achieved by receiving a Hartford/AAMC grant. Finally, the Hartford/AAMC project built momentum for our successful application to the Donald W. Reynolds Foundation to expand our work in geriatrics medicine curriculum development. For further information, contact Elizabeth Gothelf, MA, at 〈[email protected]〉.