Training In Geriatric Medicine Research Articles

Application, knowledge and training needs regarding comprehensive geriatric assessment among geriatric practitioners in healthcare institutions: a cross-sectional study

BackgroundThis study aimed to investigate the actual application, knowledge, and training needs of comprehensive geriatric assessment (CGA) among geriatric practitioners in China.MethodsA total of 225 geriatric practitioners attending the geriatric medicine or geriatric nursing training were recruited for this cross-sectional study. The questionnaire included demographics, healthcare institution characteristics, the actual application, knowledge, training needs, and barriers to CGA and geriatric syndromes (GS).ResultsPhysicians and nurses were 57.3% and 42.7%, respectively. 71.1% were female, with a median age was 35 years. Almost two-thirds (140/225) of geriatric practitioners reported exposure to CGA in their clinical practice. The top five CGA evaluation items currently used were malnutrition risk (49.8%), fall risk (49.8%), activity of daily living (48.0%), pain (44.4%), and cognitive function (42.7%). Median knowledge scores for the management procedures of GS ranged from 2 to 6. Physicians identified medical insurance payment issues (29.5%) and a lack of systematic specialist knowledge and technology (21.7%) as the two biggest barriers to practicing geriatrics. Nurses cited a lack of systematic specialist knowledge and technology (52.1%) as the primary barrier. In addition, physicians and nurses exhibited significant differences in their knowledge of CGA-specific evaluation items and management procedures for GS (all P < 0.05). However, there were no significant differences in their training needs, except for polypharmacy.ConclusionsThe rate of CGA application at the individual level, as well as the overall knowledge among geriatric practitioners, was not adequate. Geriatric education and continuous training should be tailored to address the specific roles of physicians and nurses, as well as the practical knowledge reserves, barriers, and training needs they face.

1826 Development of inter-professional simulation-based education in geriatric medicine

Abstract Background Understanding human factors involved in patient care is a focus of the Geriatric Medicine Training curriculum including the leadership of and communication within an interprofessional team. Geriatric Medicine Specialty Trainees (ST4+) need advanced communication skills and confidence in managing complex situations. Simulation-enhanced Interprofessional Education (Sim-IPE) provides insight into other disciplines roles (1). We hypothesised that the implementation of a Sim-IPE programme dedicated to communication skills could improve confidence. Method We organised a one-day Sim-IPE programme for our Geriatric Medicine ST4+. Faculty consisted of doctors, advanced nurse practitioner, social worker, occupational therapist, physiotherapist and speech and language therapist. Communication scenarios, with faculty as simulated participants, were undertaken including establishing a ceiling of treatment, management of delirium, breaking bad news, ethical feeding dilemmas, complex discharge planning and capacity assessment. Debrief discussions followed each scenario. Mixed-method evaluation was used with questionnaires collected from learners’ pre and post session in a 10-point Likert scale to compare confidence levels. Qualitative feedback was collected from learners and faculty. Results Ten Geriatric Medicine ST4+ attended plus nine faculty including two facilitators. Positive feedback was received from learners and faculty. There was improvement in confidence across all six scenarios (one being “not at all confident” and ten “extremely confident”). Pre-session average confidence was 7.2, post-session 8.7. All trainees would recommend the programme to a colleague. Common learning themes included gaining feedback from debrief discussions and shared learning from our allied-health professionals. Learners and faculty commented on the enjoyment, usefulness and value of learning within a safe team environment. Conclusion Sim-IPE can improve confidence in complex communication scenarios and human factor skills. Feedback highlighted that this programme would be useful for all General Internal Medicine Specialty Trainees.

110 Identification of Urinary Incontinence through Comprehensive Geriatric Assessment among an integrated care programme of older persons population

Abstract Background Urinary incontinence (UI) is an under-reported and treatable condition, associated with reduced quality of life. The Integrated Care programme of Older Persons (ICPOP) supports people with complex care needs in their home. There is no available research on the rate of UI among the ICPOP population. This study aimed to assess UI in this group. Methods A convenience sample of 100 patient records selected randomly from an ICPOP serving approximately 30,000 people from 2017 to present were retrospectively reviewed; including patients charts, Comprehensive Geriatric Assessments (CGAs) and outpatient letters. As part of the CGA each person was assessed for UI on domiciliary visit. Irish geriatric medicine trainees were surveyed to assess their self-reported confidence assessing and treating UI. Results Of the 100 patients CGAs reviewed, 62% were female. 11% had UI reported on their referral to ICPOP. 56% reported UI during their CGA. Only 18% of those with UI had UI generated on to their problem list. Of those patients with UI, polypharmacy (≥5 medications) was noted in 89%. 77% of those with UI were on a medication associated with worsening UI, while only 18% of those with UI were on a treating medication for UI. 25% had their UI assessed at clinic, including 7% who were referred onwards to urology for management of their UI. 80% of geriatric medicine trainees said that they did not feel confident managing UI and 100% said they would like to receive further teaching on UI. Conclusion CGA is an excellent method for identifying UI. This data suggests that UI is more prevalent among the ICPOP as compared with an inpatient population and the general population in the same age group. Further specialist teaching is needed to improve trainee confidence in this area.

276 Development of inter-professional simulation-based education in geriatric medicine

Abstract Background Understanding human factors involved in patient care is a focus of the Geriatric Medicine Training curriculum including the leadership of and communication required within an interprofessional team. Geriatric Medicine Specialty Trainees (ST4+) need advanced communication skills and confidence in managing complex situations. Simulation-enhanced Interprofessional Education (Sim-IPE) provides insight into other disciplines roles. We hypothesised that the implementation of a Sim-IPE programme dedicated to communication skills could improve confidence. Methods We organised a one-day Sim-IPE programme for our Geriatric Medicine ST4+. Faculty consisted of doctors, advanced nurse practitioner, social worker, occupational therapist, physiotherapist and speech and language therapist. Communication scenarios, with faculty as simulated participants, were undertaken including establishing a ceiling of treatment, management of delirium, breaking bad news, ethical feeding dilemmas, complex discharge planning and capacity assessment. Debrief discussions followed each scenario. Mixed-method evaluation was used with questionnaires collected from learners’ pre and post session in a 10-point Likert scale to compare confidence levels. Qualitative feedback was collected from learners and faculty. Results Ten Geriatric Medicine ST4+ attended plus nine faculty including two facilitators. Positive feedback was received from learners and faculty. There was improvement in confidence across all six scenarios (one being ‘not at all confident’ and ten ‘extremely confident’). Pre-session average confidence was 7.2, post-session 8.7. All trainees would recommend the programme to a colleague. Common learning themes included gaining feedback from debrief discussions and shared learning from our allied-health professionals. Learners and faculty commented on the enjoyment, usefulness and value of learning within a safe team environment. Conclusion Sim-IPE can improve confidence in complex communication scenarios and human factor skills. Feedback highlighted that this programme would be useful for all General Internal Medicine Specialty Trainees.

Knowledge about Alzheimer’s disease among physicians: A cross-sectional study from Anand, Gujarat

ABSTRACT Objectives: There are limited studies from India on knowledge about Alzheimer’s disease (AD) among physicians. Hence, this study was done to identify the knowledge and perceptions about AD among medical practitioners. Methodology: Anonymous cross-sectional survey was conducted among medical practitioners having at least MBBS degree. The study questionnaire included (a) demography and (b) AD Knowledge Scale (ADKS). Results: Among the 184 respondents, knowledge about AD was below par, scoring mean of 18.8 (standard deviation: 3.28) out of 30. On the subdomains of the ADKS scale, mean correct rate was highest in the subdomain of assessment (75.8%) and low in subdomains of risk factors (53.2%), symptoms (56.4%), and caregiving (52.9%). Despite 79 (42.9%) having dementia-related clinical encounters in the past 3 months, 171 (92.9%) participants had no training in geriatric medicine. Conclusions: There is a significant lack of knowledge about AD among the study population. However, the knowledge is higher among those who have had dementia- related clinical encounters.

Screening the Older for Abuse

Many countries are developing instruments to help prevent and recognize violence against the older. In the area of older abuse and its consequences, different screening methods have been developed and adapted to the country in which they are applied. Professionals are often not trained to detect signs of abuse, much less screen for the same, and therefore need continuous training in geriatrics and geriatric medicine. In order to draw attention to the older in the near future, specific measures should be prescribed not only within the framework of current legal regulations and bylaws, but also through guidelines, guides and other professional documents (soft-law), to be taken by state bodies, non-governmental organizations and other actors, for the purpose of screening violence, prevention of violence against the older, treatment of the older who have been subjected to violence and measures against its perpetrators, including forensics in cases of violence against the older. Instruments for organized screening for violence should be introduced in all sectors, but especially in the health and social care sectors, because primary health care and social work centers, in fact, are the gateway to the health and social system and make initial contact with service users, including the older.

Healthcare for older people in Africa.

Africa, the poorest and youngest populated region in the world, is set to see a rapid increase in the number of older persons in the coming three decades. While the expected increase in the prevalence of non-communicable diseases is already evident, sparse data exist on the geriatric syndromes. Healthcare systems vary considerably between the countries, with universal healthcare available in only a handful. Public healthcare is generally underfunded, overburdened and unprepared for the care of older persons and private care unaffordable. Training in Geriatric Medicine is limited to a small number of facilities in a few countries. Despite the African Union Policy Framework and Plan of Action on Ageing, there has been very little progress on the implementation of age-sensitive policies. There is an urgent need to improve care of older persons in the region.

Engagement in research during specialist geriatric medicine training: results of a national trainee survey

Meaningful ageing research across the UK is dependent on a network of engaged geriatricians. The research in geriatric specialty training (RGST) survey aimed to establish current research opportunities available to geriatric medicine specialty trainees in the UK. The RGST survey was disseminated to UK higher specialist trainees in geriatric medicine in 2019 via the Geriatric Medicine Research Collaborative network. Among the 36.9% (192/521) of respondents, 44% (83/188) reported previous research involvement and 7% (n=8) held a PhD or MD. Of the respondents with no research experience to date, 59.0% (n=49) reported a desire to undertake a period of research. One-third (31%) of geriatric registrars surveyed felt that they had gained sufficient research experience during their training. Perceived encouragement and support to undertake research was low (30.7%). Enablers and barriers to research engagement were identified. Research opportunity and engagement in geriatric medicine training is lacking. This could jeopardise the future workforce of research-active geriatricians in the UK and limit patient access to emerging research and innovation. Interventions to promote research engagement among geriatric medicine trainees are needed to facilitate integration of research into routine clinical practice to improve the health and care of older people.

137 VIRTUAL CONSULTATIONS IN GERIATRIC MEDICINE OUTPATIENT DEPARTMENTS; THE PERSPECTIVE OF GERIATRIC MEDICINE SPECIALIST TRAINEES

Abstract Background Covid-19 social distancing measures restricted access to outpatient services. “Virtual Clinics”(VCs) were introduced in Outpatients Departments (OPDs) to continue service provision. OPD experience is vital to geriatric medicine training. The geriatric medicine Higher Specialist Training (HST) curriculum requires annual OPD participation. This study sought to identify the impact of VCs on geriatric medicine training. Methods An online mixed-method questionnaire was developed and circulated among geriatric medicine specialist trainees. 20 closed-questions collected demographic information and considered opinion of VCs. 5 open-questions enabled respondents to expand views of VCs. Closed-questions responses underwent quantitative descriptive analysis. Open-question responses underwent qualitative thematic analysis. Results Response rate was 61.4%. 86.3% reported VCs were conducted via telephone calls. 58% didn't feel comfortable conducting VCs. 64.7% didn't feel VCs positively contributed to training. 90.2% stated Face-To-Face (FTF) clinics offer greater training opportunities. 74.51% stated they were less likely to discuss VCs with consultants(compared to FTF clinics). 98.04% hadn't received training in conducting VCs. Qualitative analysis revealed four main themes: (1) Patient Selection: certain patient cohorts are unsuitable for VCs. VCs are useful in relaying simple results; not for patients with complex needs; (2) Practical Considerations: there must be access to required technologies for patients and medical staff. Medicolegal concerns were raised by several respondents; (3) Patient Care: the inability to examine patients is a challenge which impacts patient care. The lack of non-verbal cues impeded communication; (4) Training Impact: Respondents felt VCs weren't beneficial to training. There was a sense that training opportunities had been missed. Conclusion This study found high rates of dissatisfaction with VCs among geriatric trainees. This may be due to: (1) Inadequate training/preparation; (2) Inappropriate patient selection or (3) Lack of video-conferencing technologies. There is a sense that VCs have negatively impacted geriatric medicine training. Current policy advocates for the continuation of VCs. If VCs continue, additional resources may be needed to address any accompanying training deficit.

92 THE RISE OF SIMULATION BASED TRAINING IN GERIATRIC MEDICINE?

Abstract Background Simulation-based training (SBT) offers opportunities for teaching and learning in safe spaces, while learners navigate the acquisition of these complex skills, and work in clinically-realistic teams, supported by faculty. Geriatric medicine is a diverse speciality, requiring trainees to navigate complex social, medical, and ethical issues, necessitating a multifaceted and interdisciplinary approach. Studies describing SBT in geriatric medicine are limited. Methods We hosted an in-situ competition designed to encourage participation in simulation and to develop a simulation faculty network across a hospital group. All healthcare professionals in the hospital group were eligible to enter. Contestants designed a simulation case scenario within a speciality of their choice. Entrants participated in five virtual workshops on core elements of SBT. Six cases were selected to participate in the virtual final. The finalists submitted a video summarising the performance of and evaluation of the learners’ experience of the scenario. Results Thirty-four teams submitted initial SBT proposals and participated in the five virtual SBT workshops over a three-week period. Of these,17.6% (n = 6) were geriatric medicine teams, comprising seven geriatric medicine consultants, four advanced nurse practitioners and 13 non-consultant hospital doctors (five registrars, six senior house officers and two interns). Case scenarios submitted by geriatric medicine teams included acute stroke care, diagnosis and management of delirium, management of perioperative delirium post hip fracture and capacity assessment. Conclusion The level of interest in SBT generated amongst geriatric medicine faculty and trainees suggests this may be a useful tool to enhance the training experience. SBT offers geriatric medicine trainees the opportunity to practice the technical and non-technical skills required to navigate complex, interdisciplinary and challenging patient scenarios, in a protected environment. In this innovation, we identified a range of geriatric medicine-related topics for which SBT was deemed to be valuable by both faculty and trainees and could be facilitated through in-situ simulation settings.

HIV and Aging: Overcoming Challenges in Existing HIV Guidelines to Provide Patient-Centered Care for Older People with HIV.

With advances in antiretroviral therapy and subsequent increase in life expectancy, People with HIV (PWH) now experience multiple geriatric syndromes in the setting of advanced aging and increased multimorbidity. HIV clinicians bear the responsibility of delivering geriatric care to this vulnerable population, despite limited geriatric medicine training and limited support from HIV service networks that were not traditionally designed to care for an aging population. Although HIV clinicians reported formal guidelines specific to older PWH to be among the most helpful interventions, current HIV guidelines present multiple issues in their applicability to the care of older PWH, including multifactorial nature of conditions in older adults, difficulty measuring patient-centered outcomes, lack of representation of older PWH in clinical trials, limited guidelines addressing geriatric syndromes, and the use of chronological age as criteria for inclusion despite advanced aging in PWH. Understanding that updated guidelines addressing above challenges may take many years to develop, we offer strategies on the application of current guidelines, including using baseline attributes, time to benefit, and the Geriatrics 5M model to aid in shared decision making and improve outcomes among older PWH.

'Everyone's nice, but …': A qualitative exploration of trainees' experiences of postgraduate geriatric medicine training in Australia.

To understand the experiences of trainees who undertake geriatric medicine advanced training in Australia. In this qualitative study, data were collected through semi-structured interviews with geriatric medicine advanced trainees. Data were analysed using a thematic analysis approach and data collection ceased when thematic saturation was achieved. Thirteen trainees participated. Trainees enjoyed the training program, supported each other and felt prepared for independent practice as a geriatrician. However, they noted the variability of supervision and feedback practices, and educational opportunities afforded to them across different clinical learning environments. They felt unable to give feedback on their training. The research project and concerns about employment after training were also substantial sources of stress. While geriatric medicine advanced trainees reported positively on much of their training, areas for improvement could include improved training for supervisors, improved support for research projects and more robust mechanisms for providing feedback.

The Status of Potentially Inappropriate Medication Prescription by General Physicians for The Elderly in Tabriz (Iran) According to Beers Criteria

Objectives: Prescribing medication for the elderly is an important health issue. This study aimed to investigate the status of Potentially Inappropriate Medications (PIMs) prescription for the elderly by general physicians in Tabriz, Iran. Methods &amp; Materials: This descriptive cross-sectional study was conducted in 2019 on the prescriptions of general physicians for the elderly in Tabriz, Iran. After initial screening of 16842 prescriptions belonged to two insurance systems (social security insurance and health insurance), 1500 prescriptions were selected. The Beers criteria 2019 was used to assess PIM prescription status and their alternatives were suggested if needed. Data were expressed as Mean±Standard Deviation (SD) and No. (%), and analyzed in SPSS v. 21 software. The Mann-Whitney U test was used to examine the differences in the study factors between the prescriptions related to two insurance systems. The relationship between patients’ age and PIM prescription was examined using Spearman correlation test. Results: The Mean±SD number of drugs in each prescription was 3.93±1.5 and the Mean±SD number of prescribed PIMs was 0.74±0.8. Polypharmacy was observed in 32.6% of the prescriptions, and 53.9% had at least one PIM. Non-steroidal anti-inflammatory drugs, antihistamines and benzodiazepines were the most PIM groups (45.6, 10.9 and 10.6%, respectively). The most common prescribed PIMs were Adult cold, Diclofenac, Glibenclamide, Ketorolac and Diphenhydramine. Number of PIMs in each prescription did were not statistically different between the prescriptions related to two insurance systems (P=0.343). Moreover, patients’ age and gender had no significant relationship with PIM prescription (P=0.312 and P=0.660, respectively). Conclusion: About 54% of the prescriptions issued by general physicians for the elderly in Tabriz contain PIMs, and polypharmacy is present in about one third of the prescriptions. In order to improve this condition, it is necessary to hold appropriate training and continuous retraining courses in geriatric medicine for general physicians. Supervisions by the Iranian Ministry of Health and Iranian Medical Council can also play an important role in improving the current situation.

483 IMPROVING THE PROVISION OF REGIONAL GERIATRIC MEDICINE TEACHING DURING THE COVID-19 PANDEMIC

IntroductionIn Wessex Deanery, prior to the COVID-19 pandemic, Geriatric Medicine trainees from 10 NHS trusts attended face-to-face regional teaching sessions. In response to the pandemic, this teaching was suspended to reduce disruption in service provision and support social distancing. There was a clear need to reintroduce teaching for continued professional development and trainee progression.MethodsIn July 2020, Geriatric Medicine trainees in Wessex completed a questionnaire survey to identify their desire for socially distanced teaching and an acceptable format for delivery. Two half-day pilot teaching sessions via MS Teams were organised in September and October 2020. Trainees provided feedback via a questionnaire survey about the relevance and quality of teaching, and to identify any barriers to attendance. Subsequently, a monthly full-day virtual teaching programme was implemented. We reported reflections of our experiences on our trainee website to support future sessions.ResultsAll trainees (n = 15) were eager for regional teaching to recommence through socially distanced education. Trainees had a preference for MS Teams, which can support interactive teaching. Attendance to the pilot sessions exceeded previous face-to-face sessions. 19 trainees attended the first session; 17 provided feedback. 28 trainees attended the second session; 12 provided feedback. Feedback was overwhelmingly positive; all reported the sessions were interesting and 82% (n = 14) that they would lead to changes in their practice. Some trainees expressed that full-day sessions would enhance curriculum coverage. 94% (n = 16) were positive of the virtual platform; it reduced travel and sessions could be recorded. Local trainees attended the second session in-person, which enhanced interactivity.ConclusionVirtual teaching has been successful in Wessex Deanery, with high attendance and positive feedback. Trainees can engage remotely without the need for travel and disruption. After the pandemic we hope to develop a regional teaching programme integrating virtual and face-to-face sessions to improve attendance and accessibility.

Delirium and Inflammation in Older Adults Hospitalized for COVID-19: A Cohort Study.

PurposeThe occurrence and predictors of delirium in older adults hospitalized for coronavirus disease 2019 (COVID-19) have not been well described. Highlighting the association with inflammatory markers may be useful for identifying delirium. This study aimed to determine the prevalence and incidence of delirium and explore its association with the C-reactive protein (CRP).Patients and MethodsThis cohort study of adults aged 65 and older with a COVID-19 diagnosis took place at an academic healthcare institution between April and May 2020. COVID-19 was diagnosed by positive nasopharyngeal swab. Serum levels of CRP were collected as a marker of systemic inflammation. The primary outcome was the prevalence and incidence of delirium. Delirium was diagnosed primarily during a patient's stay in hospital based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). To ensure that no delirium diagnosis was missed during hospital stay, clinical records were reviewed by clinicians with geriatric medicine training for retrospective diagnoses.ResultsA total of 127 patients aged 65 and older were hospitalized with a diagnosis of COVID-19. The median age was 82 years (IQR: 74–88), with 54 (43%) females. Overall, delirium was present in 62 (49%) patients: manifestations of delirium were present on the first day of hospitalization in 53 of these cases (86%), while 9 cases (14%) developed delirium during hospitalization. After controlling for age and sex, the mean CRP value over the first 3 days since arrival was associated with a higher risk of delirium (OR 1.35; 95% CI: 1.01–1.85) for every 50 mg/L increase.ConclusionIn this cohort of older adults hospitalized for COVID-19, delirium was highly prevalent. An early increase in CRP levels should raise suspicion about the occurrence of delirium and could improve its diagnosis.

Scaling Geriatric and Telemedicine Care for Older Adults in Rural Areas Through Clinical Strategies and Training

Telemedicine, the use of electronic information and communication technologies to deliver care, has grown substantially over the past few years, potentially benefiting older adults who have difficulty accessing and traveling to care locations. Given that providers and interprofessional staff with training in geriatric medicine often practice in urban rather than rural areas, older adults’ access to quality geriatric care is limited. Prior experiences with telemedicine adoption for geriatric team consultation, though limited in scope, were well accepted by older adults and demonstrated benefits such as identifying and meeting care needs for older adults. Bringing geriatric team care to large regions across the country requires further consideration of population needs, local contexts and training and enhancement of an interprofessional workforce to deliver geriatric care through telemedicine. The Veteran healthcare system has been a pioneer in telemedicine care and considers the use of telemedicine necessary for all providers in its system. This symposium aims to discuss approaches to identify and target older adults who may benefit from geriatric consultation, how care delivery is scaled through identifying common approaches and local adaptations, what the important elements are for providers and teams to deliver care effectively for the older adult population, especially those with multiple complex chronic conditions and functional limitations, and considerations for training the next generation of providers to provide care for older adults with complex conditions, particularly in rural areas with limited access.

Recommendations for a national Coronavirus disease 2019 response guideline for the care of older persons in Nigeria during and post-pandemic: A family physician's perspective.

The older persons in our society are a special group of people in need of additional measures of care and protection. They have medical, financial, emotional and social needs. The novel Coronavirus disease 2019 (COVID-19) only exacerbates those needs. COVID-19 is a new disease, and there is limited information regarding the disease. Based on currently available information, older persons and people of any age who have serious underlying medical conditions may be at higher risk of severe illness from COVID-19. Family physicians provide care for individuals across their lifespan. Because geriatricians are internists or family physicians with post-residency training in geriatric medicine, they are major stakeholders in geriatric care. The authors are concerned about the absence of a COVID-19 response guideline/special advisory targeting the vulnerable population of older adults. The management and response to COVID-19 will be implemented in part based on the local context of available resources. Nigeria has been described as a resource-constrained nation. Infection prevention in older persons in Nigeria will far outweigh the possibilities of treatment given limited resources. The aim was to recommend actionable strategies to prevent COVID-19-related morbidity or mortality among older persons in Nigeria and to promote their overall well-being during and after the pandemic. These recommendations cut across the geriatric medicine domains of physical health, mental health, functioning ability and socio-environmental situation.

Why choose geriatric medicine? A national survey among French postgraduate medical students.

Since 2017, geriatric medicine has been available as a postgraduate specialty to French year 7 medical students. We investigated the incentives of the 171 French medical students who opted for geriatric medicine as a postgraduate specialty subsequent to year 6 national qualifying examinations in 2017. A prospective quantitative survey-based study was conducted by means of a questionnaire compiled online and sent by email between December 2017 and May 2018. The questionnaire comprised 43 questions, including 14 single or multiple choice questions, 28 scaled questions evaluating factors of influence using a 5-point Likert scale, and one open-ended contingency question. Of the 171 students, 139 responses were received. The national response rate to this questionnaire was 81.2%. One hundred fourteen students (82.6%) had previous experience of training in geriatric medicine, which for 95 (84.0%) students took place between years 3 and 6 of medical training. This training influenced the choice of 102 respondents (90.2%). Factors reported as having exerted a strong or very strong influence were in particular the rewards of working with older adults; positive personal encounters with older adults in the past; the appeal of interprofessional teamwork; the challenge of cases involving complex diagnostic and therapeutic decisions; the challenge of patients with chronic conditions. The present study is the first to focus on the reasons why French students choose to specialise in geriatric medicine. The results emphasise the importance of training programs in geriatric medicine to promote enthusiasm for this specialty.

Medical students perspectives and consideration of geriatrics for future practice. An exploratory study of a public medical school in Ghana

ABSTRACT Ghana has one of the fastest growing aging populations in sub-Sahara Africa, but little is known about the geriatric workforce. A sample of 12 medical students in one Ghanaian public university participated in an exploratory qualitative study to share their perspectives on specialty choices in Ghana, interest in working with older patients, and their consideration of geriatrics for future practice. The findings revealed limited knowledge of geriatrics as well as low interest in its selection as a specialty for future practice. These were attributable to multi-faceted factors, including the lack of both exposure to geriatric medicine and geriatrics-focused training for students in this institution. It is critical that geriatric education be prioritized and incorporated in medical schools to nurture students’ interest and future consideration of the specialty. This will help bolster the number of geriatric-oriented physicians and secure specialized care for the aging population.

Geriatric Emergency Medicine Fellowships: Current State of Specialized Training for Emergency Physicians in Optimizing Care for Older Adults.

Improving emergency department (ED) care for older adults is a critical issue in emergency medicine. Institutions throughout the United States and Canada have recognized the growing need for a workforce of emergency physician (EP) leaders focused on clinical innovation, education, and research and have developed specialized fellowship training in geriatric emergency medicine (GEM). We describe here the overview, structure, and curricula of these fellowships as well as successes and challenges they have encountered. Seven GEM fellowships are active in the United States and Canada, with five offering postresidency training only, one offering fellowship training during residency only, and one offering both. The backbone of the curriculum for all fellowships is the achievement of core competencies in various aspects of GEM, and each includes clinical rotations, teaching, and a research project. Evaluation strategies and feedback have allowed for significant curricular changes as well as customization of the fellowship experience for individual fellows. Key successes include an improved collaborative relationship with geriatrics faculty that has led to additional initiatives and projects and former fellows already becoming regional and national leaders in GEM. The most critical challenges have been ensuring adequate funding and recruiting new fellows each year who are interested in this clinical area. We believe that interest in GEM fellowships will grow and that opportunities exist to combine GEM fellowship training with a focus in research, administration, or health policy to create unique new types of highly impactful specialized training. Future research may include exploring former fellows' postfellowship experiences, careers, accomplishments, and contributions to GEM to better understand the impact of GEM fellowships.