Geriatric Medicine

To prepare students to better respond to the challenges posed by the aging of the population.

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.
Hospital accreditation/payment is frequently dependent on the identification and management of problems that happen more commonly in the elderly such as:

Physicians frequently have no specific training in geriatrics/gerontology.
The Association of American Medical Colleges has recently completed a consensus conference outlining the essential geriatrics competencies for medical students that will support ongoing curriculum development.

Integrate level–appropriate content throughout the four-year medical school curriculum.
Content placement, as appropriate, into existing medical school courses and clerkships.
Examples of curriculum opportunities to integrate this content:
- -Discussion of impact of the aging kidney on pharmacotherapy during the Body Fluid Homeostasis - Renal course.
- -Expand the current discussion of pneumonia in the Pulmonary course to include risks of aspiration pneumonia in older adults.
- -Conduct functional status assessments in the social history during the Advanced Medical Interviewing course.
Assessment of students
- -Incorporation into existing course examinations and evaluations.
Student evaluation of curriculum
- -To be conducted at the end of the second and fourth years.
- -Separate questions on the relevance of content presented and on whether students can identify that the material was covered.

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).

Integrative approach to geriatrics curriculum generally well received and educationally successful.
Introduction to geriatric patients begins with the first week of medical school, in the Introduction to Being a Physician course, starting in 2000.
Early exploration of age bias and conversations with older patients during the Medical Interviewing course in first year.
Initial content on delirium and polypharmacy have been a part of the required 3rd year Adult Inpatient Medicine Clerkship since 2000.
Additional didactic and standardized patient experiences discussing common geriatric syndromes such as falls, dementia and screening in the elderly have been a component of required 3rd year Combined Ambulatory Medicine and Pediatrics Clerkship, since 2004.
Third year required Clinical Focus course in Geriatrics introduced in 2007.
Students performing well on geriatrics cases in the Clinical Competency Assessment, a comprehensive clinical skills exam taken at the beginning of fourth year.
Thriving Area of Concentration in Geriatrics.
- -Supracurricular activities with students 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.
- -Mentoring in geriatrics projects for students pursuing year-long research fellowships and longitudinal scholarly projects.

School of Medicine Office of Medical Education