University of Pittsburgh

Geriatric Medicine

Background:

The population is rapidly aging such that it is anticipated that approximately 23% of the nation’s population will be over the age of 65 by the year 2030. Allegheny County, where UPSOM is located, is demographically the second oldest county in the country. Physicians, almost regardless of specialty, will need to understand the differences in physiology and presentation of disease in the older adult to provide more appropriate care and they frequently have no specific training in geriatrics/gerontology.

Goals:

An inportant curricular goal is to prepare students to better respond to the challenges posed by the aging of the population.

Implementation:

 

Basic Science Blocks

Throughout the first and second year, the physiology of aging and pharmacology is integrated throughout the basic science courses including cell and tissue, pharmacology as well as the organ system blocks such as Introduction to neurosciences and Reproduction and Developmental Biology, to name but a few examples.

 

Advanced Physical Examination

Performing special examinations such as screening for cognitive impairment and attention to musculoskeletal physical exam are an important part of this course.

 

Clinical Experiences 1 and 2

Within this set of courses, students rotate at a variety of community and ambulatory settings, shadowing physician role models as they learn about their new roles as physicians.  Students may rotate with geriatricians and selected students may also opt for a specific rotation in palliative care in the community setting.

 

Combined Ambulatory Medicine and Pediatrics Clerkship (CAMPC)

During this required eight-week clinical clerkship, students are exposed to care of elder patients during the four-week outpatient adult medicine segment of this clerkship.  Students may also opt for a three-week selective rotation in geriatric medicine as a part of CAMPC.  CAMPC includes geriatrics as one of its required didactic sessions with a lecture followed by hands-on experience interviewing and examining standardized patients around the topics of falls and dementia.

 

Adult Inpatient Medicine Clerkship (AIMC)

During this required eight week clerkship, students frequently care for older adults regardless of the site of their rotation. On this clerkship, students are taught about the hazards of hospitalization for older adults as well as presentations of common diseases that are unique in this population. Additionally, some students may rotate for one of their months on the geriatric service at either Shadyside or Montefiore.

 

Clinical Focus Geriatrics Course

All third year students participate in a week-long session that covers multiple topics in the field of geriatric medicine, such as geriatric pharmacology, assessment of functional status, and geriatric syndromes such as dementia, incontinence, and falls. Students have the opportunity to work with other health professionals in long-term care facilities, thus exposing them to a little-seen healthcare environment. For academic year 2011-2012, this experience will include an option for selected medical students to work in intensive interprofessional teams with graduate Nursing and Pharmacy students, focusing a team-based approach to health care, thus enhancing interprofessional communication.

 

Family Medicine Clerkship (FMC)

At a minimum, students who are rotating in any of the sites of this required four-week clerkship will be exposed to care of both frail and highly functional older patients in community family practice. In this clerkship, there is an emphasis on a holistic approach to the older patient in the context of their entire family unit.

 

Senior Elective in Geriatric Medicine

Senior students may choose a four-week elective experience with the Division of Geriatrics. 

 

Assessment of Students

Skills in examining the geriatric patient are specifically assessed in the fourth year Clinical Competency Assessment as one of the ten stations in this mock Step 2 Clinical Skills exam.

 

Faculty Development

Many faculty themselves recognize gaps in their knowledge base about these subjects.  However, UPSOM faculty are available with expertise in all of these areas. Faculty expertise and comfort with this content is rapidly evolving as physician and scientist familiarity with these topics improves. UPSOM geriatrics faculty have received grants to work with other departments to integrate geriatrics into their teaching ( e.g. Internal Medicine, Ophthalmology, Gynecology).

Outcomes

This Integrative approach to geriatrics curriculum is well received and educationally successful. Introduction to geriatric patients begins early in the first week of medical school, in the Introduction to Being a Physician course. Early exploration of age bias and conversations with older patients occurs during the first year Medical Interviewing course.

Students continure to perform well on geriatrics cases in the Clinical Competency Assessment, a comprehensive clinical skills exam taken at the beginning of fourth year.

There is a thriving Area of Concentration (AOC) in Geriatric Medicine, which provides students with supracurricular activities such as visiting patients at home during the first and second years to practice history taking and physical exam skills; identifying differences in older adults; opportunities for selecting geriatrics outpatient experience as part of their internal medicine outpatient clerkship; and mentoring in geriatrics projects for students pursuing year-long research fellowships and longitudinal scholarly projects.