Transcript Training the future providers of geriatric care

Medical Student
Training in Geriatrics
Model Program in the
Osteopathic Profession
Anita Chopra, MD, FACP, AGSF
Professor and Director of Education
and Clinical Programs
New Jersey Institute for Successful Aging
UMDNJ-School of Osteopathic Medicine
The Aging Imperative in
Medical Education

Our nation’s aging population is growing
dramatically
35.6 million 2003
71.5 million 2030

85+ is the fastest growing segment of the entire
population
4 million 2003
20 million by 2050

65+ population represent 50% of all ambulatory
care visits to primary care physicians
1

The old-old consume 50% of Medicare dollars
1 Centers for Disease Control and Prevention, NCHS, National Ambulatory Care Survey, 2002
The Aging Imperative in
Medical Education

20% of the Medicare population has at least five
chronic conditions and visits 14 different physicians in
37 office visits each year
2

There are fewer than 7,000 certified geriatricians falling
significantly short of the current need of 14,000 and
the projected need of 36,000 by 2030
3

Less than 2% of graduating physicians seek careers in
geriatric medicine
4
2 Berenson, RA & Horvath, J. Confronting Barriers to Chronic Care Management in Medicare. Health Affairs. 2003; W 3-37-53.
3 Medical Never-Never Land : Ten Reasons Why America Isn’t Ready for the Coming Age Boom. Washington, DC, Alliance for Aging Resource, 2002
4 Medical Student Training in Geriatrics at the Begiining of the 21st Century, ADGAP Longitudinal Study of Training and Practice in Geriatric Medicine, October 2003
“Too often, illnesses in older people are
misdiagnosed, overlooked or dismissed as the
normal process of aging, simply because health
care professionals are not trained to recognize
how diseases and drugs affect older patients
differently than younger patients. All of these
situations potentially could translate into
suffering by patients.”
Geriatric Medicine: A Clinical Imperative for an Aging Population, A Report from the American
Geriatrics Society and ADGAP, October 2005
Training the future providers of
geriatric care ….
Are we on the right road?
Academic Geriatric Programs in
Osteopathic Medical Schools

Academic units
3 Free standing Departments of Geriatrics
 1 Center/Institute
 9 Divisions of Geriatrics



3.1 FTE’s median # of faculty working in
academic geriatrics
20% is median time spent on medical student
teaching
ISH ADGAP Database Project. Survey of Directors of Geriatric Academic Programs in U.S. Osteopathic Medical Schools. Spring 2005.
(n=10, 50% response rate). 2001 survey data used for schools who did not respond
AAMC Survey of Medical Schools
Teaching Geriatric Topics
Academic
Year
#
Responding
Part of
Existing
Required
Course
Separate
Required
Course
Separate
Elective
Course
Do Not
Offer
1990
123
106 (86%)
8 (7%)
0 (0%)
5 (4%)
2000
125
116 (93%)
10 (8%)
68 (54%)
0 (0%)
AAMC Medical School Graduation Questionnaire
Do you believe that the time devoted to instruction in Geriatrics
was adequate, appropriate or excessive?
All Schools
Inadequate
Appropriate
Excessive
Count
1990
29.1%
67.1%
3.8%
11,527
2000
38.6%
57.5%
3.9%
14,103
2005
24.5%
70.3%
5.2%
9,610
UMDNJ-SOM Model
Geriatric Program

Established in 1989 as a free standing Center for Aging at
UMDNJ-SOM

Evolved to a statewide New Jersey Institute for Successful Aging
in 2005.

Interdisciplinary faculty and clinical services




Geriatric Medicine
Geriatric Psychiatry
Geriatric Neurology
 Gerontological Nursing
 Geriatric Social Work
 Neuropsychology
Ranked among the top 20 Best Graduate Schools in Geriatric
Medicine for six consecutive years
Geriatric Curriculum
Across the Years




Integrated Coursework – Yr 01 and 02
Required Geriatric Course – Yr 02
Required One Month Clerkship – Yr 03
Elective Geriatric Rotation – Yr 04
Geriatric Curriculum: Year 01

Integrated geriatric content
Genetics of Alzheimer’s disease
 Biochemistry and age-related changes
 Neuroscience and the aging brain
 Pharmacology


OMM: criteria for use of OMT for specific at
risk patients
Geriatric Curriculum: Year 02

Required Geriatric Course

Principles of Geriatric Medicine
 Theories of Aging
 Pharmacology and Drug Prescribing
 Physiology of Aging
 Comprehensive Geriatric Assessment
 Aging Society and Ethnogeriatrics

Common Geriatric Syndromes
 Confusion: Dementias & Delirium
 Incontinence
 Falls, Immobility and Pressure Ulcers
 Psychiatric disorders – agitation, psychotic disorders,
depression and suicide
Geriatric Curriculum: Year 02
(continued)

Integrated Coursework in Geriatrics

Introduction to Patient Dynamics

Death and Dying Seminar

Pain Seminar

OMM






Bone pain
Abnormal AP curves including Dowager’s
Vertebral compressions
Normal and abnormal gait and preventing falls
Parkinson’s disease
Simulated Cases
Geriatric Curriculum: Year 03
One month Required Geriatric Clerkship

Acute care – 2 weeks

Content Areas:





Nosocomial infection and use of OMT for pneumonia and UTI
Confusion
Malnutrition
Pressure Ulcers
Long term care – 1 week

Sites:




Nursing homes and continuing care retirement communities
Subacute Care
Home and Hospice Care
Content Areas:





OBRA
Drug Prescribing
Agitation related to dementia
Depression
Incontinence
Geriatric Curriculum: Year 03
One month Required Geriatric Clerkship
(continued)

Ambulatory Care – 1 week
 Experiences:






Primary care Geriatric Medicine
Geriatric Neurology
Geriatric Psychiatry and Neuropsychology
Case Management
Family and team meetings
Specialty programs – Memory Assessment, Huntington’s
 Content Areas:


Comprehensive Geriatric Assessment: Function, Cognitive, Affective.
Psychosocial
Health promotion
Geriatric Clerkship Curriculum


Interdisciplinary team conferences
Ethics Seminar
 Quality of Life



Advance Directives
End of Life
Student Case Presentations



Falls
Dementia
Ethnogeriatrics

Online Case Studies

Required readings



Heart disease
Substance Abuse
Polypharmacy
Geriatric Clerkship WebCT site
Geriatric Curriculum: Year 04

Elective rotations
Geriatric Medicine, Neurology or Psychiatry
 Tailored to individual student learning needs
 2 – 4 week options

New Directions

3-C Curriculum



Expand to a one month Geriatric Course in Year 02
Integration of basic science and clinical concepts
Case-based learning





Approach to the older adult and ethnogeriatrics
Polypharmacy
Falls, Immobility and Iatrogenesis
Cognitive dysfunction
New evaluation strategies


OSCE
Competency-based checklist across geriatric curriculum
Student Voices……..
“ Nothing against geriatrics, but I did not expect to like this rotation at all. I was wrong. The faculty
was excellent. I saw first hand the passion they have for their work and how rewarding caring for
older adults can be.”
“ The clerkship provided an insight into the complicated care involved in geriatrics. It also
highlighted the non-medical issues that have to be addressed with the elderly such as financial,
social and housing issues.”
“ I think the most valuable aspect of my Geriatrics experience was being able to work with the
team - the geriatrician, neuropsychologist and the social worker and then being able to work with
patients in all the settings. Because I was afforded this experience, I have taken the philosophy of
being fully immersed in all aspects all of my other rotations, making each rotation a better
learning experience. Thanks for all of your hard work, dedication, organization and for making
this an extremely worthwhile experience .”
“ I liked how we received a well-balanced rotation getting a chance to experience inpatient,
ambulatory and long term care settings. I also came to appreciate the expertise of the
practitioners in the department. It was obvious that it is truly a Center of Excellence in
Geriatrics.”
For more information
Contact:
Anita Chopra, MD
Director of Education and Clinical Programs, NJISA
[email protected]
(856) 566-6470
or
Pamela Basehore, MPH
Associate Director for Education, NJISA
[email protected]