Description of Geriatrics Training Grants Approved in July 2003

Boston University, Boston, Massachusetts, $1,995,358

Boston University School of Medicine, in collaboration with Boston Medical Center, strengthened the geriatric training of every medical student, every resident in internal medicine and family medicine, many residents in surgery and other specialties, dozens of faculty members, and hundreds of community-based physicians. It integrated geriatrics into core preclinical and clinical courses for more than 600 medical students over the course of four years. It also initiated a Reynolds Geriatrics Special Interest Pathway in which students followed patients longitudinally over four years, met regularly with patients and preceptors, participated in a geriatrics interest group, and conducted summer research projects. In addition to strengthening geriatrics for as many as 300 residents, it created a Chief Resident Immersion Training Program that teaches geriatric principles to 12-14 chief residents from various departments. An existing faculty development program was expanded to encourage surgeons and related specialists on the faculty to build geriatrics curricula for their residents. A train-the-trainer approach was used to strengthen the geriatrics knowledge and skills of practicing physicians in 15 affiliated neighborhood health centers. Heavy use was made of online teaching tools and Web-based curricula.  

Emory University, Atlanta, Georgia, $1,949,396

Emory University integrated geriatrics into medical student and residency training, as well as increased geriatric medicine knowledge among its teaching faculty, using a variety of teaching resources and a core curriculum focused on key principles and concepts of geriatrics. The program emphasized case-based learning, Web technology, and interactions with older adults, including bedside teaching rounds and seniors trained to serve as simulated patients. Emory’s 456 medical students were introduced to geriatrics in all four years of medical school through integration of aging into the basic science curriculum, problem-based learning cases, and changes in the clinical methods course and medicine clerkships. Emory has one of the largest internal medicine training programs in the country with close to 200 residents. All of those residents, along with others in family medicine and emergency medicine, received a core curriculum in geriatrics. Up to 16 Reynolds Program Faculty Scholars, selected from general internal medicine, family medicine, and a variety of specialties, received individualized training in geriatrics. Specialists also participated in a work group to strengthen geriatrics in their respective areas. Web-based geriatrics curricula were developed and offered to all interested faculty members in internal, family and emergency medicine.

Indiana University, Indianapolis, Indiana, $1,998,805

The second largest medical school in the country, Indiana University trains a student body of 1,120 at its home campus in Indianapolis and eight regional campuses. It established the Geriatrics Education Network of Indiana (GENI) aimed at strengthening the geriatric training of 840 medical students, 450 residents and 223 practicing physicians during the funding period and continues to train others into the future. It achieved this goal through a train-the-trainer strategy. The first step was to train 15 physician-educators to serve as expert faculty. They, in turn, were to train practicing physicians, 24 university-based and 24 community-based. These 48 practicing physicians would train 160 more physicians, half university-based and half community-based. Training included strategies to enhance clinical teaching skills and to apply newly acquired knowledge of geriatrics content to improving the quality of care of older adults, with special sensitivity to the importance of the relationships among the patient, family, community resources and physician. Medical students and primary care and emergency medicine residents received newly created and/or enhanced geriatrics training from this trained corps of expert faculty and practicing physicians.  

State University of New York at Buffalo, Buffalo, New York, $1,999,200

Western New York has a greater proportion of older adults within its population than the rest of the state or the country. Those 75 and older are its fastest-growing population. In response to this situation, the region’s medical school, the State University of New York at Buffalo, committed itself to strengthen the geriatrics training of physicians by creating the UB Geriatric Center of Excellence. The Center trained 400 medical students, 150 primary care residents, 45 surgery residents, 35 emergency medicine residents and over 350 community-based doctors annually. Geriatrics was integrated into the pre-clinical and clinical curriculum, using problem-based learning with clinical examples. The required internal medicine rotation in the third year included geriatric home care visits. Geriatrics training for residents included the collection and feedback of practice-based data, aimed particularly at improving prescribing practices and geriatric assessment. The effort to train practicing physicians focused primarily on improving care of hospitalized elderly, including recognizing and managing post-operative delirium and pain control. Ongoing faculty development was woven into all aspects of project activities.

University of Chicago, Chicago, Illinois, $1,975,067

The University of Chicago developed, implemented and evaluated an innovative geriatrics educational program focusing primarily on the acute hospital care of older adults, aiming to reach all of the University’s medical students and internal medicine residents. This Curriculum for the Hospitalized Aging Medical Patient (CHAMP) relies heavily on a collaborative faculty development program for geriatricians, hospitalists and general internists, the faculty who do the largest proportion of clinical teaching at the institution. CHAMP combines the essential principles of geriatric inpatient care with teaching skills and tools suited for the challenges of an evolving inpatient environment. An expanded geriatrics curriculum in the medical school focused on the clinical skills courses in the first two years of medical school training, the third year general medicine inpatient rotation, and elective courses for fourth year students. Some materials were developed that can be used to teach at the bedside in blocks of time as short as 10 minutes per topic (“teachable moments”). Other materials were developed for a Web site to permit students and residents to independently explore topics in depth. CHAMP took advantage of the University’s leading role in studying hospitalist medicine to incorporate clinical outcome measures to examine the impact of these educational interventions on clinical care and patient well-being.

University of Cincinnati, Cincinnati, Ohio, $2,000,000

The University of Cincinnati focused primarily on strengthening the geriatrics training of its residents and community-based physicians. New required curricula was developed to reach 150 general internal medicine residents and 92 residents in family medicine, psychiatry, obstetrics/ gynecology, and physical medicine and rehabilitation. In addition to the new curricula, all residents now have a series of standardized encounters with simulated patients and receive periodic “Fast Facts” e-mails containing clinical information about common geriatric medicine problems. Most of the curriculum development was done by 14 clinician-educator faculty in the relevant departments who were given special training as Geriatric Medicine Faculty Scholars. Cincinnati already had integrated geriatrics into its medical school curriculum. It built on that strength to develop a new four-year, integrated, longitudinal geriatrics enrichment experience for 32 medical students. The project developed an innovative approach to strengthening practicing physicians’ training in geriatrics. A team of geriatrics experts visit physicians in their offices, provide training on specific topics, and introduce office organization strategies that help improve care of older patients.

University of Miami, Miami, Florida, $2,000,000

The University of Miami (UM) dedicated geriatrics curricular time for medical students and residents, focusing on the effectiveness of teaching and learning. UM believes that providing learners with the knowledge, skills and attitudes necessary for the provision of good care for frail older adults requires training them to be competent in treating the major geriatric syndromes that characterize frailty. These syndromes include dementia, falls, delirium, urinary incontinence, and pressure ulcers. The project, involving UM’s institutional clinical partners — Jackson Memorial Medical Center, Miami VA Medical Center, and Miami Jewish Home and Hospital for the Aged — was designed to improve what is learned, not just what is taught. The new curriculum employs a blend of teacher- and computer-assisted instruction and trained 150 medical students and 60 primary care residents per year. By investing heavily in developing the faculty’s capacity to develop, teach, and evaluate curriculum and learner impact, UM hoped to advance the careers of 30 geriatrics educators and to enlist generalist faculty, administrators and residents to reinforce geriatrics. New instructional materials, including Web-based resources, are accessible by other academic health centers.  

University of Missouri-Columbia, Columbia, Missouri, $1,899,297

Located in a state with one of the country’s largest concentrations of rural elderly residents, the School of Medicine at the University of Missouri-Columbia strengthened geriatrics in all of its training programs for physicians. It created comprehensive, multifaceted educational experiences for medical students, including new problem-based learning cases, expanded interaction with seniors, a new geriatric interest group, an enhanced Acute Care for the Elderly (ACE) program, home visits, fourth year geriatric rotations and a palliative care elective. It redesigned the geriatrics rotations for its internal medicine and family practice residents to a multidisciplinary, community-based format including inpatient consultation, hospice care, and geriatric care pathway development. Faculty development was offered to specialists and sub specialists, who served as geriatric “champions.” They designed geriatric care pathways, which served as a focus for teaching across multiple specialties. The Missouri Telehealth Network was employed to implement new models of continuing education for rural physicians through distance consultation with geriatricians and others in the care of elderly patients.

University of New Mexico, Albuquerque, New Mexico, $1,998,861

 

The University of New Mexico’s School of Medicine has established a decentralized infrastructure that relies heavily on community-based physicians to train its students and residents and serve a culturally diverse, widely dispersed rural population. Their project made use of that infrastructure and the School’s acclaimed problem-based, community-oriented curriculum to strengthen physicians’ training in geriatrics. It enhanced an already-strong geriatrics curriculum for the School’s 300 medical students through additional problem-based cases and Web-based modules. It also strengthened knowledge of geriatrics among over 200 community-based primary care physicians who help to train the medical students. Residents’ geriatric training was strengthened through the development of additional Web-based modules and improved geriatrics training of the physicians who train 50 family practice residents in communities throughout the state. The School collaborated closely with the state’s Area Health Education Centers (AHECs) and the Indian Health Service in its efforts to train community-based physicians. The instructional material developed in the project is available to all of New Mexico’s physicians through a Web site and CD-ROMs.

University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, $2,000,000

The University of North Carolina’s Medical School increased the depth and breadth of geriatrics training for all of its 640 medical students, using evidence-based content and case-based instructional materials. Emphasis was on heightening early awareness and interest in geriatrics, integrating geriatrics into a restructured second year curriculum, and increasing geriatric-rich clinical training opportunities. Geriatric medicine, family medicine and general internal medicine faculty collaborated to develop a shared comprehensive core curriculum in geriatrics for their residents. This initiative applied an evidence-based, outcomes-oriented approach to acquiring knowledge of geriatrics, focusing on opportunities for continuous quality improvement of geriatric care, such as fracture reduction, urinary incontinence, dementia and medication errors. The curriculum now employs computer-based self-instruction modules in geriatric medicine. The project increased the numbers of faculty, fellows and community-based preceptors prepared to teach geriatrics though additional fellowship options, a “Translating Research into Practice” conference and “Practicing Physician Education” program to train generalist and specialist community physicians.