Geriatrics Recruitment Resources

at the University of Pennsylvania School of Medicine

Program Overview

The evidence for racial and ethnic disparities in health status and health care within the U.S. is overwhelming. Excess deaths, morbidity, and disability are prevalent among racial and ethnic minority elders. While socioeconomic factors are the most powerful determinant of health care and health status in the U.S., racial and ethnic disparities are independent risk factors as well.

Cross-cultural issues are a significant factor in minority health care. Culture profoundly influences the presentation of symptoms by patients, physicians’ diagnostic and treatment decisions, and patients’ receptivity to recommendations. Education in these issues is therefore an important aspect of physician training.

New models of conducting research are also needed. Although traditional medical education emphasizes individual factors in health, patients are in fact embedded within a system comprised of various interpersonal, socio-cultural, institutional, and community-level structures (the social ecological model). A public health model of research places more emphasis on: diversity in samples; use of treatment that involves mixed (rather than “pure”) modalities; assessing outcomes of importance to stakeholders; and collaboration with members of the community (individuals, organizations, and policymakers).

The Knowledge and Skills in Cultural Competence and Minority Health Issues program is intended for geriatrics fellows as well as fellows from other disciplines. The program goals are to:

• prepare fellows in geriatrics and other disciplines to provide high quality care to older persons of all ethnic groups
• ensure that course participants understand the principles of community participatory research.

Program Operations

The program consists of two parts, one focused on community health, the other on community research. Seven or eight fellows from medicine, psychiatry, and oral medicine participate. The five community health sessions each last from one-and-a-half to three hours.

• The first session is a guided van ride through the surrounding local community, designed to provide a historical background and positive view of its assets and strengths. Three stops at community sites (a multipurpose senior center, an assisted living facility, and a federally qualified health clinic) allow direct interaction with program sponsors.
• The second session is an introduction to the concepts of culture.
• Sessions three, four, and five use videos, panels, and vignettes to discuss language, health literacy, spirituality, and alternative medicine.

Training in community participatory research comprises two sessions:

• an overview lecture with reading materials
• attendance at four conferences on subjects such as identifying research topics, interpreting data, and disseminating research information. Academicians and community members attend the conferences.

  Staffing Requirements

  The following personnel are needed:

  • Geriatrics faculty director
  • Part-time course coordinator
  • Community guide to narrate the van tour
  • Volunteers from each of the community groups who meet with fellows at each of the sites visited.

  Program Costs and Funding Sources

  Faculty director and course coordinator receive 5% FTE salary support. Compensation for community guide/narrator is $200. Other community participants donate their time.

  Funds derive from program project research grants focused on community health and health disparities.

  Process and Outcomes Data

  Seven to eight fellows have attended all sessions over the past four years and have given high ratings to all sessions. Fellows complete evaluations after each quarter and at the end of the year. One new fellow each year has elected to undertake a research project on a minority health topic.

  Implementation Lessons

  • As a target audience, fellows are highly receptive to cross-cultural education—in contrast to medical students, who are more sensitive about the perception that doctors could be biased in any manner.
  • The interactive sessions are better received than lectures; the community tour is particularly enjoyed by the course participants.
  • Long-standing contacts and trust between one faculty member and several community organizations facilitate the community participation in the sessions.

  Available Materials

  Tools/Resources

  • Introduction to Ethnogeriatrics survey
  • List of Cross-Cultural References

  For More Information

  Jerry C. Johnson, MD
  Chief of the Division of Geriatric Medicine
  University of Pennsylvania
  Ralston-Penn Center
  Room 208
  3615 Chestnut Street
  Philadelphia, PA 19104-2676
  (215) 662-4413
  jcjohnso@med.upenn.edu