Medical Students
Integrated Medical Student Curriculum in Geriatrics
at the David Geffen School of Medicine at University of California, Los Angeles
| SUMMARY |
| Target Audience All medical students Purpose Program History Operating Costs Outcomes Available Materials For More Information |
Program Overview
The UCLA Multicampus Program for Geriatric Medicine and Gerontology integrates geriatrics into all four years of the medical school curriculum. The overall goal is to provide medical students with the foundation for competent, compassionate care of older patients, regardless of what specialty the student pursues. This increased exposure to geriatrics training and positive geriatrician role models also serves to interest more medical students in careers in geriatrics.
The curriculum learning objectives were derived from the American Geriatrics Society's Areas of Basic Competency for the Care of Older Patients for Medical and Osteopathic Schools. The competencies cover attitudes, knowledge, and skills that are needed to care for older people, such as:
- basic science knowledge—epidemiology, physiology, pathology, pharmacology
- clinical knowledge—risk, signs, symptoms, diagnosis, work-up, prevention of common geriatric syndromes
- skills—geriatric and pre-operative assessments
- attitudes—awareness of myths about aging, appreciation of individual differences, compassionate care.
Program Operations
A variety of teaching methods have been developed and are utilized across the four-year curriculum, including:
- didactic lectures
- small-group discussions
- case-based exercises
- CD-based learning exercises
- video-based case examples
- web-based exercises
- innovative educational games
- large-group audience participation formats.
A complete list of curriculum learning objectives can be found in the Available Materials.
Staffing Requirements
The curriculum is provided largely through problem-based learning in small groups of 4-8 students with two preceptors. They meet for 2-4 hours twice a week during the fall and spring semesters for both first- and second-year curriculums. Approximately 75 faculty preceptors from all specialties (including geriatrics) and basic science departments contribute to the learning groups. Geriatric cases are included throughout this curriculum along with all other medical school content. Detailed tutor notes, teaching suggestions and content background are provided. Students change groups about every 6-9 weeks to insure consistency of content and exposure to a large number of excellent preceptors.
A complete list of staffing requirements for the geriatrics curriculum can be found in the Available Materials.
Program Costs and Funding Sources
In 2000, UCLA received a grant from the Association of American Medical Colleges (AAMC) and the John A. Hartford Foundation to develop and support multimedia resources for undergraduate medical education in geriatrics. This was supplemented by a grant from the US Department of Education's Fund for the Improvement of Postsecondary Education (FIPSE).
Funds from these small grants were used to develop specific problem-based learning cases related to geriatrics; multimedia program development such as Geriatric Jeopardy; video-enhanced learning modules; and Audience Response Systems programs. Funds also provided a small amount of faculty support and enabled consultations for specific content areas.
Process and Outcomes Data
The content developed has been enhanced and maintained by a small committee of geriatrics faculty since its inception. These efforts have led to geriatrics faculty appointments to the larger UCLA curriculum committees for the preclinical years and for the clinical years, which meet on a monthly basis.
A variety of formal methods are utilized to evaluate each component of the curriculum.
Direct student evaluations are required at the end of each lecture, block, clerkship and workshop. These are usually conducted online through the Dean's office and then forwarded to the Geriatrics Education Program Director in the Division of Geriatrics.
Objective Structured Clinical Examination (OSCE) cases specific to geriatrics are required at the end of year two and year three. Class means and item analysis are discussed in the curriculum committee meetings and distributed to the Geriatrics Division.
AAMC Senior Questionnaire results include approximately 10 questions on geriatrics content each year.
Outcomes from fourth-year student surveys indicate that students have recognized an increase in exposure to geriatrics content since about 2003-04, which has been sustained. In addition, student performance in geriatrics, based on AAMC national senior content examinations, has also improved.
Many of the multimedia teaching tools developed at UCLA have been exported extensively to other levels of training, to other disciplines, and to other universities across the country.
Implementation Lessons
- Multimedia presentations, web-based programs, and patient demonstrations require tremendous preparation, attention to technical limitations, and often labor-intensive efforts to ensure a good presentation. These methods should be reserved only for content areas that require the advantages of this methodology and should not be used without substantial forethought and preparation.
- Once curricular elements are developed, tested, and proven to be successful, substantial effort is needed to maintain them in the curriculum from year to year. In an over-crowded curriculum, problem-based cases, small-group discussions, and even core lectures are often lost to other content areas if there is no strong advocacy for maintaining them in the curriculum and the elements are not updated frequently.
- Get the Dean's office involved in recruiting faculty from other departments to incorporate geriatrics curriculum and handle the small teaching groups.
- Using funds to support non-geriatrician faculty to insert more geriatrics into the core courses can be an effective strategy.
Available Materials
Tools/Resources
- Table of Medical Student Geriatrics Curriculum Learning Objectives, Teaching Methods, and Staffing Requirements
Publications
- Multidimensional attitudes of medical residents and geriatrics fellows toward older people.
Lee M, Reuben DR, Ferrell BA.
Journal of the American Geriatrics Society
2005;53(3):489-94 - Development and validation of a geriatrics knowledge test for medical students.
Lee M, Wilkerson L, Reuben DB, Ferrell BA.
Journal of the American Geriatrics Society
2004;52(6):983-8.
Website
- A catalog of UCLA educational products created for Medical Student Geriatrics Education, including ordering information, is available at:
http://www.medsch.ucla.edu/public/geriatrics/orderform.htmFor a CD of additional curriculuar materials, please contact:
Ann C. Hu
Donald W. Reynolds Program Coordinator
David Geffen School of Medicine at UCLA
10945 Le Conte Avenue, Suite 2339
Los Angeles, CA 90095-1687
(310) 312-0531
achu@mednet.ucla.edu
For More Information
Bruce A. Ferrell, MD
Professor of Medicine
Associate Chief of Education
Division of Geriatrics
David Geffen School of Medicine at UCLA
10945 Le Conte Avenue, Suite 2339
Los Angeles, CA 90095-1687
(310) 825-8253
bferrell@mednet.ucla.edu
Introduction to Geriatrics Recruitment: Opportunities and Challenges
Geriatrics Recruitment in the Context of the Formal, Informal and Hidden Curriculums
Where to Focus Geriatrics Recruitment Efforts
References
One of the main reported reasons people decide to become physicians is that they want to help people and make a positive difference in the lives of their patients and families. Geriatric medicine is one of the specialties that most emphasizes personal and sustained relationships with patients and families.1 Geriatric medicine has the potential to meet a major goal of prospective physicians, one that leads to career satisfaction and fulfillment.
The data support this: In a 2002 survey, geriatrics was ranked first in job satisfaction among physicians.2 But even though geriatricians report high career satisfaction and the field meets some initial career objectives of prospective physicians, the number of geriatricians remains low and is currently declining. In fact, there are many barriers to choosing a career in geriatric medicine.
- The earning potential of geriatricians is the lowest of all medical specialties.3
- Throughout the course of medical school, many students receive the impression that geriatrics is a field that is not respected by other physicians.
- Too often, residency programs reinforce the stereotype of older patients as unmanageable or difficult because residents only meet hospitalized elders who are, by definition, among the most ill and frail.
- Medical trainees often encounter positive geriatrician role models too late in their training, after their career choices have been made.
Since 2004 about 10% of each year’s graduating class of medical students who choose a residency in internal medicine or family medicine have indicated an interest in pursuing geriatrics.4 But residency programs seem to deter many potential geriatricians: In internal medicine, of the 2,638 residents who took the IM-ITE, only 1.3% indicated they were planning to pursue a career in geriatrics.5 These numbers point to opportunities as well as challenges. There is a larger potential pool of students and residents interested in geriatrics than many are aware of. But to encourage and sustain their interest, geriatrics must be a respected, valued career choice for doctors.
The Institute of Medicine’s April 2008 report, Retooling for an Aging America: Building the Health Care Workforce,6 acknowledges that "as the population of older adults grows to comprise approximately 20 percent of the U.S. population, they will face a health care workforce that is too small and critically unprepared to meet their health needs." If aging Americans are to continue to stay in the best health possible, bold initiatives designed to "boost recruitment and retention of geriatric specialists and health care aides" are needed. According to the report, "Geriatric specialists are needed in all professions not only for their clinical expertise, but also because they will be responsible to train the entire workforce in geriatric principles."
Geriatrics Recruitment in the Context of the Formal, Informal, and Hidden Curriculums
Given the uneven incentives for pursuing a career in geriatric medicine cited above, it is important for those charged with recruiting into geriatrics to understand the multiple points at which students can be influenced in their career choices. What leads to trainees’ waning interest in geriatrics as they progress through their medical training can be considered in the context of what Hafferty 7, 8 has conceptualized as the formal, informal, and hidden curriculums within medical education.
The Formal Curriculum is the group of explicit goals and objectives for a specific set of skills that students need to master to become a physician. The extent to which geriatrics is included in the formal curriculum for medical trainees varies widely. The Hartford CoEs and the Donald W. Reynolds Foundation Aging and Quality of Life grant programs are making considerable progress in integrating geriatrics into the formal curriculum for medical students and residents. Some examples of CoE formal curriculum for medical students are highlighted in this manual. These educational activities can provide a valuable means of geriatrics recruitment by exposing trainees to positive role models and clinical experiences that help to dispel common misconceptions about caring for older adults and to reinforce the unrecognized positive aspects of working in geriatrics.
Underlying the formal curriculum is the Informal Curriculum— the unscripted, predominantly ad hoc, and highly interpersonal form of teaching and learning that takes place among and between faculty, fellows, residents, and students. It usually occurs outside of formal learning environments. The informal curriculum is communicated primarily through role models, and deeply influences trainees’ values, professional identities, and career choices.
Many CoE recruitment efforts have focused on communicating the positive aspects of geriatrics through the informal curriculum, not only to trainees but to faculty and medical school administrators as well. Some of these approaches are described in this manual.
The Hidden Curriculum is defined as a set of influences that function at the level of organizational structure and culture. It is what the leaders of the institution most value. There are four components to the hidden curriculum:7,8,9
- Institutional polices
- Evaluation activities
- Resource allocation
- Institutional "slang"
The hidden curriculum impacts both the formal and informal curriculums. Medical school leaders have objectives for the institution that lead to an emphasis on what is taught and valued. For example, when a new initiative in a medical school is announced, there are undertones to that announcement that convey what is valued. Leaders may offer incentives to those who help to meet these objectives.
Negative attitudes about the field of geriatrics are often communicated to trainees by medical school faculty and leaders. As a result, an important strategy to recruiting and retaining trainees in geriatrics has been to increase nongeriatrics faculties’ appreciation of geriatrics as a discipline. Further, when geriatrics is integrated into all four years of a medical school curriculum or is a required rotation for residents, the message is that the field is valued by the institution at large. As noted, many CoE activities are focused on increasing geriatrics training throughout the medical school curriculum. These efforts can influence the hidden curriculum as well as the formal and informal curriculum, all of which have the potential to enhance recruitment of trainees to geriatrics.
Where to Focus Geriatrics Recruitment Efforts
Geriatric medicine professionals who are assigned the task of recruiting the next generation of geriatricians need to keep the formal, informal, and hidden curriculums in mind as they develop recruitment efforts. They should seek opportunities to increase awareness of the hidden curriculum among faculty, students, and trainees, and make the case for geriatrics. For example, they can:
- Join the admissions committee. Geriatrics faculty can identify and support premedical students who already show an interest in geriatrics prior to medical school admission. The other committee members will in turn know to alert geriatrics faculty when they read a student statement indicating an interest in geriatrics. The geriatrics faculty can also advocate for premedical students with geriatrics interest during the selection process.
- Speak with the Dean of Admissions about the growing older adult population and the critical need to identify and support students with an interest in geriatrics.
- Join faculty committees such as the medical education committee. The interaction with faculty in other specialties raises awareness about and increases the stature of geriatrics, and offers opportunities to influence the school’s hidden curriculum. For example, when a student mentions to another committee member his/her interest in caring for older adults, the committee member will refer the student to the geriatrics faculty member. Having geriatrics faculty on the medical education committee also enables geriatrics teaching to be infused throughout different aspects of the medical school curriculum and enables the other medical specialties to see the value added aspect of geriatrics.
- Join the internship selection committee. This can enable the geriatrics faculty to identify and support medical students who already show an interest in geriatrics. The geriatrics faculty is also present at the rank list meeting to act as an advocate for students who show an interest in geriatrics.
- Meet with the local internal medicine and family medicine program directors and offer to give lectures in geriatrics or allow their residents to rotate through the geriatrics program.
- Be aware of the possibility of “losing” students at the transition points between levels of training. There are four main transition points for promoting positive models of geriatrics and recruiting students. Approaches to each of these are included in this manual.
- Premedical to Medical School
Connect early on with students who demonstrate an interest in geriatrics and foster that interest. Make sure that the geriatrics program is visible to applicants as an important and attractive feature of the medical school. - Preclinical to Clinical Years
Provide opportunities for students to have exposure to geriatrics throughout the first and second years of medical school, e.g., encourage students to apply for the Medical Student Training in Aging Research (MSTAR) Program. Remain in contact with and foster these students throughout all of their clinical rotations. This leads to good will about geriatrics that students communicate to their peers. - Medical School to Internship
This may be the most critical transition, during which promising students in geriatrics may fall through the cracks due to competing priorities and the challenges of internship. Help students through the internship application process by listening to them discuss their specialty choice, reading their essays, and writing letters of recommendation. When students receive their match, provide them with the geriatrics faculty contacts at their residency program, and contact the geriatrics faculty to alert them that the student is entering a residency at their school. - Residency to Fellowship
Support residents throughout their clinical rotations by listening to their concerns about taking care of patients, providing positive exposure to the care of older patients, and helping them choose a fellowship.
References
1. Cravens, DD, Campbell, JD. Mehr, DR. Why geriatrics? Academic geriatricians’ perceptions of the positive, attractive aspects of geriatrics. Family Medicine 2000;32(1):34-41.
2. Leigh, JP, Kravitz, RL, Schembri, M, et al. Physician career satisfaction across specialties. Arch Intern Med 2002;162:1577-1584.
3. Association of Director of Geriatric Academic Programs Status of Geriatrics Workforce Study. Training and Practice Update. May 2008. www.americangeriatrics.org/adgap/adgapTandP_update.pdf. Accessed August 15, 2008.
4. Association of American Medical Colleges. 2006 Medical School Graduation Questionnaire. http://www.aamc.org/data/gq/allschoolsreports/2006.pdf. Accessed August 15, 2008.
5. West, CP, Popkave, C, Schultz, HJ, et al. Changes in career decisions of internal medicine residents during training. Ann Intern Med. 2006;145:774-779.
6. Institute of Medicine Committee on the Future Health Care Workforce for Older Americans. Retooling for an Aging America: Building the Health Care Workforce. April 2008. www.iom.edu/agingamerica. Accessed August 15, 2008.
7. Hafferty, FW. Beyond curriculum reform: confronting medicine's hidden curriculum. Acad Med. 1998 Apr;73(4):403-7.
8. Hafferty, FW, Franks, R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994 Nov;69(11):861-71.
9. Suchman, AL, Williamson, PR, Litzelman, DK, et al. Toward an informal curriculum that teaches professionalism: Transforming the social environment of a medical school. J Gen Intern Med 2004;19 501-504.
Medical Student Summer Institute in Geriatric Medicine
at Boston University Medical Center
| SUMMARY |
| Target Audience Third- and fourth-year medical students Purpose Program History Operating Costs Outcomes Available Materials For More Information |
Program Overview
The goal of the Summer Institute is to stimulate interest in careers in academic geriatric medicine and aging-related research. This program was established in 1986 as one means to address the shortage of academic geriatricians available to train health care professionals in the principles of geriatrics. Up to 20 third or fourth year students are selected each year and given opportunities to learn more about the field and interact with mentors.
Program Operations
Activities of the week-long Summer Institute include clinical and research seminars on key geriatrics/aging topics, site visits to clinical programs, and small-group development of a research proposal. Faculty members and mentors include nationally recognized academic geriatricians and Boston University faculty conducting aging research.
Applicants must have U.S. citizenship or permanent resident status (due to Federal funding). Selection is based on:
- a clearly demonstrated, strong interest in geriatric medicine, as reflected by curricular and extracurricular involvements
- prior relevant clinical or basic science research experience
- a letter of recommendation from a faculty member
- the content of a short essay (200 words or less) outlining career goals, interest in geriatrics, and reasons for applying
Staffing Requirements
Two administrative staff devote portions of their time to recruitment, organization, and evaluation. Twenty-seven interdisciplinary faculty participate in the program.
Program Costs and Funding Sources
Airfare, dormitory housing, and a small daily food stipend are funded in full for each student. Transportation is provided between the dormitories and the Medical Center. Visiting guest faculty members receive an honorarium, and faculty travel/hotel costs are covered as needed.
The program is sponsored by the American Geriatrics Society (AGS) and the Boston University School of Medicine. Funding is through the National Institute on Aging (NIA) R13 mechanism.
Process and Outcomes Data
80% of the students who participated in the program from 1995 -1999 were tracked using surveys and electronic databases. As of 2005, 15% were AGS members, 7% had the Certificate of Added Qualifications in Geriatric Medicine, and four participants held faculty appointments in geriatrics. Of the 21 participants from the 2003 program who are now finishing their residency training, three (14%) are pursuing fellowship training in Geriatric Medicine.
Implementation Lessons
- It is challenging to track students over time to obtain outcome data.
- The most effective way to recruit students directly is through electronic strategies.
- As more schools develop geriatrics curricula at the student level, crafting a curriculum that meets diverse student needs is challenging.
Available Materials
Tools/Resources
Website
- Summer Institute website: www.bmc.org/geriatrics/educationMedicalStudents_SIGM.htm
For More Information
Rebecca A. Silliman, MD, PhD
Chief, Geriatrics Section
Boston University Medical Center
Robinson 2
88 E. Newton Street
Boston, MA 02118
(617) 638-8383
rsillima@bu.edu
Seniors as Mentors Program
at Mount Sinai School of Medicine
| SUMMARY |
| Target Audience First-, second-, and third-year students Purpose Program History Operating Costs Outcomes Available Materials For More Information |
Program Overview
The pilot Seniors as Mentors Program was introduced in 2005-06. It utilizes community-dwelling functional older adults living with chronic illnesses as adjuncts (Mentors) in conveying geriatric content. Mentors are diverse in age, race, religion, ethnicity, education, sexual orientation, and socioeconomic status. The Program matches first-year students, in groups of two or three, with older adults. The primary purpose is to ensure that students see patients as people, not just as diseases and organs. Students establish a long-term relationship with their Mentors over the course of the academic year. Students observe firsthand the challenges faced by these older patients, how their medical conditions impact their quality of life, and the coping mechanisms they have developed to live with the challenges their chronic illnesses pose.
The Seniors as Mentors program is a required clinical experience for all first-, second-, and third-year medical students. The program goals are to:
- have students develop a strong foundation in patient-centered medical care through longitudinal relationships with older patients (Mentors)
- promote team learning and team care
- have students understand transitions of care.
This program is inspired by the 23 medical schools which established Senior Mentor Programs as part of the AAMC-Hartford Geriatrics Curriculum Program in 2000 and 2001, modeled after the University of South Carolina's original program.
Program Operations
Course objectives for students are to:
- reflect with fellow students and the primary care physicians about developing and maintaining a longitudinal relationship with a patient
- recognize the burden of chronic illness and the importance of the chronic care model
- recognize the complexity of coordinating care for older adults
- understand the influence of the home environment on the patient
- learn how to prioritize and balance patient responsibilities with competing professional and personal responsibilities
- work as part of a primary team to manage a patient longitudinally.
Students are precepted by their Mentor’s primary care physician and are regarded as junior members of their Mentor’s medical team. All physicians involved in the program are geriatricians. They serve as faculty preceptors and formally meet with their medical students four times over each academic year to discuss and analyze the Mentor’s health status, as well as to review the patient’s medical information. Multiple informal meetings have also occurred outside these set formal meeting times.
Students form relationships with their patient care teams as their Mentors navigate the health care system. Students have the opportunity to experience chronic illness from both the patients' and the health care providers' points of view. They learn about the challenges of, and the opportunities to advocate for, coordination of care. When a Mentor is hospitalized, the first- and second-year students are notified; they then visit the Mentor in the hospital and learn about the inpatient experience. A “SWAT” team comprised of geriatrics and palliative care faculty works with the patient and the student to assure that appropriate emotional support is available for students.
During the years of medical school, the students follow their Mentors as they age and traverse the various sites of care in the health continuum. Students become an integral part of their Mentor’s chronic care management team. They have the opportunity to witness firsthand the role of health care providers and the need for and importance of communication, coordination, and teamwork in patient care.
Staffing Requirements
The program is overseen by a leadership team of clinician-educators in the departments of Geriatrics and Medical Education. The program is taught by faculty Course Directors in the mandatory first- and second-year “doctoring”/clinical skills courses (The Art and Science of Medicine I and II), as well as in the third-year clerkship (Integrated Internal Medicine-Geriatrics Clerkship). The Course Directors are medical doctors whose specialties are internal medicine and geriatrics (in years one and two), and geriatrics (in year three).
Geriatrics faculty preceptors, who work with the students to understand the patients’ care, are an essential feature of the program’s success. Currently there are 25 geriatrics faculty preceptors for the program.
A full-time Program Coordinator manages day-to-day operations. The Program Coordinator is a trained geriatrics social worker who serves as a liaison between the Mentors, students, faculty, and Course Directors. The coordinator also helps facilitate relationships between the students and Mentors, and sends reminders of upcoming formal meetings as well as e-mails to students about inpatient admissions to, and discharges from, the hospital.
Program Costs and Funding Sources
The primary expense is the salary of a full-time Program Coordinator to help with scheduling and communication. Additionally, one or two social activities are held yearly for the Mentors to meet with their doctors and the students.
Initially funded through donations, the program is now being absorbed into the medical school’s Chronic Care curriculum. It is anticipated that about half of the students will be paired with a senior when this occurs; the rest will work with other patients with a chronic illness, such as HIV or chronic kidney disease.
Process and Outcomes Data
Focus groups of Mentors reported that participating in the Seniors as Mentors program provided them with a sense of utility and purpose in their lives; valuable social connections with the students; the opportunity to become more aware of their health status; and a sense of empowerment, as they helped future physicians dispel common misconceptions about aging.
Research is also ongoing to determine whether student participation in the Seniors as Mentors Program effects favorable change on their patient-centeredness and attitudes toward older adults.
Implementation Lessons
- The Seniors as Mentors Program owes its success, in part, to the collaborative efforts of the departments of Geriatrics and Medical Education, and to the support of the Dean for Medical Education. During the 2007-08 school year, the program continued to build on the lessons learned in the first two years of the program, and a pilot program has been launched for third-year medical students. The extension of the program into the third year integrates the "lessons learned" by students during the first two years into their actual care of patients during their clerkships in geriatrics and internal medicine.
- The educators hope that students will enhance their comfort and skill in relating to older people and those with chronic illness; understand how age-associated changes affect health and coping with chronic illness; and recognize the roles of physicians and other members of the health care team in helping to manage illness and enrich lives. It is hoped that the students will become more receptive to working with older and chronically ill patients, and more eager to acquire the skills needed to work effectively with these patients over time.
Available Materials
Tools/Resources
- Detailed description of the Seniors as Mentors Pilot Program
- 2005 Listing of U.S. Medical Schools with Senior Mentor Programs in Geriatrics
Publications
- Gearing up for a graying generation
Croasdale, M
American Medical News
June 9, 2008
www.ama-assn.org/amednews/2008/06/ 2009/prsa0609.htm - Special Issue focusing on Seniors as Mentors Programs
Gerontology and Geriatrics Education, 2006 - University of South Carolina School of Medicine
Roberts, E, Richeson, N, Thornhill, J, Eleazer, GP
Academic Medicine
2004;79(7 Suppl):S161-7
For More Information
Rainier P. Soriano, MD
Assistant Professor
Department of Geriatrics and Adult Development
Mount Sinai School of Medicine
Box 1070
One Gustave L. Levy Place
New York, NY 10029
(212) 241-1519
rainier.soriano@mssm.edu
How to Use the Network Resource Center
Integrated Four-Year Elective Geriatrics Track for Medical Students
at Baylor College of Medicine
| SUMMARY |
| Target Audience All medical students Purpose Program History Operating Costs Outcomes Available Materials For More Information |
Program Overview
In order to provide quality care for our nation’s elderly population, all medical trainees need opportunities to learn about the unique aspects of geriatric care, under the guidance of geriatrics faculty and research mentors.
The Geriatrics Track for Medical Students was created in 2001 to prepare medical students to provide this care and to interest students in careers in geriatrics. The program aims to:
- increase students' knowledge base and sensitivity to the issues of aging adults
- introduce the principles of inpatient, outpatient, nursing home, and home care for older adults
- teach functional, social, cognitive, and physical assessment skills
- facilitate research activities and critical thinking.
The Geriatrics Track was developed in response to faculty and staff observations that first-year students who were enthusiastic participants in the Geriatrics Interest Group were being “lost” when they started their clinical rotations. As part of the four-year program, the Geriatrics Track provides beginning second-year students with hands-on clinical experiences, an attractive feature for students who are eager to begin working with patients.
Program Operations
The Geriatrics Track includes various preclinical and clinical electives for students interested in learning more about the care of older adults. Students participate in patient care in a variety of inpatient and outpatient settings. Faculty mentors work with students throughout the four-year program, which includes the design and completion of a clinical or basic sciences research project.
Students who complete the Geriatrics Track receive a Certificate of Educational Achievement in Geriatrics and a letter of accommodation in the medical school file.
All students are welcome to elect any of the Geriatrics Track components without having completed previous Track courses.
The Geriatrics Track consists of the following components:
Year 1: The Texas Geriatrics Interest Foundation (TGIF)
Students are introduced to geriatrics and gerontology through a joint University of Texas School of Medicine and Baylor College of Medicine student interest group. Monthly activities include didactic lunch conferences, panel discussions, social activities with geriatric medicine faculty, and community service experiences with agencies that support seniors. All students, in any year, are welcome to attend.
Year 2: Aging-related Themes and Geriatric Skills Courses
Aging-related Themes Course: During the Fall of Year 2, all Baylor medical students receive 10 hours of lecture on the Physiology of Aging, given by faculty from the Baylor Huffington Center on Aging.
In addition, a preclinical elective, the Geriatric Skills Workshop, offers eight 90-minute evening sessions providing hands-on training in the assessment of older adults. Workshop topics include:
- sensory assessment, including sensitivity training with impaired vision eyeglasses and other tools
- gait and balance assessment
- physical, occupational, and speech therapy
- use of common medical devices
- mental status evaluation
- history and physical exam skills
- wound care – assessment and treatment
- communicating with older people
- breaking bad news
- care for the dying patient.
Year 3: All Baylor medical students participate in a one-year Longitudinal Ambulatory Care Experience (LACE) one afternoon a week. For students participating in the Geriatrics Track, the LACE requirement can be fulfilled by participation in the GeriHomes Track, in which medicine and care coordination is taught through two home visit programs consisting of house calls in homes, assisted living communities, and nursing homes. Students also visit adult day centers, hospices, and other community agencies for older adults. A project to improve the home visit program or community it serves is required at the end of the year. Participation in the GeriHome Track is by application, with space for 6 students per year.
Year 3-4: Geriatrics Clinical and Research Rotations
During the third or fourth year, students in the Geriatrics Track participate in a 4-week geriatrics clinical care rotation in a hospital setting.
Students also conduct a clinical or basic sciences research project that will have a positive impact on the care of seniors. A research faculty mentor helps students develop the research question, design a study, collect data, and analyze the results. Competitive scholarships are available for travel to the American Geriatrics Society (AGS) Annual Meeting to present the research project.
Staffing Requirements
A Huffington Center on Aging faculty member serves as the Geriatrics Track director, and nine additional faculty support the clinical and research experiences in the Geriatrics Track.
Geriatrics fellows play an additional teaching role; for example, significant responsibility was given to one second-year fellow whose research focused on educational issues. The Geriatrics Track requires about 25% time for an administrative staff person.
Program Costs and Funding Sources
In addition to faculty and administrative staff time, program costs include student scholarships to attend the AGS Annual Meeting and costs of the geriatrics skills course, which can reach $1,500. Research support for each student is about $2,000, and up to three students are supported every year.
This program is supported by the Hartford Center of Excellence grant with minimal supplemental funds from the institution.
Process and Outcomes Data
During the first year, two students completed the track. In 2008, six to eight will complete all the aspects of the track.
At least two of the students that have passed through this program have reported that they will become geriatricians.
A similar Geriatric Skills course is in progress at Saint Louis University, indicating that this approach has “traction.”
Implementation Lessons
- The biggest challenge is marketing: being present at “club” events where all student activity groups enroll members, and using other student venues.
- Another challenge is letting the students choose the topics for Student Chapter noon conferences.
- After implementing the program, it was shown that there are no advantages to excluding those who do not want to participate in the entire track.
- The administrative and logistical burden is significant, especially because the students tend to do everything “at the last minute.”
Available Materials
Tools/Resources
- Geriatrics Skills Workshop syllabus, including course goals and overview
- Geriatrics Track timeline overview
Website
- Geriatrics Track Homepage: www.bcm.edu/osa/handbook/?PMID=6148
For More Information
Aimee Garcia, MD
Assistant Professor of Medicine
Geriatrics Track Course Director
Baylor College of Medicine
VA Medical Center
2002 Holcombe Blvd., 2C-110
Houston, TX 77030
(713) 794-7121
aimeeg@bcm.tmc.edu
or
Geraldine Salmeron, MD
Assistant Professor of Medicine
Section of Geriatrics
Baylor College of Medicine
6550 Fannin, 11th Floor
Houston, Texas 77030
(713) 394-3873
salmeron@bcm.tmc.edu
Aging Organ Systems Curriculum for Second-Year Medical Students
at the Wake Forest University School of Medicine
| SUMMARY |
| Target Audience Second-year medical students Purpose Program History Operating Costs Outcomes Available Materials For More Information |
Program Overview
Traditionally, geriatrics was taught as a stand-alone course in the second year of the Wake Forest medical school curriculum. Beginning in 1998, an overall curriculum redesign provided an opportunity to integrate geriatrics content, including the demographics of aging, aging physiology, and common age-related diseases, across the entire medical school curriculum. For the second-year curriculum, this entailed integrating geriatrics into 10 organ-based topics. In addition to the educational goals, this curriculum was also intended to raise students’ awareness and interest in geriatrics as a career choice.
The integration of geriatrics content first occurred by modifying the small-group case-based learning curriculum, which supplements content taught in lecture format. While this worked well in introducing clinical decision making for older people early in the curriculum, it did not sufficiently introduce the spectrum of physiological changes with aging or common disease processes in older adults.
Additionally, the weighting of course content from the cased-based component of the curriculum on the examinations has been lower than that of the lecture curriculum. Thus, teaching geriatrics only in the case-based content sent a message to students that geriatrics knowledge was not “worth” as much as other disciplines. Therefore, a need was identified to integrate geriatrics into the lecture-based curriculum as well.
Program Operations
A geriatrics faculty member who served as the Lecture Coordinator oversaw the development and integration of “Aging Organ Systems” lectures into the Year 2 curriculum. With the support of the Associate Dean for Undergraduate Medical Education and the Year 2 Curriculum Director, a key faculty member was identified to deliver the geriatrics curriculum for each topic area.
The learning objectives for the geriatrics lectures in each of the 10 organ-based topic areas are to:
- describe changes in susceptibility to disease with aging
- distinguish “normal” aging from disease
- recognize characteristics of the older patient that may affect outcomes or treatment strategies
The lectures usually begin with a case that prompts a brief discussion to engage students in the topic. An electronic curriculum allows lecturers to use technology to enhance active learning in real time in the classroom. For example, a Student Response System is used to introduce common misconceptions about aging of the nervous system. Students (who all have school-issued laptop computers) log in to a site where the lecturer has posted four True-False questions about aging of the nervous system, such as “Significant memory loss is a normal part of aging.” The students submit a response and the system allows the lecturer to display aggregate results to the class. The displayed results serve as a springboard for an initial discussion. To keep students engaged, the correct answers are given during the body of the lecture.
Staffing Requirements
A Lecture Coordinator (geriatrics faculty member) is needed during the first year to focus on integrating geriatrics content into the organ-based curriculum, at approximately one calendar-month of dedicated effort. Each course has a departmental leadership structure overseen by the Office of Medical Education, with ten faculty members needed to plan and deliver the organ-based lectures. Their time is covered by funding provided by the Office of Undergraduate Medical Education, routed through the various departments.
Ongoing support by the medical school for individual lecturers and continued Lecture Coordinator oversight is needed at approximately 0.5 calendar-months per year. A dedicated administrative assistant is helpful in the ongoing monitoring of lectures. The Lecture Coordinator is funded through the geriatrics section of the Office of Medical Education.
Program Costs and Funding Sources
The primary program cost is the faculty and staff time delineated above. Development of the program to integrate geriatrics into the Wake Forest curriculum was funded through a U.S. Health Resources and Services Administration Geriatric Academic Career Award (GACA).
Process and Outcomes Data
114 medical students go through the second-year curriculum each year. The AAMC graduation survey found that students’ perception of their level of exposure to geriatrics at Wake Forest has increased greatly since this project was introduced in 2004. In the 2003 graduating class, 31% of students agreed or strongly agreed that geriatrics/gerontology education was part of all four years of their medical education. In 2007, 63.8% of the graduating class agreed with this statement (compared with 48.1% nationally).
Implementation Lessons
- A key aspect of the success of this type of program is not only commitment from the dean’s office and course directors, but also centralized oversight of the project. As faculty leave the institution and new faculty arrive, programs such as this can become lost in the shuffle due to the fact that lecturers are based in different departments. Since the project has been developed, the electronic curriculum at Wake Forest allows quick perusal of the lecture line-up for the entire year, and any concerns can be addressed by the Lecture Coordinator.
- While technology is very useful in getting important physiology or disease points across, there is no substitute for real patient contact to impact attitudes toward older adults. For example, in addition to discussions regarding hematological diseases in the older adult, the hematology/lymphatic lecture features a healthy elderly survivor of lymphoma who discusses his/her experiences with chemotherapy.
- In the initial implementation of the project, the Lecture Coordinator met with the faculty responsible for the “Aging Organ Systems” lectures to review the purpose and scope of the project and to discuss important aspects of aging related to the organ-system. In the first lecture of the series, a greater emphasis is placed on the demographic imperative for having the series and the plan for evaluation of content through all the topics.
- Five of the ten initial lecturers for this program had been participants in the John A. Hartford Foundation-funded Geriatrics Education Retreats (GERs), designed to train faculty about the importance of integrating geriatrics training into the subspecialties of Internal Medicine. Therefore, they easily grasped the concept of integrating geriatrics into organ-system education. Those who did not have this experience required a little more direction and development and were directed to review articles and other materials.
- The Lecture Coordinator served as the lecturer for the nervous system topic and attended all other lectures in person (or listened to the audio lectures online) and gave direct feedback. This process allowed for refinement of the initial series. Any change in the lectures or lecturers is reviewed by the Lecture Coordinator.
- In addition to working with the individual lecturers to develop content, the Lecture Coordinator can also identify unnecessary duplication of content or essential components that may be left out of the curriculum. The program also records all lectures, and sampling of quality of the lectures is routinely done online.
Available Materials
Tools/Resources
- Lecture objectives and sample cases
- Lecture slides from various departments (available upon request)
For More Information
Hal Atkinson, MD, MS
Assistant Professor
Section on Gerontology and Geriatric Medicine
Department of Internal Medicine
Sticht Center on Aging
Wake Forest University School of Medicine
Winston-Salem, NC 27157
(336) 713-8583
hatkinso@wfubmc.edu
Ambulatory Geriatric Care Rotation for Third-year Medical Students and Internal Medicine Interns
at the Wake Forest University School of Medicine
| SUMMARY |
| Target Audience Third-year medical students and Internal Medicine interns Purpose Program History Operating Costs Outcomes Available Materials For More Information |
Program Overview
A one-month rotation in the Acute Care for the Elderly (ACE) unit is required for all upper-level Internal Medicine residents. However, by the time many residents complete this rotation, their career paths have been set and post-residency training plans have been determined.
The one-month Ambulatory Geriatrics Experience Rotation was created in 2000 to reach students and interns before those critical career decisions are made, as a means to attract more medical trainees to careers in geriatrics. Because the strongest tool for attracting trainees to geriatrics is clinical role models, trainees develop relationships with outstanding geriatrician mentors during the rotation, while developing their core clinical skills.
This rotation was made mandatory for all Internal Medicine interns in 2007. Third-year medical students have previously been randomly assigned to participate in a two-week experience as part of their Ambulatory Internal Medicine rotation. The goal is to provide this experience for all third-year students.
The Rotation’s main goals are to:
- dispel the common misconception that older patients receive the majority of their medical care in the inpatient setting
- help students and interns develop an appreciation for the health care system for older people
- integrate essential geriatrics knowledge and skills into medical trainees’ clinical practice, regardless of the ultimate specialty they choose.
Program Operations
Students are given the opportunity to provide care to older patients in a variety of clinical settings: long-term care, house calls, hospice, primary care clinics, and consultative geriatrics clinics. The program objectives are for participants to:
- demonstrate communication and professional skills necessary to work productively with older adults
- demonstrate sensitivity to patient preferences and cultural backgrounds
- practice competent internal medicine for older people (expectations adjusted for student or resident status)
- demonstrate knowledge of and attentiveness to geriatric syndromes
- demonstrate a rational approach to drug prescribing in the older adult
- identify the basic structure, financing, and challenges of the health care system for older people, including transitions of care between settings.
The Ambulatory Geriatrics Experience rotation includes the following:
- Geriatric Memory Assessment Clinics: Within the weekly clinic, learners observe neuropsychological testing and learn from the geriatrics attendings and fellows how to differentiate between various types of cognitive impairment, address safety concerns, and administer pharmacological and nonpharmacological aspects of treatment.
- Primary Care Outpatient Clinic: Learners work with geriatrics attendings, fellows, and a geriatric nurse practitioner. Third-year medical students progress from shadowing to active evaluation, while more advanced learners practice history-taking, physicals, and medical decision making.
- Physician's House Call Program: During weekly house-call visits with the geriatrics fellows, learners get a first-hand glimpse of the patient’s home environment. During orientation, learners are asked to evaluate social settings and pay particular attention to care strategies that disabled patients and their families use to remain at home. This allows students to see not only the medical but also the social aspects of geriatric care.
- Long-Term Care (Nursing Home and Assisted Living): Learners conduct weekly rounds at various long-term care facilities. They are encouraged to read hospital discharge summaries and use them to guide their decision making. Students also learn the common pitfalls encountered when patients make the transition to a long-term care setting and the importance of appropriate discharge summaries. Students participate in case-based discussions led by the attendings. They attend lectures on how to determine the appropriate level of care for patients, health care financing, and long-term care issues, such as caring for chronic wounds, reducing polypharmacy, and addressing advanced directives.
- The ACE Transition Program: Learners and the geriatrics fellow make an investigative visit to a patient who has been discharged from the ACE unit. The ACE team has daily interdisciplinary meetings where cohesive discharge plans are discussed and implemented. The ACE Transition Program visit helps to determine how well the patient is making the transition to home; to assess the need for subacute or acute rehabilitation or hospice from the inpatient setting; and to assess how the individual patient and caregivers are coping. For example, when a patient is discharged from the hospital to rehabilitation at a nursing home for the first time, the information gathered from the ACE Transition Program visit is presented to the interdisciplinary ACE team on a weekly basis. In this way, teaching rounds focus on continuous quality improvement and interdisciplinary education.
- Didactic Teaching: Learners participate in the ongoing Geriatrics lecture series, which includes topics such as wound care, rehabilitation, theories of aging, cognitive behavior therapy, and falls. Students and residents are also active participants in a bimonthly Journal Club, and residents work together to present a journal article each month. A notebook of readings is also provided to each trainee, containing material from the American Geriatrics Society Geriatrics Review Syllabus and additional core reading material on levels of care, health care financing, and individual geriatric syndromes. A goal for the next year is to develop electronic modules with associated prerecorded “minilectures” to supplement the ongoing lectures and provide consistency of learning for each rotating trainee.
- Pre- and Post-test: A knowledge-based multiple choice and fill-in-the-blank test is given at the beginning and the end of each rotation.
- Research Opportunities: Learners, particularly fourth-year medical students, are exposed to the ongoing research within the Sticht Center on Aging and are encouraged to develop research projects.
The curriculum was written in accordance with Accreditation Council for Graduate Medical Education guidelines for competencies in patient care, medical knowledge, practice-based learning and improvement, interpersonal skills and communication, professionalism, and systems-based practice.
Staffing Requirements
All six clinical geriatrics faculty participate in some aspect of the Ambulatory Geriatrics Experience rotation, including the nursing home medical director; the clinic director, as preceptor for the outpatient clinics; and the ACE attending who facilitates the interdisciplinary team meeting and the ACE Transition Program reports. An administrative staff member handles all the scheduling for the rotation (10% effort).
Additionally, PhD faculty participate actively in Journal Clubs, the Aging Conference, and the Core Conference Series.
Program Costs and Funding Sources
The medical school provides financial support to cover approximately 5 -10% of each faculty member's effort. The medical school also recognizes teaching excellence for faculty devoted to medical student education, which can be used as part of the published promotion process.
Process and Outcomes Data
Students’ perceptions of the amount of education in geriatrics have steadily risen over the last three years, as measured by the American Association of Medical Colleges (AAMC) graduation survey. The in-training examination results for geriatric medicine have also steadily risen over the last three years: upper-level internal medicine residents score in the 97th percentile for geriatrics.
Students rate the Ambulatory Geriatrics Experience rotation, the outpatient clinic, the nursing home, the consultation clinic, house calls, and the ACE Transition Program on a scale of 1 (very poor experience) to 10 (very best experience ever). They can also indicate what they liked and didn’t like about their experience. Students can also evaluate specific faculty attendings, fellows, nurses, mid-level practitioners, etc. Of the feedback from 40 interns between 2006 and 2007, the average rating was 7.83/10.
A dedicated tracking system is planned to quantify the outcomes of the program and track future careers in geriatrics. There is also a plan to include a reporting system to identify students who choose a career in geriatric medicine.
Implementation Lessons
- The feedback provided by learners through their evaluations continually informs the rotation curriculum. Feedback has been generally positive. The ACE Transition Plan portion is the newest addition to the AGE rotation and has received varied responses from "very interesting to see how people actually live" to "sometimes we travel to unsafe places." The Geriatrics Primary Care Clinic uniformly receives praise, and learners express the desire to spend more time there.
- It is essential to have “champions” among the institution. The program has outstanding support from the Internal Medicine Residency office, the Residency Program Director, and the coordinator for the Ambulatory Internal Medicine rotation for third-year medical students. The positive feedback and the institutional support have been leveraged to make the Ambulatory Geriatrics Experience rotation mandatory for all Internal Medicine residents.
Available Materials
Tools/Resources
For More Information
Hal Atkinson, MD, MS
Assistant Professor
Section on Gerontology and Geriatric Medicine
J. Paul Sticht Center on Aging
Wake Forest University School of Medicine
Winston-Salem, NC 27157
(336) 713-8583
hatkinso@wfubmc.edu
Year-end Professional Skills Assessment Geriatrics Case
at the University of Wisconsin-Madison School of Medicine and Public Health
| SUMMARY |
| Target Audience All third-year medical students Purpose Program History Operating Costs Outcomes Available Materials For More Information |
Program Overview
The Year-end Professional Skills Assessment program in geriatrics was created to evaluate third-year medical students to ensure that they have developed the clinical competencies in geriatrics necessary to proceed with their medical education.
These include:
- recognizing how the features of the aging process are distinct from those of age-related illness
- identifying psychosocial and economic risk factors for older adults that predispose them to illness and loss of function
- performing the basic components of a geriatric assessment
- recommending age-appropriate preventive care for older adults
- demonstrating knowledge of basic approaches in screening for and managing geriatric syndromes/illnesses
- adjusting treatment strategies.
Incorporating a geriatrics-specific case in the overall Year-end Professional Skills Assessment program provides greater visibility for geriatrics as an important area of specialization, with the possibility of interesting more medical students in careers in the field.
Program Operations
A comprehensive, objective-structured clinical examination is administered to students at the end of Year 3 of medical school. It is a degree requirement and must be passed before the student is allowed to graduate from the School of Medicine.
Students rotate through multiple 15-minute clinical stations during which time they have ten minutes to interview the patient. Each case aims to assess the student’s communication skills, knowledge, and ability to synthesize information elicited from the standardized patient. During the final five minutes, faculty ask programmed questions to assess the students' synthesis of the information elicited. A case evaluator videotapes each student’s performance. These cases are intended to assess competency rather than differentiate average from excellent students. As such, they attempt to screen for the small subset of students who do not have the interviewing skills, knowledge, or capacity to synthesize the key concepts of the case.
Each station is based on a clinical core competency list that is developed by the third- year clerkship directors and the geriatrics education liaison. It is distributed to students at the beginning of Year Three. At Wisconsin, geriatrics is one of the few non-departmental cases in the Year-end Professional Skills Assessment.
The geriatrics case can also be used for assessment of performance in other learning venues such as a clerkship or an elective rotation. To incorporate it into a larger skills examination requires the following steps:
- meeting with faculty who oversee the skills assessment at the medical school for buy-in and consensus
- identifying the competencies to be tested
- creating the case with school experts in instructional design and geriatrics
- reviewing the case with the Year-end Professional Skills Assessment committee
- educating standardized patients and case evaluators for uniformity in the administration and evaluation of the case
- scheduling evaluators if multiple cases are to be run simultaneously
- storing the assessments into an electronic database, e.g., PC tablets and concurrent video capture of all cases
- creating remediation processes for those students who obtain marginal or failing grades on this case.
Once there is completion of a case description, a script for standardized patients and a checklist for evaluators, then the case is embedded into the larger skills examination and infrastructure.
Staffing Requirements
Different staffing requirements exist within the three phases of the program. The case development phase requires geriatrics faculty member content expert(s), an administrative staff member with expertise in instructional design, and a seasoned standardized patient to help translate the key concepts and details into a script. The evaluators’ checklist must also be created by the case developer.
The case administration phase covers the actual six half-day testing session. Over 150 medical students are tested. Typically, two geriatrics stations are run simultaneously for 12 students per half day. This requires two case evaluators per half day and one back-up faculty to fill in for any evaluator who cannot be present. A Year-end Skills Professional Assessment administrator needs to coordinate this schedule and ensure that the faculty adjust their schedules and are reminded several days prior to the examination.
The remediation phase typically requires one faculty member or a small working group. They must identify the component(s) of the case that a student performed poorly on and create a remediation plan to help improve the student’s skills or knowledge base prior to readminstering the examination five months later.
Program Costs and Funding Sources
The following personnel and training are required:
- Six to eight hours of development time by a geriatrics faculty member
- An instructional design expert (either internal staff or a consultant)
- Paid time of an experienced standardized patient who helps develop the case script
- Faculty time to administer the cases within the examination and proctoring time of the Year-end Professional Skills Assessment administrators (the exact program costs for this aspect of the program depend on the number of students tested)
- Extensive training for the volunteer standardized patients (the cost for training these individuals is usually integrated within the infrastructure of the schools testing center)
- The cost for the faculty time to conduct the remediation dimension of the program, with a typical remediation meeting and follow-up to enact the plan taking between two and three hours per student
In addition to funds from the school testing center, earmarked faculty time and money are released from the Geriatric Research Education and Clinical Center and the geriatrics section. The GRECC has faculty time earmarked for education and the geriatrics section releases faculty time and money for these activities.
Process and Outcomes Data
Out of the 750-plus students who have been assessed over the past five years, approximately 2% have had marginal or failed performances on their geriatrics cases. No students have argued that the case was unfair or did not test the competencies that were emphasized.
Four distinct geriatrics cases have been developed since 2002; a fifth case is currently being adapted from an earlier case. The geriatrics case directly aligns with topics from the written geriatrics competencies of the medical school curriculum. Information from the case examination is analyzed and given back to course directors as feedback and presented to the Educational Policy Committee to determine if the curriculum is meeting the needs of our students.
Several levels of evaluation occur to test the internal validity of the cases to distinguish between students who do and don’t demonstrate the core competencies tested. During the initial case development, test students evaluate each case. Once the cases are employed in the larger examination, analysis occurs to determine how failures on multiple cases correlate. Typically, students who struggle in one case also show inadequate performance in other cases. If a specific case fails more students than the mean or does not detect any marginal or failing students, then closer scrutiny occurs regarding that case. This has not occurred to date with the geriatrics case. Video capture also helps to corroborate if the evaluator appropriately assessed the student by allowing another evaluator to independently judge the student’s performance.
Long-term educational outcomes have not yet been gathered regarding the students’ performance on the geriatrics case and the capacity of this evaluation tool to predict performance on standardized tests or measures of proficiency in caring for older persons at the residency or practicing-physician level.
Implementation Lessons
- For initial acceptance of the geriatrics case, the geriatrics program director needed to work closely with the Year-end Professional Skills Assessment committee and key administrators of the student testing site to gain buy-in. The program director also worked with the Associate Dean for Curriculum to demonstrate the need for a geriatrics case that is distinct from cases delivered by the Departments of Medicine and Family Medicine. The Year-end Professional Assessment Skills program has flourished due to strong institutional support from key curriculum leaders. Aligning the case topic with both local competencies and the forthcoming geriatric competencies supported by the Association of American Medical Colleges persuaded leadership to proceed with support for the geriatrics case.
- It typically takes two to three months for case development from conception to administration of the beta-cases to students acting as test subjects. The case developer needs to identify a test population that will be comparable to the students being evaluated. This typically has been either fourth-year medical students or third-year students from other schools who have the integrity to maintain the security of the case. Feedback from the 3-5 test students has resulted in cases with higher ratings for quality than cases tested by fewer student test subjects.
- The evaluation of these cases leads to three categories of performance: pass, marginal, and fail. Given the wide variety of faculty views regarding student performance, it is essential that evaluation criteria and an explanation of these criteria occur with all case evaluators. The evaluation checklist attempts to help the evaluators identify the presence or absence of discrete skills or behaviors to enhance uniformity amongst testers.
Available Materials
Tools/Resources
- Example of geriatric competencies for third-year medical students
- Example case
- Script for standardized patient
- Checklist and direction for case evaluators
- Schedule for evaluators
For More Information
Steven Barczi, MD
Associate Professor of Medicine
Division of Geriatrics and Gerontology
University of Wisconsin School of Medicine and Public Health
Madison VA GRECC (11G)
2500 Overlook Terrace
Madison, WI 53705
(608) 280-7000
steven.barczi@med.va.gov
Area of Concentration and Geriatrics Certificate Program for Medical Students
at the University of Pittsburgh School of Medicine
| SUMMARY |
| Target Audience All medical students Purpose Program History Operating Costs Outcomes Available Materials For More Information |
Program Overview
The Area of Concentration in Geriatric Medicine aims to encourage students to consider a career in aging by promoting an interest in aging as part of a medical career, regardless of chosen specialty and clinical or academic path. Completion of the four-year program leads to a Certificate in Geriatrics in addition to the MD degree. The program combines clinical and research experiences with didactic instruction to enhance students’ understanding of the complex health issues affecting older adults.
The Area of Concentration program began in the 1990s because students were interested in medicine-related activities outside of the usual medical school activities. The Geriatric Medicine Concentration was the second of eight concentration areas that were created.
Program Operations
During the first year, students participate in a home visit program, completing six home visits over the school year, as well as six monthly group sessions to talk about their home visits with peers.
Between the first and second year, about 20 students each year complete a summer research experience. During the second year, students participate in a monthly geriatrics case series linked to the organ system based curriculum. Up to 60-70 primarily second-year students participate in a clinical discussion that focuses on the age-related aspects of the organ system they are studying. This helps integrate patient care with class learning, as well as giving the students a perspective on how age affects a person's organs.
Students are also involved in a scholarly
project related to aging, which must result in a manuscript to be published or a paper to be submitted to faculty. (Note: all medical students are required to do a scholarly project).
In the third year, students participate in a month-long clinical rotation.
In the fourth year, students choose an aging elective for research or a focused clinical activity and attend a variety of social events.
Students who complete a research project present at the American Geriatrics Society annual meeting during their second or fourth year.
Students in all years attend a series of evening sessions with visiting speakers. Student leaders organize and promote most of the activities. Students are welcome to participate in any components of the four-year program without being required to complete the Area of Concentration in Geriatrics.
Staffing Requirements
A faculty member from the Geriatrics Division serves as the program coordinator (5% FTE) and an administrative staff coordinator handles program logistics (5% FTE). Lectures, mentoring of research activities, and clinical experiences are all provided by faculty volunteers.
Program Costs and Funding Sources
The medical school pays 5% of the faculty member’s salary to coordinate the program. Costs for group meetings and case studies reach a few thousand dollars and are covered by foundation and internal sources. Summer training costs are covered by training grants, and administrative costs are 5-10% of a secretary's time.
Funding comes from the Hartford Center of Excellence, the Geriatrics Division, National Institute on Aging T32 and T35 grants, and the American Geriatrics Society state affiliate. The Geriatric Medicine program collaborates with the medical school’s Hartford Center of Excellence and T32 program in Geriatric Psychiatry.
Process and Outcomes Data
The program has an average of 25-35 participants per year, with 8-10 obtaining the Certificate in Geriatrics. Not all students participate in all Area of Concentration in Aging activities, and not all participants complete the entire program. It is estimated that one to three of those who obtain the Certificate pursue a career in geriatric medicine.
Measures of success include:
- number of student participants by year
- number of participants in summer research programs
- number of students who select an aging topic for the required medical school scholarly project
- number of graduates with a Certificate in Geriatrics
- initial and long-term career choice.
Implementation Lessons
- Students become engaged in and excited about the program in the first year because it provides opportunities for encounters with patients. These students become the program’s best recruiters, particularly through word-of-mouth.
- Consistency of faculty leadership has been important to the program’s ongoing success and has resulted in wide acceptance within the medical school.
Available Materials
Tools/Resources
- Program Outline
- Case Series Description and Approach to Case Presentation
- Scholarly Project Overview
- GEMS Topics and Interview Questions
For More Information
Stephanie A. Studenski, MD, MPH
Professor of Medicine
Division of Geriatric Medicine
University of Pittsburgh School of Medicine
Kaufmann Medical Building, Suite 500
3471 Fifth Avenue
Pittsburgh, PA 15213
412-692-2364
StudenskiS@dom.pitt.edu
