Geriatric fellowship training has significantly advanced in the past two decades in both number and organization of formal accredited fellowship programs. A recent survey examined career decision making, fellowship training, and current professional activities of fellowship trained geriatricians from 1990 - 1998. (1) The original survey included an open-ended question regarding further training experiences that geriatricians would have found valuable during their fellowship training to prepare them for their current career positions. The results and analysis of this question will be reviewed here and were recently published in the April 2004 issue of the Journal of the American Geriatrics Society. (2) The survey responses reflected the need for additional skills relevant to four aspects of professional performance: Administration and Management, Clinical Geriatrics, Research, and Education.
Over half of respondents documented the need for increased training in administration and management. The areas cited included nursing home administration / medical directorship and billing / finance. Advanced training in long-term care administration and medical director certification is available through the American Medical Director's Association (AMDA). Additionally, AMDA offers training for residents and fellows with an interest in long-term care via their AMDA Futures program. This fully funded experience provides exposure to nursing home administration and long-term care in conjunction with the annual AMDA symposium. Applications for the program are available via the AMDA website www.AMDA.org.
Regarding clinical training, 66% requested further subspecialty training. Given the time constraints of the one year fellowship, not all subspecialities can be adequately covered. Further collaboration with subspecialty departments is recommended along with review and revision of existing fellowship experiences to strengthen and enrich the training in all clinical areas.
A need for research training during fellowship was identified by 17%. Again, the first year fellowship leaves limited time for research and academic pursuits. For those fellows who wish to pursue careers in research, further training is required. This would include funding for subsequent years of training, mentorship, formal coursework and a significant time commitment. These opportunities are available at many institutions and fellows should inquire into Robert Wood Johnson Clinical Scholars programs, NIH supported clinical research and career development awards and research oriented Master of Public Health programs.
Six percent cited further training needs in education (teaching skills and program development). Fostering leadership and teaching skills are important aspects of fellowship training. Leadership roles are available in communities, universities, healthcare organizations and national organizations like AGS and AMDA. Formal faculty development training is available through a number of resources including programs at Stanford University and the Harvard Macy Institute. For fellows with interest in academic careers as clinician-educators, application for the Bureau of Health Professions Geriatric Academic Career Award (GACA) is strongly suggested upon completion of fellowship training. This five year career development award aims to increase the number of junior faculty at accredited schools of allopathic and osteopathic medicine and to promote the development of their careers as academic geriatricians who emphasize training in clinical geriatrics including the training of interdisciplinary teams. Information is available on-line at: http://www.hrsa.gov/grants/preview/guidancebhpr/hrsa04024.htm
Overall, accredited geriatric fellowship programs must assure that their training incorporates the national training guidelines with particular attention to unmet emerging career needs as identified by this survey. Many of these can be covered in the one year of fellowship training but a second year of focused training may be the optimal way to establish professional competence and career development in these areas. Fellows are encouraged to carefully examine their career goals and aspirations and to ensure that their fellowship experience will meet these goals.
References
1. Medina-Walpole A, Barker WH, Katz PR, Karuza J, et al. The Current State of Geriatric Medicine: A National Survey of Fellowship Trained Geriatricians 1990-98. J Am Geriatr Soc 2002;50:949-955.
2. Medina-Walpole A, Barker WH, Katz PR. Strengthening the Fellowship Training Experience: Findings from of a National Survey of Fellowship Trained Geriatricians 1990-98. J Am Geriatr Soc 2004;52: 607-610.
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