National Consensus Conference on Geriatric Education Recommends 26 Geriatrics Competencies for Medical Students

Thanks to seismic demographic shifts, physicians will be treating a rapidly growing number of older patients over the coming decades. That's why it's particularly important that medical students - who'll be starting their careers as the nation's Baby Boomers head into retirement -- learn geriatrics basics, like which medications to avoid when treating the elderly, how to evaluate gait and balance problems, and how to manage patients with dementia or delirium.

While many medical schools have been working to incorporate more geriatrics education into their curricula there has been no consensus as to what medical students absolutely must learn about geriatrics - until now.

A National Consensus Conference on Geriatric Education, convened the Association of American Medical Colleges (AAMC) and John A. Hartford Foundation, recently reached consensus on a minimum set of geriatrics competencies that all medical students should acquire. Through a process that involved leaders in medical education -- including members of the Association of Directors of Geriatric Academic Programs (ADGAP) and program directors from a variety of other disciplines -- the group has identified 26 key competencies in geriatrics.

"These are observable behaviors in geriatric care based on underlying knowledge, skills and attitudes that medical students should be able to demonstrate before starting an internship," says conference co-chair Rosanne M. Leipzig, MD, PhD, professor and vice-chair of education at Mount Sinai School of Medicine's Brookdale Department of Geriatrics and Adult Development. "Each begins, "The graduating medical student, in the context of a specific older adult patient scenario (real or simulated), must be able to:…""

While previous attempts to list key competencies had been made, the resulting lists tended to be too lengthy, adds Dr. Leipzig. "The problem was that the lists were overly comprehensive - so much so that the medical school curriculum committees, deans of education, and geriatrics educators felt totally overwhelmed by the extensive lists of topics, amount of curricular time and faculty needed, and lack of clarity over the level of proficiency expected of the student."

The newly identified 26 competencies fall into eight general categories: medication management; cognitive and behavioral disorders; self-care capacity; falls, balance, and gait disorders; healthcare planning and promotion; atypical presentation of disease; palliative care; and hospital care for elders.

Specific competencies in the "medication management" category include the ability to explain how age-related physiological changes affect responses to various medications and dosing regimens, and to identify both mediations that should be avoided or used with caution in older adults and the potential problems associated with each. The abilities to define and distinguish among delirium, dementia, and depression, and to develop an evaluation and non-pharmacologic management plan for agitated demented or delirious patients are among the competencies included in the "cognitive and behavioral disorders" category. Among the "atypical presentation of disease" competencies is the ability to generate a differential diagnosis based on recognition of the unique presentations of common health problems in older adults, including acute coronary syndrome, dehydration, urinary tract infection, acute abdomen, and pneumonia.

"Our goal in working with the medical schools, made possible through the foresight and generosity of the John A. Hartford Foundation, has been to assure that all medical students are exposed to and aware of the skills, knowledge, and attitudes necessary to care for aging adults," says M. Brownell Anderson, MEd, Senior Associate Vice President of Medical Education at the AAMC. "The conference was held to achieve consensus around a set of core competencies for geriatrics. We look forward to seeing how medical school faculty incorporate these competencies in their programs."

Those involved in the conference are now working to disseminate the recommendations, get key stakeholders to endorse them, and identify easily accessible tools for teaching and assessing the competencies. Many of these tools, as well as the competencies themselves, are already available on the Portal of Online Geriatrics Education (www.POGOe.org), a free, online clearinghouse that offers access to high-quality training and related materials. To make finding the tools easier, the Donald W. Reynolds Foundation has provided support to allow POGOe to flag these over the next year, as aids to ensuring geriatrics competence among students.