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AGS POSITION STATEMENT

Education in Geriatric Medicine

BACKGROUND

Geriatric medicine and gerontology have made important strides in the education of professionals from the numerous disciplines that care for older adults. A defined and growing body of skills and scientific knowledge are available, and their application is necessary for competent medical care of older adults. Nearly all of the nation's medical schools now offer some geriatric curricula and a growing number of physicians have specialized in clinical care of the older adults, health care systems management, geriatric education, and aging research.

The American Geriatrics Society (AGS), which represents clinicians, researchers, administrators and educators in the area of geriatric medicine, should continue to serve as an advisory body in setting standards for determining the requirements for and dissemination of geriatric medical education. Additionally, the AGS should serve as a resource for policy-makers in overcoming barriers to effective care of older adults that can be eliminated through improvements in the formal processes of education.

POSITIONS

1. Gerontology and geriatric medicine should be integrated into the curriculum for each year of medical school, and clinical experiences in geriatrics should be required.

Rationale: Since nearly all medical graduates will find themselves caring for elderly patients, knowledge of aging and the aged should be a required part of the curriculum. Age-related changes should be integrated into basic science courses, and clinical aspects of aging should be integrated into each clinical science course and clinical rotation, with the obvious exceptions of pediatrics and obstetrics. Focused instruction in geriatric assessment and physical diagnosis is needed. Clinical experiences are necessary to dispel myths of aging and provide exposure to healthy and dependent seniors in multiple settings including the hospital and outpatient areas, as well as retirement communities, patient’s home, and the teaching nursing home.

2. Residency and fellowship training programs that involve primary or consultative care of elderly patients should be required to have scheduled clinical and didactic experience in geriatrics. The full spectrum of healthcare settings should be utilized for training.

Rationale: In order to improve the health care of elderly patients throughout our care systems, the body of knowledge on aging must be assimilated by all practitioners who care for older persons. Optimal care of elderly patients should not depend on referral or consultation by geriatrics "experts" alone but needs to be in the mainstream of all specialty care of the adult. Geriatric medical education should expand into ambulatory, home, and long-term care settings, to parallel the increasing utilization of these sites in geriatric care. Emphasis should be placed on teaching the scientific body of knowledge regarding the coexistence of the aging process and disease states, as well as the skills necessary to promote healthy aging and provide for comprehensive, interdisciplinary assessment and management of older adults with functional impairments throughout the continuum of care.

3. Future faculty responsible for geriatric education within family medicine, internal medicine, and psychiatry should have academic geriatric fellowship training which includes instruction in clinical care, teaching, research, and administration. Faculty in other specialties who are responsible for geriatric education should have specific advanced training in gerontology and geriatric medicine, especially as it relates to their discipline.

Rationale: Ample high quality geriatric fellowship positions are available for physicians already trained in family medicine, internal medicine, and psychiatry; therefore all future geriatrics faculty in these disciplines have access to advanced training. Geriatric fellowship and advanced training opportunities are increasingly available for faculty in other specialties as well.

4. Formal recognition of expertise in geriatric medicine should be considered by all specialties that provide care to older adults.

Rationale: The American Board of Family Practice, American Board of Internal Medicine, and American Board of Psychiatry and Neurology formally recognize expertise in geriatrics via their Certification of Added Qualifications in Geriatric Medicine and Geriatric Psychiatry, respectively. Such formal recognition enhances the academic credibility of the field and promotes continuing medical education in geriatrics. All specialties that are involved in the care of the elderly should be encouraged to consider additional geriatric training and to include appropriate age-related questions in their specialty certification examinations.

5. Practicing physicians who provide substantial care to older adults should be strongly encouraged to gain continuing medical education in geriatrics. All sectors of the healthcare market place, including both the for-profit and not-for-profit arenas should be penetrated.

Rationale: The recent and rapid growth in our knowledge of new and effective approaches to the care of older adults warrants aggressive dissemination to practicing physicians for improved geriatric care. Continuing medical education in geriatrics is increasingly available and in various formats including didactic and interactive presentations, medical journal programs, and web-based services. The Geriatrics Recognition Award is sponsored by the AGS to specifically recognize physicians who are committed to advancing their continuing medical education in geriatrics.

6. Continued increased funding is needed for the support of medical student, residency and fellowship training programs in geriatric medicine. This must be available for training in acute inpatient, outpatient, and long-term care settings. Additional funding is necessary to support the development of geriatrics faculty and a sufficient number of faculty to direct clinical research and educational programs.

Rationale: For geriatric academic efforts to achieve success and long-term viability, adequate resources including funds, personnel, space, time, and equipment are necessary. A number of sources of support have been developed over the last several years, including the National Institutes of Health, Health Resources and Services Administration, Department of Veterans Affairs, and several foundations. These will continue indefinitely to allow for the development of adequate numbers of geriatrics faculty. Equally important will be the promotion of these programs, so that highly qualified applicants can be attracted to these resources. Adequate funding is still a problem at all levels of geriatric education. Support for medical student education, fellowship programs (especially for academic training beyond the one year clinical fellowship) and faculty development is of most immediate concern. Although some additional support is received from the Department of Veterans Affairs, state governments and private foundations, continued and increased financial assistance is needed.

Developed by the AGS Public Policy Committee and approved November 1984 by the AGS Board of Directors. Revised November 1989. Revised November 1991. Reviewed April 1993. Revised in May 2000 by the AGS Education Committee and the AGS Public Policy Advisory Group. The AGS thanks Steven Counsell, MD, Sharon Levine, MD, and Debra Nichols, MD for their work on this statement. Address correspondence to: American Geriatrics Society, The Empire State Building, 350 Fifth Avenue, Suite 801, New York, NY 10118, 212-308-1414, Fax: 212-832-8646, info.amger@americangeriatrics.org.