Training the future providers of geriatric care

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					  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       #        Part of      Separate    Separate    Do Not
  Year     Responding   Existing     Required    Elective     Offer
                        Required      Course      Course
                        Course
 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      Gerontological Nursing
        Geriatric Psychiatry    Geriatric Social Work
        Geriatric Neurology     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                      Heart disease
        Dementia                   Substance Abuse
        Ethnogeriatrics            Polypharmacy


   Online Case Studies
   Required readings
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
            chopraan@umdnj.edu
            (856) 566-6470
            or
            Pamela Basehore, MPH
            Associate Director for Education, NJISA
            basehore@umdnj.edu

				
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