Geriatric Fellowship Programs Research Articles

The Current State of Geriatric Medicine: A National Survey of Fellowship‐Trained Geriatricians, 1990 to 1998

The rapid growth of the older population has focused national attention on the need for physicians trained in geriatric medicine. To gain insight into the evolving status of the field, with particular focus on career decision-making and academic career development of trainees, we conducted a survey of physicians recently completing geriatric fellowships. The 107 accredited extant geriatric fellowship programs in the United States and Puerto Rico were contacted to identify trainees from 1990 to 1998. A mailed survey addressed relevant career development and training issues. Four hundred ninety out of 787 (62%) physicians responded; 20% completed 1 year and 80% 2 or more years of training. Half made the decision to pursue a career in geriatrics during residency, 27% decided before/during medical school, and a mentor influenced 48%. Currently, 80% have a Certificate of Added Qualifications in geriatric medicine, 69% hold academic appointments, 78% teach, 39% participate in research, and 44% author publications. Most are doing predominantly clinical work in multiple settings. Further analysis of the 1996-to-1998 cohort revealed that those completing fellowships of 2 or more years are more likely to identify all geriatrics as their professional focus, conduct and author research, work with multidisciplinary teams, and participate in professional geriatric societies. This national survey documents career decision-making and the academic and clinical profiles of physicians completing geriatric fellowship training in the past decade. Longer fellowship training is associated with academic career development. Although there is a national need to train clinical geriatricians, the additional need to train and fund future geriatric academic leaders requires increased attention.

Ethics Corner: Cases from the Hebrew Rehabilitation Center for Aged

This article begins a new six-part series in the Journal of the American Medical Directors Association devoted to medical ethics. Each issue, a case will be presented from the Ethics committee at the Hebrew Rehabilitation Center for Aged (HRCA) in Boston, Massachusetts. Following a description of the case and a discussion of the ethical issues that the case raises, Dr. Steven Levenson will discuss the implications for medical directors. Founded in 1905 as the Jewish Ladies Home for Aged, HRCA is now a 725-bed long-term care facility in Boston, Massachusetts. There is a 20-bed skilled nursing unit, with permanent residents occupying the remaining beds. The main campus also houses an outpatient clinic and adult day health program. The mean age of the inpatient population is 89 years old and the average length of stay for a permanent resident is 4 years. Medical care is provided by a closed medical staff. The HRCA is a major teaching site for the Harvard Geriatrics Fellowship Program and is home to the Research and Training Institute, whose members conduct clinical and social science research. The 12-member ethics committee is composed of representatives from psychiatry, geriatric medicine, social services, nursing, hospital administration, dietary, and the therapies (eg, physical therapy, occupational therapy, recreation, creative arts). There is also a community representative. Training and experience of ethics committee members varies from member to member, and members are encouraged to read the medical ethics literature and attend relevant educational programs. Consult requests are referred to the ethics committee chairperson, who assigns the consult to two committee members. Any staff member at HRCA may request an ethics consult to address an ethical dilemma in the care of a resident. The ethics committee consultants’ findings are discussed with the requesting party, and a report is placed in the resident’s medical record. The ethics committee meets monthly, at which time the month’s consults are discussed. A journal article is distributed at each meeting for discussion the following month. Other activities of the ethics committee have included participation in staff education programs, quality assurance initiatives in areas such as documentation of advance directives, and development of institutional policies relating to areas such as the withdrawal and withholding of treatment.

CURRICULAR STRATEGIES FOR GERIATRICS EDUCATION IN A MEDICAL SCHOOL

Geriatrics education at the University of Valle Medical School uses many teaching strategies in undergraduate and postgraduate programs. These include improving communication with older patients, accepting one's own aging, teaching human values, providing experiences with well elderly, and participating in an interdisciplinary team. There are common curricular areas in geriatrics for health care disciplines which include medicine, dentistry, nursing, speech therapy, physiotherapy, and occupational therapy. However, each discipline also has specific curricular components. There is a curricular program for family medicine and internal medicine residents. A curriculum design was approved for a new geriatrics fellowship program which is in development. Finally, the progression of the curriculum is according to the learning needs of each level of education among medical students, residents and fellows.

Revisiting the one-year geriatric fellowship option: a preliminary assessment.

To ascertain early opinions of geriatric fellowship program directors regarding the 1-year clinical training option. A brief mail survey of the 100 program directors listed in Graduate Medical Education, 1998-1999. Answers (favorable (+), no effect (0), or negative (-)) to questions regarding the effect on the training program, position of the director, and geriatrics as a discipline. This preliminary assessment produced decidedly mixed results. Seventy-six program directors responded (76% response rate). The clearest positive effect on the program itself was on the quantity of applicants (63% +, 4% -) but less so on their quality (33% +, 15% -). The clearest negative impact was on research aspects of the fellowship (0% +, 67%-). Other effects on the program were either null (clinical aspects and faculty morale) or moderately negative (educational, administrative, and financial aspects and the position of the program director), with few effects on the geriatrics division as a whole. Overall, the 1-year option was felt to have adversely affected geriatrics as a respected professional field (11% +, 41% -). Nevertheless, the majority (61%) answered that introduction of the 1-year option was wise. Although not attributed to this training pathway, program directors overwhelmingly perceived (75 % +) that geriatrics has enjoyed enhanced strength and attractiveness as a discipline since introduction of the 1-year option in 1992. The 1-year geriatric fellowship option has, at best, proved a mixed blessing to program directors. However, optimism regarding the future would seem to justify continuing to offer this option because of several observations and trends: (1) the increase in quantity and also perhaps quality of applicants; (2) growth in numbers of fellows and higher percentage program fill rates; (3) success of both 1- and two-year fellows in passing the Certificate of Added Qualifications examination and consequent increased generation of certified fellowship-trained geriatricians; (4) strong sentiment that geriatrics is gaining strength and attractiveness; and (5) that introduction of the 1-year option was wise.

Geriatric Training in Adult Psychiatry Residency Training Programs

The authors surveyed all Accreditation Council for Graduate Medical Education-accredited psychiatry residency training programs in the United States to determine 1) the type and amount of geriatric training provided, and 2) differences in the programs that door do not offer geriatric training for residents. Substantial geriatric training was offered in 50.7% of all programs. Compared with the programs without geriatric training, these programs were more likely to be in a Psychiatry Department, with a Division of Geriatric Psychiatry and/or a geriatric fellowship program. These data suggest that current geriatric training in many psychiatry residency programs is inadequate to prepare residents for treating elderly patients and to encourage residents to pursue careers in geriatric psychiatry.

Cultural Diversity Training in a Multidisciplinary Geriatrics Fellowship Program

For health-care educators the challenge of incorporating geriatric and gerontologic content into already overloaded curricula is compounded by the need to also include cultural and ethnic diversity as they relate to health care. A multidisciplinary geriatric fellowship program suggets one approach to achieving both goals: teaching geriatrics and diversity concurrently. Multidisciplinary education, in which faculty and trainees from several disciplines participate in clinical and didactic activities, provides a natural conduit for conveying the richness and complexity of ethnicity and culture as they impact on health-seeking behaviors and health-care delivery. This article describes a three-year multidisciplinary fellowship program that incorporated ethnic and cultural content into geriatric clinical education and training, and includes recommendations to faculty.

Fellowship training in geriatrics

Geriatric medicine fellowships have begun to earn a berth in most department of medicine across the country. After 1994, initial certification of Added Qualification in Geriatric Medicine (AQGM) will require a period of geriatrics fellowship training. The requirements for accreditation of fellowship programs have been carefully developed and reflect emerging trends in graduate medical education. Nevertheless, recruitment into geriatrics fellowship programs has fallen far short of that in many other internal medicine fellowship programs. The lack of adequate reimbursement for the time and the evaluation and management skills needed to care for frail elderly patients prevents geriatrics from being an attractive career. On the other hand, several factors suggest a brighter future: the satisfaction of graduates of geriatrics fellowship programs, the increasing demand for clinical services for the elderly, and the wide open opportunities for research in this field.

MAXIMIZING RESOURCES IN GERIATRIC EDUCATION THROUGH COOPERATION: THE METROPOLITAN AREA GERIATRICS SOCIETY EXPERIENCE

The role of the New York Metropolitan Area Geriatrics Society (MAGS), an affiliate of the American Geriatrics Society, in supporting educational activities in the 11 academic geriatric medicine fellowship programs in the metropolitan area is described. A 1991 survey of each program's educational resources revealed a striking disparity in the self‐perceived quality of the various program components at each site and a unanimous interest in sharing and complementing existing activities. Whereas all programs were positive about the strength of their conferences and grand rounds and the interest of their teaching faculty, they were generally concerned about their home care component; clinical research; and, most of all, the time availability of their teaching faculty. Through MAGS, a number of activities have been developed to help support the fellowship programs. Opportunity for intersite exchange of geriatric fellows is being actively pursued. This cooperative effort may be a model for similar activity in ot...

Psychologists in geriatric medicine: Results of a national survey.

Physician directors of geriatric medicine fellowship programs (N=51) were surveyed on their current and desired involvement with psychologists, perceived areas of expertise of psychologists, comparisons of psychologists with overlapping health care professions, and factors limiting involvement of psychologists in geriatric medicine. Results indicate that psychologists are quite involved in most geriatric medicine training programs and that directors of these programs welcome their greater involvement. Significantly, psychologists and psychiatrists are rated as similar in expertise in most areas of clinical practice.

Creating Immediate Medical Leadership in Geriatrics

To the Editor.— The growth of the elderly population in the United States necessitates rapid development of a sizable physician group trained to lead programs and provide patient care in medical schools, hospitals, nursing homes, and the community. The early manpower projections 1,2 predicted a need for approximately 7500 to 10 000 geriatricians. More recent estimates have raised this projection to 20 000.3 In addition, most of today's 500 000 practicing physicians need improved training to deal more effectively with the new demography of elderly persons. It is clear that due to the small number of physicians entering geriatric fellowship programs (100 to 150 per year), this route will make only a modest contribution to fulfilling the predicted needs of the American society for geriatricians. In the past 3 years, an examination, cosponsored by The American Boards of Internal Medicine and Family Practice has been taken by 6000 physicians for

The Need for a Community Health Component in Geriatric Fellowship Programs

Post-residency geriatric fellowship training programs are being instituted in qualified university and community teaching hospitals across America. The ever-expanding needs of our elderly population demands trained and skilled medical personnel. Current curricular guidelines and traditional practices in institutions with similar programs may produce only "academically-career oriented" physician graduates. Such individuals may not elect to leave "academia" and practice in mainstream, non-urban America. While legitimate needs exist for future faculty, the greater need is for geriatricians in-practice. How do we enhance not only graduates' willingness to leave academia but also to expand their skills and competencies to effectively impact on whole regions? This article addresses such issues.

Clinical funding for geriatric fellowship programs.

The Medicare program provides the largest single source of funding for the clinical portion of housestaff training programs. Despite the fact that the clinical training in geriatric fellowship programs focuses heavily on the care of Medicare recipients, the proportion of funds supporting geriatric fellowships that is derived from Medicare is actually smaller than that of most other fellowship programs. Legislation passed by Congress in 1986, and just recently implemented, creates an opportunity to increase Medicare funding for geriatrics. Those concerned with geriatric fellowship training must have a clear understanding of how Medicare funding for graduate medical education will occur under the new legislation if the opportunity is to be used effectively. Finally, other barriers created by general pressures on housestaff budgets that may interfere with capitalizing on the opportunity are discussed.

Geriatrics

During the last year, two events occurred that more clearly delineated the position of geriatrics in American medicine. First, a certifying examination signifying special competence in geriatric medicine was offered under the joint sponsorship of the American Board of Internal Medicine and the American Academy of Family Physicians. The American Board of Internal Medicine provides these statistics: more than 4000 physicians took the examination and 56% of those taking it passed. Second, the Accreditation Council for Graduate Medical Education accepted applications for certification of geriatric medicine fellowships in internal medicine, and the training programs are now receiving notification of their accreditation status. Thus, the certificate of special competence in geriatrics and the accreditation of geriatric fellowship programs in internal medicine more clearly define the specialty of geriatrics and provide standards to measure training programs and their physician products. Since the appearance of Rubenstein's landmark study of a geriatric evaluation unit

Geriatric medicine in the United States. The current activities of former trainees.

To improve the health care received by frail older persons, an effort has been made in the United States to increase the number of physicians trained in geriatric medicine and geropsychiatry. The goal of training has been to create leaders in education, research, and patient care. To assess the progress of this effort, we surveyed physicians (284 in geriatric medicine and 91 in geropsychiatry) who graduated from U.S. geriatrics fellowship programs. Responses were obtained from 224 medicine (79% response) and 59 psychiatry fellows (65% response). Sixty-five percent of former geriatric medicine fellows report spending 10% or less time on teaching; 44% report doing no research, and 44% report spending more than half their time in patient care. Compared to other primary care specialties, the geriatricians reported caring for larger proportions of older patients and spending more time per patient visit. However, their role in teaching, research, and long-term care is minimal.

A compendium of objectives for geriatric dentistry

A two-phase survey was conducted with 82 persons identified as having special knowledge in geriatric dentistry. In Phase 1, they were asked to list competencies required of the geriatric dentist. In Phase 2, they were asked to rate the relative importance of 150 competencies for five different educational settings: dental school, general practice residency, prosthodontic specialty program, geriatric fellowship program, and continuing education. The resulting compendium of objectives suggests that geriatric dentistry should become integrated into general dentistry, with relatively few competencies reserved for specialists.

Critical skills assessment for the treatment of geriatric patients: Geriatric Dentistry

SummaryThis paper reports the results of a needs assessment survey conducted to identify education objectives for the dentist geriatric fellowship program initiated by the Veterans Administration in 1982. A cascading sample design was used to identify 82 persons recognized as experts in geriatric dentistry. Each was asked to list five knowledge, skill, and attitudinal objectives considered most crucial for comptence of the geriatric dentist. The 30 major critical competencies cited and their relative frequencies are presented as a kind of definition of the competent geriatric dentist and a guide to planning and evaluation of geriatric dentistry programs

Geriatrics Residency and Fellowship Programs

<h3>To the Editor.—</h3> Prior to 1970, there were only occasional geriatrics courses offered in medical schools and relatively little interest in the practice of geriatric medicine.¹In 1972, this country's first formal geriatrics residency program was initiated at the Mount Sinai City Hospital Center in New York.²Impressive progress has been made in instituting residencies and fellowships in geriatric medicine during the past 12 years. Biennially since 1980, the American Geriatrics Society, in cooperation with the Boston University Gerontology Center, has surveyed the medical schools in the United States and Canada to compile the data for the<i>Directory of Geriatrics Programs for Residencies and Fellowships</i>. A summary of the contents of the three editions of the<i>Directory</i>(April 1980, April 1982, and January 1984) demonstrates the progress that has been made in establishing programs (Table 1). Actual geriatrics fellowship programs in the United States numbered 44 in 1982

Veterans Administration —: DENTIST GERIATRIC FELLOWSHIP PROGRAM*

GerodontologyVolume 3, Issue 3 p. 205-207 Veterans Administration —: DENTIST GERIATRIC FELLOWSHIP PROGRAM* First published: October 1984 https://doi.org/10.1111/j.1741-2358.1984.tb00421.x * A reprint of a brochure prepared by the Veterans Administration, Department of Medicine & Surgery, Office of Academic Affairs, Washington, DC 2042U. U.S.A. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume3, Issue3October 1984Pages 205-207 RelatedInformation

Studies in geriatric education: II. educational materials and programs.

There has recently been an increase in educational programs and materials in geriatrics, but their quality and content have not been adequately assessed. This study concerns important objectives and core contents in geriatric education, with a review of training programs, books, and audiovisual materials. Specific areas of need for printed and audiovisual materials are identified. Medical student and graduate level programs were found to address relatively few objectives. Geriatric fellowship programs, although having more extensive coverage, had some notable deficiencies. This information may be of use to those conducting training programs or preparing educational material in geriatrics.