Residency Programs Not Preparing Students for Geriatric Population

Cathy Tokarski

March 10, 2005

March 10, 2005 — Medical education is not preparing future physicians well enough to meet the health needs of patients aged 65 years and older, a population whose size will begin to explode in the coming decade, according to a new study.

To address that deficiency, medical residency programs should develop more accredited geriatric training programs and adopt a stronger overall focus on the medical needs of an older patient population, writes lead author Elizabeth Bragg, PhD, RN, a research associate at the Institute for Health Policy and Health Services Research of the University of Cincinnati College of Medicine in Ohio. Her article appears in the March issue of Academic Medicine.

Patients aged 65 years and older are currently seeking more outpatient medical care from specialists, who typically have little or no training in geriatric medicine compared with primary care and family physicians, according to the article. In 2001, 53% of outpatient visits by older patients were paid to non–primary care specialists compared with 40% in 1980, the article noted.

Specialists may lack the clinical experience to determine how an older patient population, or an individual with multiple chronic conditions, might fare after surgery or under a specific drug regimen, Dr. Bragg told Medscape. "A cardiologist may be expert for treating the heart, but not in how to care for the heart of an older patient," she said.

Only 27 of the 91 residency review committee (RRC)-accredited specialties of the American Council for Graduate Medical Education currently have specific geriatric training requirements, the article found in its 2002-2003 review of nonpediatric residency specialty programs. And the geriatric requirements in some of those specialties were "very minimal," Dr. Bragg said.

In general internal medicine, for example, the RRC has required geriatric training since 1989, and revisions to these requirements were made in 2003. While previous requirements listed certain topics that should be taught to medical residents, such as addressing end-of-life care and recognizing elder abuse, the new requirements "omit these specifics," the article noted. "The requirements are there, but they are not being taught," Dr. Bragg said.

Other specialties lacked more than minimal requirements. In emergency medicine, for example, the only geriatric-related RRC requirement is instruction on the detection and management of elder abuse and neglect, the article found. At the same time, approximately 20% of all emergency department (ED) encounters involve the elderly, and adults older than 75 years have the highest rate of ED use, according to the article.

Urology, with 48% of outpatient visits from patients aged 65 years and older, added "limited" geriatrics medical training requirements in July 2003. And neurology "does not have specific RRC requirements for geriatrics medicine training," although the training programs in vascular neurology and neurology pain management require such training, according to the article.

A twofold solution is necessary to address the dearth of residency training in geriatric care, according to Dr. Bragg. "Our residency groups need to recognize the importance of geriatrics and make more requirements available and accredit different programs" beyond the 27 that now have such requirements, she said.

Second, more funding and resources are necessary to train medical school faculty to teach students how to care for an older patient population, Dr. Bragg said. Medical students contemplating a career in geriatric medicine "need good mentors."

Acad Med. 2005;80:279-285

Reviewed by Gary D. Vogin, MD

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