Geriatrics Education for Specialty Residents Project Supports Emory Collaboration Introducing Geriatrics Into Otolaryngology Training

Thanks to a collaborative effort supported by the American Geriatrics Society's Geriatrics Education for Specialty Residents (GSR) project, otolaryngology residents at Emory University School of Medicine are getting training that better prepares them to care for older adults - who make up as much as a third of all otolaryngology patients.

"As many as 1 in 3 of the patients otolaryngologists see are geriatric patients -- but there is no formal training in geriatric principles in most otolaryngology training programs," says Michael M. Johns, III, MD, assistant professor in Emory's Department of Otolaryngology and director of Emory's Voice Center. Dr. Johns, who did his otolaryngology residency at the University of Michigan Health Center and a fellowship in laryngology at Vanderbilt University Medical Center, recognized the need for incorporating geriatrics into Emory's otolaryngology residency program soon after joining the faculty in 2003.

"A lot of the basic principles of geriatrics - concerning polypharmacy, geriatrics syndromes and general principles of aging were new to me as a practicing faculty member," he says. "I saw a huge need here to try to integrate geriatrics into the curriculum and GSR has greatly facilitated this."

Emory is well known for its strong geriatric medicine programs, so the GSR provided a perfect fit. The GSR supports collaborations involving specialty faculty and geriatricians that develop, initiate and evaluate initiatives integrating geriatrics into surgical and related specialty residency training. Part of AGS' Geriatrics For Specialists' Initiative, which is funded by the John A. Hartford Foundation, the GSR has awarded $32,000 grants to 41 programs since July, 2001. In 2005, it awarded a grant to Dr. Johns and Joseph Ouslander, MD, professor of medicine and nursing and the director of the division of geriatric medicine and gerontology at Emory. Working together, they have been integrating geriatrics into the Emory otolaryngology curriculum in a variety of ways.

For starters, Dr. Johns surveyed faculty in the otolaryngology department to come up with a list of key geriatric otolaryngology topics. He then assigned the topics - age-related hearing and balance problems, age-related voice problems, swallowing difficulties, dry mouth, care of older head and neck cancer patients, and geriatric rhinology, allergy, smell and taste-to department members giving Grand Rounds.

"All of this information is presented in our Grand rounds now," says Dr. Johns, who next plans to create an electronic version of the Grand Rounds presentations so the information will be more widely accessible.

He and Dr. Ouslander have also developed a series of self-directed electronic lectures -- covering geriatrics principles and geriatric topics relevant to otolaryngology -- that residents can access online. The lecture slides use a program called Articulates that provides an optional voice-over and automatically advances the slides, offering an experience that's more like a live lecture. All of the lecture slides should be online by the end of this year.

"We wanted to put together a curriculum that's self-sustaining without requiring ongoing funding," Dr. Johns explains. "We also wanted to be able to present this information in an electric form not just one year, but in future years, because our geriatrics expertise is in demand and being pulled in a lot of directions and they can't be omnipresent in every program."

In addition, Dr. Johns and colleagues in the otolaryngology department are revising Emory's otolaryngology rotations. Starting this summer, residents rotating through each otolaryngology topic will be required to complete case write-ups of otolaryngological problems affecting geriatric patients. Each case report will include a summary of the patient's problem; supporting CT scans, endoscopy images or other applicable media illustrating the problem; and descriptions of relevant principles of geriatric medicine.

"We want the curriculum to grow," says Dr. Johns, "and we hope that with the cases we can continue to build on it."