Geriatric Training Crucial for Today's Medical Schools
Dichele, Rita Mary, Aging Today
With the predicted 78 million baby boomers cresting age 65 in the next two decades, the medical community needs to be ready to respond to the eclectic demands of a generation known for getting what it wants. The Institute of Medicine (IOM) Committee on the Future Health Care Workforce for Older Americans projected in its 2008 report, Retooling for an Aging America: Building the Healthcare Workforce (iom.edu/Reports/2008/Retoolingfor- an- Aging- America- Building- theHealth-Care-Workforce.aspx), that we will need 36,000 geriatricians by 2030. According to The American Medical Association, there are now only 7,000 geriatricians in the United States.
Medical schools have responded by developing curriculum to familiarize students with the elder cohort, as well as to attract doctors to a previously undersold profession. Medical school faculty are attempting to increase awareness, sensitivity and empathy toward a group often erroneously stereotyped as difficult to treat because they are allegedly cranky, uncooperative and stubborn. As recommended in the IOM report, the programs provide non-clinical venues for practice, allowing students to engage with elders on their turf- in nursing homes, community programs and patients' residences.
Training a Geriatric Specialist
In 2005, there were 19 medical schools with senior mentor programs in geriatrics-today there are approximately 58 such schools. These programs train students through unconventional methods, with a hands-on curriculum that includes buddy programs with Alzheimer's patients, healthy elder mentoring, residential patient treatment, visits to successful aging models such as senior centers, recreational activities, assisted living facilities, health fairs and community dances. Funding for these programs come from sources such as the John A. Hartford Foundation, Donald W Reynolds Foundation and the National Institute on Aging for the purpose of promoting geriatric curriculum.
But recruiting physicians for geriatric work remains difficult. It is still viewed as less appealing, as reported in the Journal of the American Geriatrics Society (JAGS), "Caring for Older Americans: The Future of Geriatric Medicine" (53:6, 2005). Medical students are reluctant to become geriatricians because of poor reimbursement, preconceived perceptions of older people's lifestyle and non-reimbursed time spent between patient visits to manage chronic conditions.
Research described in JAGS, "Medical Students Perspectives on Geriatrics and Geriatric Education" (58:10, 2010), reported University of Miller School of Medicine students feeling conflicted when faced with prolonging life in a population that might be better off left to die on their own terms or timeframe. The research described students as disinterested in the routine care of older adults and preferring to be on the "cutting edge of science."
Nevertheless, if the demographic of elders continues to grow as predicted, medical students will be treating fewer young patients and more elders who have geriatric syndromes, such as a propensity toward falls and nutrient deficienciesconditions beyond the scope of basic medical training.
But, geriatric research is becoming more prevalent. In fact, since 2005, when literature was modest, numerous studies were published in "Caring for Older Americans" regarding research on helping medical students improve their skills in interviewing patients, identifying barriers that might impede elders from adhering to medical recommendations, and recognizing issues (such as transportation) that preclude older adults from accessing healthcare. Relevant issues on senior mentoring programs date back to 2004 in JAGS. And research conducted in 2006, as reported in Educational Gerontology in "Using a Geriatric Mentoring Narrative Program to Improve Medical Student Attitudes Towards the Elderly" (35:10, 2009), found a program at Drexel University of Medicine requiring students to write narratives regarding their experiences with older people in non-clinical venues beneficial. …