Medical Student Medical Student Training in Training in GeriatricsGeriatrics

Model Program in the Model Program in the Osteopathic ProfessionOsteopathic Profession

Anita Chopra, MD, FACP, AGSFProfessor and Director of Education and Clinical ProgramsNew Jersey Institute for Successful AgingUMDNJ-School of Osteopathic Medicine

The Aging Imperative in The Aging Imperative in Medical EducationMedical Education

Our nation’s aging population is growing Our nation’s aging population is growing dramaticallydramatically 35.6 million 2003 71.5 million 203035.6 million 2003 71.5 million 2030

85+ is the fastest growing segment of the 85+ is the fastest growing segment of the entire populationentire population 4 million 2003 20 million by 20504 million 2003 20 million by 2050

65+ population represent 50% of all 65+ population represent 50% of all ambulatory care visits to primary care ambulatory care visits to primary care physiciansphysicians11

The old-old consume 50% of Medicare dollars 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 The Aging Imperative in Medical EducationMedical Education

20% of the Medicare population has at least 20% of the Medicare population has at least five chronic conditions and visits 14 different five chronic conditions and visits 14 different physicians in 37 office visits each yearphysicians in 37 office visits each year22

There are fewer than 7,000 certified There are fewer than 7,000 certified geriatricians falling significantly short of the geriatricians falling significantly short of the current need of 14,000 and the projected current need of 14,000 and the projected need of 36,000 by 2030need of 36,000 by 203033

Less than 2% of graduating physicians seek Less than 2% of graduating physicians seek careers in geriatric medicinecareers in geriatric medicine44

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, 20024 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 Too often, illnesses in older people are misdiagnosed, overlooked or dismissed misdiagnosed, overlooked or dismissed as the normal process of aging, simply as the normal process of aging, simply because health care professionals are because health care professionals are not trained to recognize how diseases not trained to recognize how diseases and drugs affect older patients and drugs affect older patients differently than younger patients. All differently than younger patients. All of these situations potentially could of these situations potentially could translate into suffering by patients.”translate into suffering by patients.”

Geriatric Medicine: A Clinical Imperative for an Aging Population, A Report from the AmericanGeriatrics Society and ADGAP, October 2005

Training the future Training the future providers of geriatric care providers of geriatric care

….….Are we on the right road?Are we on the right road?

Academic Geriatric Academic Geriatric Programs in Osteopathic Programs in Osteopathic

Medical SchoolsMedical Schools Academic unitsAcademic units

3 Free standing Departments of 3 Free standing Departments of GeriatricsGeriatrics

1 Center/Institute1 Center/Institute 9 Divisions of Geriatrics9 Divisions of Geriatrics

3.1 FTE’s median # of faculty 3.1 FTE’s median # of faculty working in academic geriatricsworking in academic geriatrics

20% is median time spent on 20% is median time spent on medical student teachingmedical 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

Academic Academic YearYear

# # RespondiRespondi

ngng

Part of Part of Existing Existing Required Required CourseCourse

Separate Separate Required Required CourseCourse

Separate Separate Elective Elective CourseCourse

Do Not Do Not OfferOffer

19901990 123123 106 106 (86%)(86%)

8 (7%)8 (7%) 0 (0%)0 (0%) 5 (4%)5 (4%)

20002000 125125 116 116 (93%)(93%)

10 (8%)10 (8%) 68 (54%)68 (54%) 0 (0%)0 (0%)

AAMC Survey of Medical Schools Teaching Geriatric Topics

All SchoolsAll Schools InadequateInadequate AppropriateAppropriate ExcessiveExcessive CountCount

19901990 29.1%29.1% 67.1%67.1% 3.8%3.8% 11,52711,527

20002000 38.6%38.6% 57.5%57.5% 3.9%3.9% 14,10314,103

20052005 24.5%24.5% 70.3%70.3% 5.2%5.2% 9,6109,610

AAMC Medical School Graduation Questionnaire

Do you believe that the time devoted to instruction in Geriatrics was adequate, appropriate or excessive?

UMDNJ-SOM Model UMDNJ-SOM Model Geriatric ProgramGeriatric Program

Established in 1989 as a free standing Center for Established in 1989 as a free standing Center for Aging at UMDNJ-SOMAging at UMDNJ-SOM

Evolved to a statewide New Jersey Institute for Evolved to a statewide New Jersey Institute for Successful Aging in 2005.Successful Aging in 2005.

Interdisciplinary faculty and clinical servicesInterdisciplinary faculty and clinical services Geriatric MedicineGeriatric Medicine Geriatric PsychiatryGeriatric Psychiatry Geriatric NeurologyGeriatric Neurology

Ranked among the top 20 Best Graduate Schools Ranked among the top 20 Best Graduate Schools in Geriatric Medicine for six consecutive yearsin Geriatric Medicine for six consecutive years

Gerontological Nursing Geriatric Social Work Neuropsychology

Geriatric CurriculumGeriatric Curriculum Across the Years Across the Years

Integrated Coursework – Yr 01 and Integrated Coursework – Yr 01 and 0202

Required Geriatric Course – Yr 02Required Geriatric Course – Yr 02 Required One Month Clerkship – Yr Required One Month Clerkship – Yr

0303 Elective Geriatric Rotation – Yr 04 Elective Geriatric Rotation – Yr 04

Geriatric Curriculum: Geriatric Curriculum: Year 01Year 01

Integrated geriatric content Integrated geriatric content Genetics of Alzheimer’s diseaseGenetics of Alzheimer’s disease Biochemistry and age-related changesBiochemistry and age-related changes Neuroscience and the aging brainNeuroscience and the aging brain Pharmacology Pharmacology OMM: cOMM: criteria for use of OMT for riteria for use of OMT for

specific at risk patientsspecific at risk patients

Geriatric Curriculum: Geriatric Curriculum: Year 02Year 02

Required Geriatric CourseRequired Geriatric Course

Principles of Geriatric MedicinePrinciples of Geriatric Medicine Theories of AgingTheories of Aging Pharmacology and Drug PrescribingPharmacology and Drug Prescribing Physiology of AgingPhysiology of Aging Comprehensive Geriatric AssessmentComprehensive Geriatric Assessment Aging Society and EthnogeriatricsAging Society and Ethnogeriatrics

Common Geriatric SyndromesCommon Geriatric Syndromes Confusion: Dementias & DeliriumConfusion: Dementias & Delirium IncontinenceIncontinence Falls, Immobility and Pressure UlcersFalls, Immobility and Pressure Ulcers Psychiatric disorders – agitation, psychotic Psychiatric disorders – agitation, psychotic

disorders, depression and suicidedisorders, depression and suicide

Geriatric Curriculum: Geriatric Curriculum: Year 02 Year 02 (continued)(continued)

Integrated Coursework in GeriatricsIntegrated Coursework in Geriatrics

Introduction to Patient DynamicsIntroduction to Patient Dynamics

Death and Dying SeminarDeath and Dying Seminar

Pain SeminarPain Seminar

OMMOMM Bone painBone pain Abnormal AP curves including Dowager’sAbnormal AP curves including Dowager’s Vertebral compressionsVertebral compressions Normal and abnormal gait and preventing fallsNormal and abnormal gait and preventing falls Parkinson’s diseaseParkinson’s disease

Simulated CasesSimulated Cases

Geriatric Curriculum: Year 03 Geriatric Curriculum: Year 03 One month Required Geriatric One month Required Geriatric

ClerkshipClerkship Acute care – 2 weeksAcute care – 2 weeks

Content Areas:Content Areas: Nosocomial infection and use of OMT for pneumonia and Nosocomial infection and use of OMT for pneumonia and

UTIUTI ConfusionConfusion MalnutritionMalnutrition Pressure UlcersPressure Ulcers

Long term care – 1 weekLong term care – 1 week Sites:Sites:

Nursing homes and continuing care retirement communitiesNursing homes and continuing care retirement communities Subacute CareSubacute Care Home and Hospice CareHome and Hospice Care

Content Areas:Content Areas: OBRAOBRA Drug PrescribingDrug Prescribing Agitation related to dementiaAgitation related to dementia DepressionDepression IncontinenceIncontinence

Geriatric Curriculum: Year 03 Geriatric Curriculum: Year 03 One month Required Geriatric One month Required Geriatric

Clerkship Clerkship (continued)(continued)

Ambulatory Care – 1 weekAmbulatory Care – 1 week Experiences:Experiences:

Primary care Geriatric MedicinePrimary care Geriatric Medicine Geriatric NeurologyGeriatric Neurology Geriatric Psychiatry and NeuropsychologyGeriatric Psychiatry and Neuropsychology Case ManagementCase Management Family and team meetingsFamily and team meetings Specialty programs – Memory Assessment, Huntington’sSpecialty programs – Memory Assessment, Huntington’s

Content Areas:Content Areas: Comprehensive Geriatric Assessment: Function, Cognitive, Comprehensive Geriatric Assessment: Function, Cognitive,

Affective. PsychosocialAffective. Psychosocial Health promotionHealth promotion

Interdisciplinary team conferencesInterdisciplinary team conferences Ethics SeminarEthics Seminar

Quality of LifeQuality of Life Advance DirectivesAdvance Directives End of Life End of Life

Student Case PresentationsStudent Case Presentations Falls Falls DementiaDementia EthnogeriatricsEthnogeriatrics

Heart diseaseHeart disease Substance AbuseSubstance Abuse PolypharmacyPolypharmacy

Online Case StudiesOnline Case Studies Required readingsRequired readings

Geriatric Clerkship Curriculum

Geriatric Clerkship Geriatric Clerkship WebCT siteWebCT site

Geriatric Curriculum: Geriatric Curriculum: Year 04Year 04

Elective rotationsElective rotations Geriatric Medicine, Neurology or Geriatric Medicine, Neurology or

PsychiatryPsychiatry Tailored to individual student learning Tailored to individual student learning

needsneeds 2 – 4 week options2 – 4 week options

New DirectionsNew Directions 3-C Curriculum3-C Curriculum

Expand to a one month Geriatric Course in Year 02Expand to a one month Geriatric Course in Year 02 Integration of basic science and clinical conceptsIntegration of basic science and clinical concepts Case-based learningCase-based learning

Approach to the older adult and ethnogeriatricsApproach to the older adult and ethnogeriatrics PolypharmacyPolypharmacy Falls, Immobility and Iatrogenesis Falls, Immobility and Iatrogenesis Cognitive dysfunction Cognitive dysfunction

New evaluation strategiesNew evaluation strategies OSCEOSCE Competency-based checklist across geriatric Competency-based checklist across geriatric

curriculumcurriculum

Student Voices……..Student Voices…….. “ “ Nothing against geriatrics, but I did not expect to like this rotation at all. I 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 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.”have for their work and how rewarding caring for older adults can be.”

“ “ The clerkship provided an insight into the complicated care involved in The clerkship provided an insight into the complicated care involved in geriatrics. It also highlighted the non-medical issues that have to be geriatrics. It also highlighted the non-medical issues that have to be addressed with the elderly such as financial, social and housing issues.”addressed with the elderly such as financial, social and housing issues.”

“ “ I think the most valuable aspect of my Geriatrics experience was being I think the most valuable aspect of my Geriatrics experience was being able to work with the team - the geriatrician, neuropsychologist and the 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. 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 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 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, rotation a better learning experience. Thanks for all of your hard work, dedication, organization and for making this an extremely worthwhile dedication, organization and for making this an extremely worthwhile experience .”experience .”

“ “ I liked how we received a well-balanced rotation getting a chance to I liked how we received a well-balanced rotation getting a chance to experience inpatient, ambulatory and long term care settings. I also came experience inpatient, ambulatory and long term care settings. I also came to appreciate the expertise of the practitioners in the department. It was to appreciate the expertise of the practitioners in the department. It was obvious that it is truly a Center of Excellence in Geriatrics.”obvious that it is truly a Center of Excellence in Geriatrics.”

For more informationFor more information

Contact:Contact:Anita Chopra, MDAnita Chopra, MDDirector of Education and Clinical Director of Education and Clinical

Programs, NJISAPrograms, NJISAchopraan@umdnj.educhopraan@umdnj.edu(856) 566-6470(856) 566-6470

oror

Pamela Basehore, MPHPamela Basehore, MPHAssociate Director for Education, NJISAAssociate Director for Education, NJISAbasehore@umdnj.edubasehore@umdnj.edu