Geriatrics Recruitment Resources

Environmental Challenges
Programmatic Challenges
Common Themes

Environmental Challenges
Fewer physicians are being recruited into academic medicine in general and geriatrics in particular. The 2008 Institute of Medicine report, Retooling for an Aging America: Building the HealthCare Workforce, leaves no doubt about this challenge: "As of 2007, there were 7,128 physicians certified in geriatric medicine and 1,596 certified in geriatric psychiatry. According to one estimate, by 2030 these numbers will have increased by less than 10 percent; others predict a net loss of these physicians because of a decreased interest in geriatric fellowships and the decreasing number of physicians who choose to recertify in geriatrics. According to the Alliance for Aging Research, by 2030 the United States will need about 36,000 geriatricians."

Contributing factors are many. Low physician reimbursement by Medicare (on average 8 percent less than managed care reimbursement), and the additional time needed to provide care for frail elderly patients have resulted in low salaries and other factors that discourage physicians-in-training from pursuing careers in geriatric medicine.

For those hardy individuals who make it through to academic geriatrics, challenges related to variable funding streams from the National Institutes of Health (NIH) and other federal, local, and private sources mean that CoE directors must piece together funding for geriatrics fellowships and other activities from a variety of sources.

Programmatic Challenges
Leaders of CoEs are challenged to build the capacity of junior faculty to become the teachers and researchers of tomorrow, to address the shortage of senior faculty, and increasingly, to expand geriatrics expertise beyond academic geriatrics programs. As champions of geriatrics training and research, program directors are looking closely at how they can optimize resources and embed sound management practices. Many are working to develop internal marketing strategies, and some have increasingly explored fundraising strategies for local support and beyond.

Common Themes
A few common themes, or key points, emerged from interviews with CoE directors around the country:

CoEs are innovative. Leaders have incorporated a range of novel approaches that successfully address challenges related to expanding academic geriatrics programs, managing training and research activities, and training subspecialties physicians in geriatrics.

Leadership and management skills are not taught in medical school. Most CoE directors have had to learn management skills and business-oriented strategies primarily on the job. Many of those interviewed credited leadership training received after completing their medical training for strengthening their management skills and stimulating them to think in new ways. That additional training, advice from peers, plus experience, have taught them to think strategically, a critical component of smart growth for their programs.

Geriatrics is Collaborative. In order to address the complexities of caring for older patients, clinical geriatrics is by necessity collaborative and multidisciplinary. Academic geriatrics is also collaboratively oriented with regard to aging-related research and expanding geriatrics training into other subspecialties and disciplines. Long before the NIH formally recognized a new roadmap for collaboration and cross-specialty and cross-disciplinary engagement, geriatrics “got it.” Leaders interviewed in this report include some who have found ways to simultaneously strengthen geriatrics and build bridges with other disciplines to expand resources and develop new approaches.

The personal connection is powerful. CoE directors frequently emphasized the importance of the mentoring they received as they were forging their careers, the support and role modeling they received for building their programs via on-site consultations with senior leaders, and their own satisfaction in mentoring others. Many advocated for broader programs for mentoring and consultation. For programs to thrive, leaders stressed building strong relationships with senior management, including keeping deans and other administrators up-to-date about successes and goals, but also asking how geriatrics could be helpful to them and the institution.

Build a diversified portfolio. CoEs are expanding the number and type of funding sources to ensure longer-term stability and growth.

With CoEs, one size does not fit all. In terms of the management strategies described in this report, not all "best practices" are easily transferable from one setting to another. This is due to differences in the programmatic focus; maturity of the program; size and interests of faculty; sources, kinds, and depth of resources for geriatrics; and a variety of institutional characteristics. Nevertheless, it is hoped that the views and information shared here can stimulate discussions and opportunities.

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

at Emory University/University of Alabama at Birmingham Southeast Center of Excellence in Geriatric Medicine

Program Overview

Emory University and the University of Alabama at Birmingham (UAB) Schools of Medicine, which comprise the joint Southeast Center of Excellence in Geriatric Medicine, collaborate to provide a program of financial support and mentoring for the advanced training of senior fellows and junior faculty physician-scholars preparing for careers in geriatric medicine as clinician-researchers or clinician-educators.

The joint Center of Excellence (CoE) was developed to capitalize on the institutions’ geographic proximity, mutual areas of research expertise, and other synergies that enhance the capabilities of both institutions to serve the educational and research needs of future academic geriatricians. The joint CoE seeks to foster interdisciplinary and interinstitutional research programs that offer trainees access to a broader range of mentoring, training, and research opportunities than each institution could provide individually.

The goals of the joint program are to:

• provide salary support that gives scholars protected time for research or for clinician- educator training
• provide rigorous training in grant writing, research, and advanced level clinical education
• provide mentoring, oversight, and evaluation of a pilot research project for the duration of the grant project (and beyond, if requested).

The CoE provides funding for the following activities:

• Training Support Grants— one year of salary support of up to $50,000 plus benefits for senior geriatric medicine fellows (PGY 5 and 6) and physician junior faculty, to ensure at least 50% protected time for scholars to obtain research training or to obtain advanced level training in clinical education.
• Pilot Project Grants—up to $20,000 for scholars to conduct one-year pilot research projects that will yield preliminary data for scientific presentations, publications, and subsequent major grant proposals. Educational or quality improvement projects may be proposed by trainees pursuing careers as clinician- educators.
• Combination Grant Program—applicants for Training Support Grants may incorporate a pilot project into their application. Salary support for the trainee must be within the limits specified for Training Support Grants (50% FTE or $50,000 plus benefits). The Pilot Project Grant limit of $20,000 applies to the pilot project portion of the combination application. Expenses in this case are defined as everything except the trainee’s salary and benefits.

Program Operations

Potential applicants are recruited through university-wide funding announcements, fellowship recruitment, and ongoing promotion at the joint CoE quarterly research seminars held alternately at UAB and Emory. A research advisor is provided at each site to assist the applicant with formulating the research questions and developing a proposal utilizing a standardized format and process. Applicants are encouraged to utilize potential mentors at both sites during this initial process, to provide a greater range of perspectives and mentoring Up to four new scholars are accepted each year. Scholars with meritorious projects may be granted additional funding after the initial one-year period.

Applicants can request up to 50% of protected time by submitting a letter from their program director that provides assurance of protected time.

All proposals are reviewed by at least two selected reviewers from the alternate university and all members of the Joint CoE Steering Committee. Reviewer feedback is provided in a letter to each applicant and revised proposals are encouraged.

Once the research proposal is accepted, a joint mentoring committee is established for each scholar. Mentors are generally senior academic geriatricians or other faculty with a strong interest in aging who can provide professional development guidance. Each scholar selects a senior faculty member from Emory or UAB to serve as their primary mentor.

Quarterly progress reports to the Joint CoE Steering Committee are required of all scholars. Scholars are also expected to attend the joint CoE Quarterly Research Seminars and associated training (didactic and discussion groups) and social activities (joint scholar/mentor dinners prior to each quarterly session). The informal social interactions with senior faculty and potential mentors from both universities at the quarterly joint sessions provide a supportive environment for potential and current clinical fellows and scholars.

Staffing Requirements

The following personnel are needed:

• A Program Director and six faculty from Emory and UAB who sit on the Joint Steering Committee
• Partially funded (10-15% effort) Research Advisors
• Business Administrators at each site
• Curriculum/Evaluation Coordinators at each site

Program Costs and Funding Sources

The program is funded through the Hartford CoE grant, with matching funds from Emory and UAB. Estimated per year costs for the next cycle are: scholars’ salary support and Pilot Projects: $300,000–350,000; fellows recruitment: $35,000; leadership and mentors: $100,000; administration: $32,000; travel, conferences, etc.: $83,000.

Process and Outcomes Data

As of September 2008, the joint CoE has provided research opportunities and mentoring to over 65 geriatric medicine fellows and funding for 27 junior faculty scholars. To date, 20 of the junior faculty scholars are currently practicing in an academic setting and at least eight of these have developed their academic careers in geriatrics research.

Success is measured by career development, publications, presentations, intramural and extramural grants, and other related achievements of the Joint CoE scholars and other participants.

Implementation Lessons

• The joint CoE discovered within the first two years of operation that a research advisor was needed to assist in the initial proposal development process for both potential clinician-educators and clinician-researchers. Partially supported (10% effort) research advisors for each site were recruited from within the faculty of each university. The advisors continue to provide oversight to the ongoing research process as part of the Joint CoE Steering Committee.
• The continued support and mentorship from all joint CoE faculty and mentors are imperative at the earliest points in a fellow’s or junior faculty member’s research and/or clinical educator development.
• A collaborative program between two universities can improve the quality of the training through effective planning, partnering, and frequent communication. The joint CoE stays in touch daily by e-mail, meets monthly by conference calls, and meets quarterly for joint training sessions at the Quarterly Research Seminars.

Available Materials

Tools/Resources

• Overview of Joint CoE Training Programs, including details on the programs and application process

Tools/Resources

• Joint CoE Homepage, which features an overview of the grant program, including proposal development process, review criteria and research areas www.aging.uab.edu/SubChannel/Training/scegm.aspx

For More Information

Carol Reis-Starr, PhD
Associate Director for Curriculum and Evaluation
Southeast CoE in Geriatric Medicine
Division of Geriatric Medicine and Gerontology
Emory University
1841 Clifton Rd #530
Atlanta, GA 30329
(404) 728-6570
creisst@emory.edu

or

Peter Bosworth, MBA
Associate Director for Administration
Southeast CoE in Geriatric Medicine
Division of Gerontology, Geriatrics, and Palliative Care
University of Alabama at Birmingham
201CH 19
Birmingham, AL 35294-2041
(205) 934-9261
PBosworth@aging.uab.edu

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at the University of California, San Francisco School of Medicine

Program Overview

A mandatory day-long retreat is held off-campus for all first-year fellows in the medical subspecialties, including geriatrics. The retreat fills an important void by addressing professional needs and training requirements common to all first-year subspecialty fellows. It also helps promote collegiality and cross-divisional collaboration. This serves to raise awareness about geriatrics among all medicine subspecialty fellows.

This annual retreat is intended to create a forum that bridges specialties and familiarizes fellows in the Department of Medicine with topics necessary for recruitment into academic careers that are not specialty-specific. These include:

• understanding the academic pathways and criteria for promotion
• obtaining research funding and salary support
• providing effective subspecialty consultations
• working collaboratively across divisions

Program Operations

The retreat begins with an icebreaker activity. A variety of educational methods, including large- and small-group discussions and lectures, are used to address the core topics. The Chair of the Department of Medicine leads a discussion about the structure, funding, and promotion process of academic medicine departments. Breakout groups led by senior faculty from a variety of disciplines focus on strategies for funding and how to become successful clinician-educators, basic science researchers, and clinical researchers.

Staffing Requirements

The following personnel are needed:

• Chair of the Department of Medicine (one hour)
• Director of Graduate Medical Education in the Department of Medicine (for retreat logistics planning)
• Six to eight senior faculty (one hour each)
• Minimal administrative support staff time

Program Costs and Funding Sources

Faculty and administrative time, meeting space, handouts, and food, totaling approximately $500. Most costs are indirect. Funded by the Department of Medicine.

Process and Outcomes Data

As of 2002, 90 fellows have participated in the retreat and have rated the retreat with good to excellent scores on evaluations. The retreat continues to be refined based on the feedback received each year.

Implementation Lessons

• Arrangements must be made with program directors well in advance because it is difficult to free fellows from clinical work.
• It helps to begin the retreat in the middle of the day so that fellows can complete necessary work before going off campus.

Available Materials

Publication

• A Retreat for First-Year Medicine Fellows.
  Johnston, B, Fenton, C, Jain, S
  Academic Medicine, 2002

For More Information

Bree Johnston, MD, MPH
University of California at San Francisco
4150 Clement Street
San Francisco, CA 94121
(415) 221-4810, x3983
bree.johnston@ucsf.edu

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at the University of Rochester Medical Center

Program Overview

The University of Rochester Division of Geriatrics and Aging, in collaboration with the University of Rochester Warner Graduate School of Education and Human Development, conducts a year-long academic career development course that focuses on achieving excellence in teaching and career development. This course is designed to prepare fellows as the next generation of academic clinician-teacher-scholar geriatrics leaders.

The program is an innovative addition to current geriatrics fellowship training and enhances the development of all fellows as clinician-teacher-scholars while providing additional opportunities to integrate and assess the Accreditation Council for Graduate Medical Education (ACGME) core competencies.

Participants gain:

• the prerequisite knowledge and experience to successfully develop, implement, and evaluate various educational materials that target interdisciplinary trainees
• the teaching and leadership skills necessary to succeed as clinician-educators and leaders in academic geriatrics.

Program Operations

The academic career development course is offered to fellows in geriatric medicine, dentistry, psychiatry, and other subspecialties at the University of Rochester. The year-long course meets twice a month for one hour and includes reading assignments, class participation and presentations, and product development.

12 University of Rochester faculty with expertise in each topic area participate in the course on an annual basis. They are not given any monetary or financial incentive to participate.

Several faculty members teach more than one session. The course director is also a University of Rochester faculty member who attends each class and teaches 30% of the classes. Classes consist of small-group didactic sessions typically beginning with a PowerPoint presentation, followed by an interactive feedback/discussion session. Some classes are case-based and all
involve active participation and presentation/discussion.

The curriculum focuses on three areas:
The Clinician: Fellows are encouraged to identify a clinical niche and to use that niche throughout the year as an educational and research focus. The practicum experiences include ethnicity/diversity training (ethnogeriatrics) as well as training to improve communication with patients and families. This supplements the experiences of the traditional one-year clinical geriatrics fellowship.
The Teacher: Fellows gain experience in classroom teaching, podium presentations, poster sessions, small group facilitation, giving effective feedback, clinical reasoning, exam-question writing, and lay-audience teaching. To coordinate these teaching experiences with their clinical niche, each fellow chooses one geriatric syndrome or topic to focus on throughout the year. At the conclusion of the year, each fellow has a portfolio of developed educational materials (posters, lectures, cases) to share with the entire group.
The Scholar: Fellows gain experience in writing abstracts, giving poster presentations, academic curriculum vitae development, mentoring strategies, peer assessment and professional competence, preparing publishable articles, and literature reviews.

Staffing Requirements

12 University of Rochester faculty with expertise in each topic area participate in the course on an annual basis. They are not given any monetary or financial incentive to participate. Several faculty members teach more than one session.
There is one course director, who is provided 5-10% time for the course.

Administrative support involves helping to develop the schedule of faculty participants, photocopying course materials, and sending e-mails to faculty and course participants.

Program Costs and Funding Sources

The costs involved are faculty time and photocopying of teaching materials.

Funding for the course is currently provided by a Health Resources and Service Administration’s Bureau of Health Professions grant to train physicians, dentists, and behavioral health professionals.

Process and Outcomes Data

Fellows complete mid-year and end-of-year evaluations that assess their overall satisfaction with the course, the usefulness and impact of the course, and the efficacy of the teaching methods provided with respect to their future careers. The mean individual session Likert score was 4.0, with a range of 3.5-4.6. 100% of the fellows responded positively to several open-ended questions, including “How do you think this course will impact your future career?” Additionally, the majority of fellows choose to pursue academic careers upon completion of their fellowship.

Fellows’ career paths are also monitored and tracked by intermittent mail and e-mail surveys for five years to determine intermediate and long-term outcomes of scholarly activity: professional activities, teaching venues, academic development, publications, and promotion. There is no current data available from this fellowship to compare career choice prior to and after the implementation of the Academic Career Development Course.

The new classes and materials created by the fellows have substantially increased the number of scholarly products within the curriculum. For example, fellows submitted abstracts for poster presentations to the American Geriatrics Society, the American Dental Association, and the American Association for Geriatric Psychiatry. In collaboration with the nursing education department at Monroe Community Hospital, a core lecture series for certified nursing assistants was developed. The reviews from the series participants were extremely positive, with recent expansion of the series to include presentations at other local university-affiliated nursing homes.

All of the scholarly products were new additions to the fellowship curriculum, not required of former traditional geriatric medicine or interdisciplinary geriatric fellows in prior years of training. Fellows received both verbal and written feedback on their scholarly products, including their grand rounds and lay presentations, their mock poster sessions, and pre- and post-test evaluations of the communication sessions.

This course resonates well with the May 2006 Fellowship Position Paper from the American Geriatrics Society and the Association of Directors of Geriatric Academic Programs. Several options for further leadership training and projects were suggested as a result of it, as was a proposed education curriculum for additional years of fellowship training.

Implementation Lessons

• This program has been extremely well received among participants. The challenge has been to recruit other subspecialty fellows to participate in it, in addition to the geriatrics fellows.
• Additionally, this course has provided an avenue to teach and evaluate the ACGME core competencies which are critical to a successful fellowship training experience.

Available Materials

Tools/Resources

• Course topics for 2007-08
• Course projects for 2007-08

Publication

• Academic Career Development in Fellowship Training
  Medina-Walpole, A, Fonzi, J, Katz, PR
  Journal of the American Geriatrics Society
  2007;55(12):2061-7

For More Information

Annette Medina-Walpole, MD
Associate Professor of Medicine
University of Rochester Medical Center
Medical Director, The Living Center
The Highlands at Pittsford
500 Hahnemann Trail
Pittsford, NY 14534
585-389-0988, x262 (voicemail)
585-383-9074 (fax)
annette_medinawalpole@urmc.rochester.edu

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at the University of Pittsburgh School of Medicine

Program Overview

This activity provides a structure for fellows and junior faculty who are pursuing academic geriatrics research careers to plan, implement, and evaluate their career goals, with the advice of mentors and a program coordinator.

Given the short supply of researchers in various aging-related fields, this activity aims to ensure the academic success of health professional trainees who are pursuing careers as researchers in these fields. Because these junior investigators need to have a diverse skill set and knowledge base, the structured portfolio was created to help trainees break out of the traditional mindset in which research careers start with a PhD, followed by years spent in a lab under one mentor, learning a predetermined set of skills.

Trainees develop a clear career and research plan that is an individualized roadmap to what they want to learn, and who and what will help them achieve success along the way. As they progress through their career, trainees add evidence—including abstracts and papers, and feedback from their biannual progress report—that goals are being met and progress is being made. These and other materials can subsequently assist each trainee in job searches, applying for research grants, and receiving academic promotions.

Program Operations

Trainees undergo an initial assessment of their research competencies using a format developed at the University of Wisconsin (see Clinical Research Appraisal Inventory in Available Materials). Trainees then follow a defined format for establishing and monitoring career goals, tracking mentor meetings, and reporting their progress. The trainee sets his or her own goals and markers of
success, with advice from a panel of program leaders and mentors from various health professions and divisions.

Every six months, the trainee presents his or her progress to the panel. During this session, the panel and trainee analyze the trainee's progress, and the trainee is able to give feedback on the panel’s and department's roles in advancing her or his career plan. Goals and plans are then modified as needed.

The portfolio structure is completely up to the trainee. Most trainees prefer to use a three-hole binder, but some have opted to use a digital format. The portfolio is mandatory only for the first year of full-time research, but many trainees maintain their portfolios long after the required period.

Staffing Requirements

A faculty member of the division of geriatrics serves as the program coordinator, and an administrative coordinator’s time is needed for sending out reminders for submission of biannual progress reports, scheduling portfolio review meetings, etc.

Program Costs and Funding Sources

The program coordinator and administrative coordinator require approximately 5% FTE each. The mentors' time is a part of their teaching responsibilities.

The program is funded by the Hartford Center of Excellence, the Pepper Center, and a National Institutes of Health T32 research training grant.

Process and Outcomes Data

Since 2003, 15 trainees have maintained their portfolio as part of the mandatory research training program, but many—including one alumnus who is now an Associate Professor—continue to utilize the structure throughout their careers.

Implementation Lessons

• One of the values of the portfolio approach is that everyone involved—trainees, teachers, mentors—agrees on the trainee’s goals and plans for meeting them.
• This shared plan facilitates collaboration between the entire team and helps to ensure that the trainees’ educational, research, and career objectives are met.

Available Materials

Tools/Resources

• Clinical Research Appraisal Inventory
• Research Portfolio Outline
• Trainee Evaluation Form

For More Information

Stephanie Studenski, MD, MPH
Professor, Department of Medicine
Division of Geriatric Medicine
University of Pittsburgh School of Medicine
3471 Fifth Avenue
Kaufmann Medical Building, Suite 500
Pittsburgh, PA 15213
(412) 692-2360
StudenskiS@dom.pitt.edu

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at Mount Sinai School of Medicine

Program Overview

In order to assure the highest quality of teaching in geriatrics among physician-training programs across the country, clinician-educators must possess significant pedagogic skills and a mastery of relevant content. The goal of the annual Master Clinician-Educator Program in Geriatrics is to produce expert geriatrics educators within geriatric medicine as well as within other disciplines.

In 2005, its pilot year, the program was offered exclusively to fellows enrolled in Mount Sinai’s geriatrics fellowship program. Starting in the 2005-06 academic year, the program was expanded to include selected Mount Sinai nongeriatrician chief residents and/or junior faculty in addition to geriatrics fellows.

The Master Clinician-Educator Program focuses on fundamental teaching principles, clinical teaching in sites specific to geriatrics, education research skills, and evaluation/assessment techniques that address issues fundamental to the care of older adults.

The specific learning objectives are for participants to:

• become familiar with classic teaching principles
• become aware of venue-specific skills necessary for teaching geriatrics
• acquire skills in curricular development
• design learner- and topic-specific curricula in geriatrics content
• communicate his/her curricular design effectively

Upon satisfactory completion of the program, scholars receive a Certificate in Geriatrics Medical Education from the Department of Geriatrics.

Program Operations

The Master Clinician-Educator Program is offered during the second year of the geriatrics fellowship, during the final year of chief resident training, or over a one-year period for selected junior faculty from other disciplines. Up to four geriatrics fellows and three junior faculty or chief residents are enrolled in the program annually. Chief residents or junior faculty are chosen by a competitive application process that favors those planning to
relocate and practice academic medicine at another institution within the next three to five years. To encourage those who are not geriatrics fellows to participate, the Department of Geriatrics provides mentorship to enable trainees to develop expertise and visibility as geriatrics-oriented educators within their disciplines.

The program consists of a weekly two-hour seminar. Additional hours of independent study and scholarly work are expected between sessions. Seminars include didactic sessions, experiential learning opportunities, other classroom sessions, and application-based work and workshops. The workshops consist of work in progress reports on goals, objectives, curricula, and evaluations based on the scholars’ own work. Scholars are also able to watch others teach in the medical school and reflect on the process and content of that teaching. Four sessions result in educational tools produced by the scholars that can be added to their portfolio of portable, ready-to-use geriatrics training materials.

Program trainees also teach in different clinical arenas where they are observed and receive feedback from faculty. Because of the interdisciplinary nature of the Clinician-Educator Program, all scholars learn how to work with a variety of other specialists in order to integrate geriatrics curriculum, content, and teaching throughout institutions and across the continuum of care.

Participants are also required to complete a scholarly project and a publication timeline during their training year. They also develop a mentored career plan to enable them to become faculty who promote and teach geriatrics at other institutions.

Staffing Requirements

Three geriatrics faculty members (one at 20% and two at 10%) and one part-time administrative assistant who serves as program coordinator (at 20%) are needed to staff the program.

Program Costs and Funding Sources

The total annual budget of approximately $150,600 covers staffing costs, fellows’ salaries, food, books, and office expenses.

The program development was funded by the Donald W. Reynolds Foundation via its Consortium for Faculty Development to Advance Geriatric Education (FD~AGE) grants; its ongoing operation is supplemented by funds from the John A. Hartford Foundation Center of Excellence and the Brookdale Department of Geriatrics and Adult Development.

Process and Outcomes Data

44 Scholars have graduated from the program since 2005.

Pre- and post-survey program evaluations are conducted. Prior to the course, 85% of the scholars wanted a career in academics, 5% stated they had experience with curricular development, and 1% reported that they had formal training. After the course was completed, 85% of the scholars felt more comfortable in starting curricular projects.

10% of the participants have presented their work at national meetings and are currently working on their manuscripts.

32% of the scholars are faculty members in geriatrics/palliative care at Mount Sinai, 59% are in geriatrics/palliative care or geriatrics/internal medicine at other institutions, and 9% are faculty in other subspecialties with geriatrics interest.

Implementation Lessons

• This is a developmental process for the scholars, which requires a time commitment from them to work outside the classroom, as well as a time commitment from the teaching faculty to hold individual mentoring meetings.
• An evaluator should be part of the development team.

Available Materials

Tools/Resources

• Precourse survey

Publications

• Learning in Adulthood
  Merriam, SB, Caffarella, RS
  Jossey-Bass. San Francisco 1999
• Curriculum Development for Medical Education
  Kern, DE
  The John Hopkins Press. Baltimore 1998
• ABC of teaching and learning
  Kern DE, Thomas PA, Howard DM, et al
  BMJ series: 2003;326

For More Information

Helen Fernandez, MD
Mount Sinai School of Medicine
Brookdale Department of Geriatrics and Adult Development
10th Floor, Annenberg Building
One Gustave L. Levy Place
Box 1070
New York, NY 10029-6574
(212) 241-5561
Helen.Fernandez@mssm.edu

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at the Indiana University School of Medicine

Program Overview

The purpose of the Clinical Investigator Training Enhancement (CITE) program is to prepare health care professionals for a career in clinical research and to teach the skills necessary to compete successfully for grant funding, conduct and analyze research findings, and publish work in scientific journals. Over the past several decades, it has been increasingly recognized that a cadre of clinician-scientists committed to and trained in patient-centered research is essential to complement the numerous advances emanating from the basic biomedical and laboratory sciences.
The program serves as an excellent local resource for advancing careers in academic geriatrics.

Most participants already have a doctoral degree (MD, PhD, DNS, DDS, or DPT) or are in training for one. Potential applicants include, but are not limited to:

• fellows or other health care professional trainees who have substantial protected time for clinical research
• junior faculty who have career awards or support from their division or department head for participation in the program
• other faculty who have focused previously on basic research or other academic activities but are now committed to pursuing a career in clinical research.

Program Operations

The program includes two main components:

• a two-year formal clinical research curriculum, at the end of which participants receive a Master of Science in Clinical Research degree
• a clinical research project conducted under the mentorship of a faculty scientist whose discipline or area of clinical investigation corresponds to the research interests and career aims of the student.

This is an integrated program in which the formal curriculum complements and parallels the ongoing clinical research that is relevant to each enrollee's career. This differs from a sequential program in which individuals focus predominantly on formal coursework for several years, deferring actual research until they have attained their degree.

The rationale for the integrated approach is two-fold. First, the coursework is most meaningful when applied to research in which the enrollee is engaged and hopes to continue following program completion. Second, success in clinical research requires not only formal training, but also several primary outcomes, particularly publications and grants.

Program participants meet at least once a month with their primary mentor, and five times during the two-year program with their Advisory Committee, at approximately four-month intervals.

In addition to the work for the MS degree, program graduates complete a grant proposal for funding as well as one or more manuscripts for publication. The combination of a degree and research output substantially enhances the likelihood of a participant’s sustained success as a clinical investigator following program completion. Because the program involves both coursework and ongoing clinical research, a 70% time allocation for a two-year period is strongly recommended.

Staffing Requirements

The following personnel are needed:

• A primary mentor who chairs the trainee’s Advisory Committee and forwards an evaluation report to the Program Director following each Advisory Committee meeting.
• The Program Director, who meets individually with each program trainee twice a year to discuss his or her progress and needs,as well as to solicit feedback.
• An Advisory Committee consisting of the primary mentor and other relevant faculty scientists for each enrollee. The Committee oversees the trainee's progress, provides guidance and necessary support, evaluates the completion and quality of research, and offers ongoing career advice.

Program Costs and Funding Sources

The major cost of the program is the time commitment of the program participants (a recommended 70% time allocation for two years) for the completion of the full program; typically, this requires support by the head of the division, department, or research unit in which the trainees reside. Many program participants have salary or stipend support funded by a fellowship, training grant, or junior faculty career award. Others arrange for the necessary protected time with their supervisor, with the express purpose and intent of building the research capacity and productivity of their division or department. Participants receive no salary support from the CITE program.

There is no salary support from the CITE program for mentoring activities. Time for administrative activities depends on the number of trainees and the trainees' projects.

Program funding is through a National Institutes of Health K-30 grant.

Process and Outcomes Data

The program is too new to have any outcomes data on the number of trainees who go on to achieve R01s. Because this is a general program, there is also no data specific to geriatrics or aging-related research.

Implementation Lessons

• Because its goal is to support advanced training in clinical research, the program is an excellent local resource for advancing careers in academic geriatrics. Other Hartford Centers of Excellence and geriatrics programs may have access to similar research enhancement programs on campus, and trainees should be encouraged to participate in them.
• Hands-on experience with a specific research project is a major aspect of the CITE program; the geriatric message and methods are best introduced through this practical experience.
• This program provides a strong foundation of training for fellows and junior faculty with only minimum prior training in clinical research methods and design.
• It is very important to pair participants interested in aging and geriatrics with mentors who have experience and interest in aging research.

Available Materials

Website

• Contents include program description, curriculum, and application http://www.regenstrief.org/training/cite

For More Information

Christopher M. Callahan, MD
Professor of Medicine and Director
Indiana University Center for Aging Research
Regenstrief Health Center, 6th floor
1050 Wishard Boulevard
Indianapolis, IN 46202-2859
(317) 423-5592
ccallaha@iupui.edu

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at Duke University School of Medicine

Program Overview

In 2005 the Duke University Division of Geriatrics and Aging Center established a year-long Geriatrics Excellence in Teaching Series (GETS) to help geriatrics faculty and fellows develop as clinician-educators. The program, which is also open to other health professionals at the Duke Aging Center, focuses on developing skills in teaching, curriculum development, and educational scholarship that are essential for succeeding in careers in geriatric academic medicine.

The program provides an innovative approach to training clinician-educators through a variety of active learning strategies that:

• expose participants to innovative, adult learning-centered approaches for enhancing learning and instruction in medical education
• provide a conceptual space for faculty and fellows to discuss contemporary issues in academic medicine.

Program Operations

The year-long program consists of ten one-hour sessions covering a variety of topics in medical education. The sessions occur monthly during the existing Geriatrics Grand Rounds program slot. Attendance ranges from 15 to 20 participants per session.

A PhD-level educator serves as the program director. Sessions are facilitated by the program director and one or two invited faculty or fellows from the Division of Geriatrics and Aging Center. Invited facilitators are identified based on their expertise in a given topic area or by their expressed desire to learn more about the topic to be covered; there is no financial incentive or compensation for their participation. The program director works closely with the cofacilitators in developing and implementing the sessions.

Topics for the series are determined by the program director, based on a review of the faculty development literature and contemporary issues in academic medicine, and on the results of an annual needs assessment conducted with faculty and fellows. All sessions are taught using active learning strategies (including small- and large-group discussion, video review, case discussion, role play, readings, and writing assignments) to foster learners’ participation. Sessions usually start with a discussion of participants’ perceived challenges in the topic area being considered. This information provides facilitators with an understanding of the needs of the group and helps them to focus the seminar on the participants’ interests. There is limited use of PowerPoint slides; sessions are interactive and focus on participants’ challenges and on constructing new knowledge.

Participants gain the skills to develop their academic careers; they learn how to improve their teaching practices and to develop effective educational programs and educational scholarship.

Cofacilitators have the opportunity to be mentored by a PhD educator to develop and implement educational programs, and to collaborate with peers in the development of educational activities.

Staffing Requirements

The following personnel are needed:

• Program director (5%) (Funded by the Reynolds grant)
• Invited faculty or fellows to teach the sessions—faculty are encouraged to participate; some volunteer to teach.
• Administrative staff (for preparation of handouts, course promotion, etc.)

Program Costs and Funding Sources

The costs involved are: the program director’s time; fellows/faculty time to plan, cofacilitate, and attend the sessions; light refreshments; and photocopying of teaching materials. Each one-hour session costs approximately $60, excluding faculty time.

The program is supported by a grant from the Donald W. Reynolds Foundation Aging and Quality of Life Program, but will be incorporated into the regular budget once the Reynolds grant expires.

Process and Outcomes Data

Participants assess each program session via a feedback form. They are asked to rate the quality of the session, usefulness of the content, and adequacy of interactive opportunities for questions and discussion. Participants also describe how they will apply what they learned in the session to their teaching practices.

An end-of-program survey is conducted to assess participants’ satisfaction with the program and to determine the impact of the series on their roles as educators. The survey asks participants to rate:

• the overall benefit of the series
• the utility of concepts and tools offered for their teaching practices
• whether or not they have used knowledge and skills taught in the program
• the degree to which the series helped them improve their confidence as educators/teachers.

The survey also asks participants to identify the session they found most beneficial, to name topics they would recommend for future sessions, and to provide general constructive feedback for improving the program.

All respondents agreed or strongly agreed that the GETS provided them with resources (concepts and tools) that they will be able to use in their teaching practices. All also reported to have used knowledge and skills learned in the series in their teaching practices.

88% agreed or strongly agreed that, as a result of their participation in this series, they were more confident in designing educational programs as well as teaching medical learners; 100% agreed that they would recommend the series to other faculty and fellows.

Some specific comments from participants regarding skills learned that were particularly helpful to them as teachers/educators include noting the importance of:

• Focusing on teaching as an important goal and a valuable skill that can be learned and practiced
• Principles of adult learning theory such as establishing the learner ‘need to know’: “The distinction between pedagogy and andragogy will help me design curricula and talks in the future”
• Matching instructional strategies and evaluation methods to learning objectives
• Providing feedback to learners
• Soliciting feedback for both the portfolio and self-development as a teacher
• Remembering to set learners’ goals at the beginning of encounter and then give specific feedback on these goals.

For more details on program outcomes, please see Available Materials.

Implementation Lessons

• A needs assessment of participants determined the topics deemed most relevant to participants daily lives as clinician-educators.
• Sessions were designed to be interactive and to promote skill development through actual practice of a variety of strategies.
• Open discussion time during sessions proved essential for allowing all attendees an opportunity to identify shared challenges and propose effective solutions.
• The program was offered in a time slot customarily reserved for a very traditional didactic Grand Rounds. This time proved convenient for both faculty and fellows.
• Participation of clinician-educators as coteachers was a particular strength of the program, as clinician-educators were able to practice planning and implementing educational skills sessions with a professional educator. Drawing on the existing expertise of the group, this collaboration among faculty positively impacted the quality of the GETS and the experience of faculty and learners alike.

Available Materials

Publications

• The Geriatrics Excellence in Teaching Series: An Integrated Educational Skills Curriculum for Faculty and Fellows Development
  Pinheiro, S, Heflin, M
  Journal of the American Geriatrics Society,
  2008;(56)4:750 - 756

Website

• Slides, handouts, and references are available at http://careinaging.duke.edu

For More Information

Sandro O. Pinheiro, PhD
Mitchell T. Heflin, MD
Duke University School of Medicine
DUMC 3003 – 3502 Blue Zone
Durham, NC 27705
(919) 660-7563
sandro.pinheiro@duke.edu
hefli001@mc.duke.edu

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at Weill Medical College of Cornell University

Program Overview

This year-long course aims to teach first- and second-year geriatrics fellows, as well as interested junior faculty, core research methods and design skills. The course covers topics such as clinical epidemiology, research architecture, biostatistics, health services research, and qualitative methods, and provides training in data entry, analysis, and programming. Given the shortage of geriatrics clinician-investigators and clinician-educators, it is particularly important that geriatrics fellows receive a firm grounding in fundamental research skills to help ensure their success in academic geriatrics.

The course is mandatory for first- and second-year geriatrics fellows.

Program Operations

The course meets for one hour each week. Students are required to read journal articles that address points covered in weekly didactic lectures and are then asked questions about the articles that reinforce key concepts covered in each class. In 2009 the course will be offered to interested faculty and fellows throughout the Weill Cornell institution.

Staffing Requirements

Three core faculty teach the classes, including the Hartford Centers of Excellence Director. An administrative assistant distributes reading assignments and discussion questions to attendees on a weekly basis.

Program Costs and Funding Sources

Each session requires about 2.5 hours of preparation time; between the course director and the two faculty who participate, the total amount of effort over the course of the year is
5-7.5%. The administrative assistant requires approximately 1% FTE.

The seminar was developed and implemented under the Hartford Centers of Excellence grant.

Process and Outcomes Data

Participants are surveyed at the completion of the course regarding their likes/dislikes and what they would like to see changed in the future. The course was enthusiastically evaluated by the first cohort of fellows/junior faculty. Participants felt that the course was instrumental in helping them to conduct original research, strengthened and consolidated their understanding of biostatistics (particularly multivariable analysis), and helped them to develop and implement better age-relevant research questions/hypotheses. Many reported that the course helped to lay the foundation for further research training. Sections on research design and multivariable statistics were judged to be particularly important topics, and well presented.

Plans are underway to survey course graduates to determine how they have made use of the materials in their current positions.

Implementation Lessons

• Offering the course every other year is necessary as the division has two first- and two second-year fellows (two receive the course in their first year of training and two in their second year).
• Information covered has had to be somewhat general, given the diverse backgrounds of the learners. For example, some have had biostatistics and methodology courses, while others have not.
• The course is now offered to research assistants employed through the Division of Geriatrics, to help improve the overall quality and quantity of divisional research products.
• One goal for the future is to have additional faculty from both within and outside of the Geriatrics Division teach sections of the course, as a way to introduce these faculty members to ongoing research activities within the Division, thus promoting interdisciplinary research activities.

Available Materials

Tools/Resources

• Course Syllabus

For More Information

Cary Reid, MD, PhD
Associate Professor of Medicine
Division of Geriatrics and Gerontology
Weill Medical College of Cornell University
525 East 68th Street, Box 39
New York, NY 10065
(212) 746-1729
mcr2004@med.cornell.edu

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