GSR-Supported Collaboration at University of Connecticut Health Center Revamps Urology Curriculum for Residents, Addresses Misconceptions About the Care of Frail Older Patients

Medical residents often share one of two common misconceptions about frail, older patients, says John A. Taylor, III, MD, Assistant Professor of Surgery in the Division of Urology at the University of Connecticut Health Center.

"One common mistake is to assume that the care of the frail elderly patient is identical to the care of every other patient," Dr. Taylor says. "The other is to assume that the frail elderly cannot be offered treatments available to other patients. What residents need to know is that while elderly patients shouldn't be cared for in exactly the same manner as other patients, they shouldn't be excluded from certain types of care based solely on their age, either. You need, among other things, to do a special assessment for these patients that includes consideration of how they're likely to recover from treatment."

In an effort to better acquaint the residents he trains with these and other principles and basics of geriatric care, Dr. Taylor is collaborating with George Kuchel, MD, Traveler's Chair in Geriatrics and Gerontology, Director of the UConn Center on Aging and Chief of the Division of Geriatric Medicine, to revise the urology residency curriculum. They're doing so with support from the American Geriatrics Society's Geriatrics Education for Specialty Residents (GSR) grants program.

The GSR program, part of AGS' Geriatrics-for-Specialists Initiative (GSI), supports collaborations between medical specialty faculty and geriatricians that develop, initiate and evaluate programs integrating geriatrics into surgical and related specialty residency training. Funded by the John A. Hartford Foundation, the GSR has awarded $32,000 grants to 41 programs over the last six years. Drs. Taylor and Kuchel received a two-year grant in December 2005.

Their work on curriculum changes isn't their first collaboration, however. The two started collaborating on research in 2003, when Dr. Taylor first arrived at the university. (In another, ongoing collaboration, Dr. Kuchel and Peter Albertsen, MD, a member of the urology faculty, are mentors to Dr. Taylor, a 2005 Dennis W. Jahnigen Scholars Award recipient. With support from the Jahnigen program, Dr. Taylor is conducting research concerning the pathogenesis of chronic urinary retention.)

"Coming to the university was an eye opener," Dr. Taylor says. "Working with George, I began to understand the concepts behind the care of the elderly and the specific problems of the elderly. I was an attending who already had several years of training, and these were concepts I'd never heard of before. Given that we see such a large number of elderly patients - over 50% of the patients we see in urology are over 65 -- George and I discussed applying for a GSR grant."

To acquaint residents with geriatric care in general, and geriatric urology in particular, Dr. Taylor has made a number of changes in the curriculum in consultation with Dr. Kuchel and others in the geriatrics division. The weekly two-hour didactic sessions that follow urology residents' Grand Rounds now cover geriatric material whenever appropriate. Sometimes, a didactic session focuses specifically on a geriatric health problem. When that's the case, a member of the geriatrics faculty joins the session.

"This works well for us - it gives us a weekly opportunity to address geriatrics concepts," says Dr. Taylor.

In addition to familiarizing residents with those concepts, the revised curriculum also covers the full range of urological problems affecting older adults -- including incontinence, urological cancers, voiding problems, and benign prostatic hyperplasia. This, Taylor hopes, will put to rest another common misconception - that geriatric urology is all about geriatric incontinence.

"Geriatric incontinence is a big part of it," Dr. Taylor adds. "But there's much more to it than that. Just this week we had a speaker on renal carcinoma in the aging population. With age, rates of cancer increase. Bladder cancer, one area of my research, is most common at ages 69 and 71 for males and females respectively and we're seeing more aggressive cancer in the frail elderly.

The university has made a commitment to integrating geriatric principles and practices into the care of the elderly throughout its health care network. "Hopefully," Dr. Taylor says, "what we're doing is a way to move forward within the context of one surgical specialty -- and serve as a model for the entire institution."