Fostering Careers in Geriatrics: A Focus on Four Inspiring Trainees

To accomplish AGS’ mission of improving the health, independence and quality of life of all older people, we must attract and retain healthcare professional trainees who will dedicate  their careers to geriatrics clinical care, research, and education. In this article we meet four women who, at the early stages of their medical careers, have demonstrated a strong concern  for older adults and a committed interest in their health and care.

Suvi Neukam, President of the AGS Student Chapter at the University of New England College of Medicine, was one of the recipients of this year’s Medical Student Training in Aging  Research (MSTAR) scholarship administered by the American Federation for Aging Research (AFAR) and the National Institute on Aging. The MSTAR program provides up to 130  medical students, early in their training, with an enriching experience in aging-related research and geriatrics, under the mentorship of top experts in the field. In her MSTAR program, Neukam was  partnered with Jacqueline Kerr, PhD, of the University of California, San Diego. Under Dr. Kerr’s leadership, Neukam worked on Multilevel Intervention for Physical Activity in  Retirement Communities (MIPARC), a four year study, funded by the National Heart, Lung and Blood Institute, designed to improve physical activity levels in older adults.

The AGS collaborates with AFAR on organizing a special student poster session at the AGS annual meeting, during which MSTAR scholars and other students who have submitted  abstracts to the annual meeting come together to discuss their research and network with peers and mentors. In 2011, travel stipends were provided to over 100 students who  participated in this poster session. In addition, all MSTAR scholars and other student presenters who were not already AGS members received a complimentary student  e-membership.

Upon receiving notification of her free student membership, Neukam wrote to AGS President, Barbara Resnick:

MSTAR’s mission to inspire aspiring physicians about working with older adults was very much accomplished in me. I have had an incredibly educational and rewarding summer at the University of California San Diego working with Dr. Jacqueline Kerr and the MIPARC team. As I begin my second year of medical school, I am more confident than ever in my desire to become a geriatrician. And, as President of my school’s AGS chapter, I have been hard at work all summer planning ways to help bring some of the experiences and resources that inspired me to my student colleagues. Thank you … for extending the AGS e-membership to me and other students. I have come to really appreciate any opportunity to learn about how I can become a better physician for older adults.

Kara Coffey is a fourth year medical student at the Robert Wood Johnson Medical School in Camden, New Jersey. Although Coffey is studying to be a pediatrician, she was given a unique opportunity to participate in the Chief Resident Immersion Training in the Care of Older Adults (CRIT) retreat when a last-minute spot became available. The overall goal of CRIT is to foster collaboration among specialties in the management of medically complex older patients. CRIT focuses on an unfolding interactive surgical case divided into three modules, following a geriatric patient from the emergency department to hospital discharge.

Coffey wrote about her experience spending a weekend with leaders in geriatrics and Chief Residents from multiple specialties, learning about the importance of working as an  interdisciplinary team.

Chief Residents play an important role in caring for the millions of patients treated in the nation’s teaching hospitals, and in training medical students and residents. Most importantly, they are charged with the task of acting as models for students and residents to emulate. During the course of the weekend, I took advantage of the opportunity to get to know our residents and faculty better, but more importantly, I had the opportunity learn from people whom I admire tremendously. I feel very fortunate to have had the opportunity to hear them speak so passionately about geriatrics topics that are certainly transferable to all fields of medicine.

While I am pursuing a career in pediatrics, the issues surrounding both ends of the age spectrum are similar. Most importantly, these include surmounting the barriers in communication or understanding between the patient and provider, as well as incorporating family members not only in the medical decision-making process, but also as direct caregivers in the home environment.

The elderly patient population has so many medical, psychological, and social issues that have to be teased apart in order to understand and identify a proper diagnosis. Teaching the next generation of healthcare professionals how to meet the unique healthcare needs of older patients, and how to do so in an empathic manner, is critical as the U.S. population ages.

For this newsletter, two AGS trainee members prepared summaries of 2011 annual meeting symposia they attended that helped to expand their knowledge of unique approaches to geriatrics care. Lauren Gleason, is a Resident at the University of Rochester and one of the current AGS Resident Section chairs. She attended a session entitled Addressing Delirium: An Interdisciplinary Acute Care of Elderly (ACE) Approach. She wrote:

Faculty from the University of Wisconsin Hospital presented their innovative Acute Care for Elders (ACE) consult service, composed of an interdisciplinary team of a geriatrician, an advanced practice nurse, a social worker, a pharmacist, and a physical therapist. This team was assembled to decrease the length of a patient’s hospital stay when diagnosed with delirium, by drawing on the various strengths and specialties of each team member, as patients with delirium can impact the healthcare system at many levels.

To combat a high incidence of delirium at their hospital, the team conducted a “Delirium Awareness Campaign,” which included conferences, posters, and pocket cards that encouraged providers to follow a delirium protocol of non-pharmacological interventions.

The team evaluates patients upon the request of the primary team physician, with the goal of new consults being placed shortly after admission. Walking rounds take place daily along with interdisciplinary rounds, which are interactive and comprehensive, and the consult teams’ recommendations are placed in the chart in conjunction with a phone call to the primary service, which helps ensure recommendations are carried out and questions answered.

Through functioning as an interdisciplinary team, the providers have been able to educate their colleagues about geriatric syndromes such as delirium and to improve eldercare in their hospital. This is a holistic model that many healthcare organizations can use to increase the quality and effectiveness of care provided to their older patients.

Susan Nathan, a fellow at Rush University Medical Center in Chicago, is the current AGS Fellows-in-Training Section chair. She summarized a symposium on Preventing  Readmissions and Avoidable Hospitalizations: Using Technological Innovations Proven and Emerging.

As of now, the Patient Protection and Affordable Care Act legislation allows the Center for Medicaid and Medicare Services to withhold a portion of all in-patient Medicare payments due to excessive readmissions, starting with up to 1 percent in federal fiscal year 2013, and rising to 3 percent in 2015. This financial penalty has significant ramifications for all healthcare providers across healthcare settings. This symposium focused on some technological interventions to tackle this multifaceted and daunting problem.

An approach utilized by the VA focuses on care coordination/home telehealth (http://www.telehealth.va.gov/ccht/index.asp) as a way to address the lack of timely care after hospital discharge. This system acts across the continuum to address a paucity of care delivered to patients whose main barrier to care is geographic isolation.

“Discharge Wizard,” enables the discharge summary to be automatically populated as the hospital course proceeds. It is linked to the EMR, thus limiting the data that is input by the physician at the end of the hospitalization. This minimizes common discharge pitfalls including illegible handwriting, confusion about duration of and indication for medications, and redundancy of imaging and other diagnostic studies.

A universal transfer form addresses the fact that discharges and readmission are not strictly between the hospital and home; patients often traverse many levels of care before reaching their ultimate destination. The Continuum of Care Improvement through Information New York (http://ccitiny.org) is one such system designed to decrease medication errors and improve communication between various care providers, by including up-to-date contact information for all providers involved in the patient’s care.

Project RED (https://www.bu.edu/fammed/projectred/index.html) is founded on eleven components and has been proven to reduce re-hospitalizations. A novel portion of Project RED uses a virtual interactive nurse discharge coordinator to facilitate patient discharge and review the after-hospital care plan, including a post-discharge call from a pharmacist.

A common theme among all the speakers was that poor communication and limited contact with a healthcare provider are major risk factors for re-admission. The presenters used technology in novel ways to intervene at different steps in the discharge process. But, merely automating a process that does not work will not create a functional process. Technology is a tool in our toolbox to address this problem, but there need to be sound processes in place for any significant change to be made.