Description of Geriatrics Training Grants Approved in June 2006

Brown University, Providence, RI – $2,000,000

 

Brown University has planned, designed, and implemented and evaluated an integrated, competency-based geriatrics curriculum for all of its 344 medical students across all four years of their training.  The curriculum redesign included new geriatric content in the first two student years, new geriatric patients and content on geriatric diseases and conditions in all but the pediatric clerkship, the development of a geriatrics virtual curriculum as a complement to the basic science curriculum, and a four-year cross-disciplinary area of emphasis in aging.  This project also enriched 150 internal medicine and 48 emergency medicine residents with geriatrics content.  For example, new geriatric teaching cases for students and residents in emergency medicine use the department’s simulation center.  Faculty development for basic sciences senior faculty members and geriatrics faculty ensures that those who teach geriatric content to students experience a series of educational retreats using the teaching of geriatrics content as the vehicle for general educational skills development.

 

Florida State University, Tallahassee, FL – $1,999,310

 

In recognition that the state of Florida has the highest percentage of older adults of any state, Florida State University College of Medicine was created by legislative act in June 2000 with a mandate to provide a special emphasis on preparing students to care for elderly patients, underserved minorities and rural populations.  It focused its program on teaching in two key behavioral areas: geriatric-care principles such as communication skills, functional assessment and therapeutic review, and geriatric-syndrome management for syndromes such as delirium, falls and polypharmacy.  Students receive a four-year longitudinal curriculum in geriatrics incorporating these principles.  They also participate in a senior mentor program and have the option to participate in a geriatrics interest group.  A newly geriatricized family medicine residency includes a system-wide delirium prevention program, among other things.  Faculty responsible for teaching medical students and all of the teaching hospital’s hospitalists – physicians who work only in hospitals – are trained in geriatrics in order to better teach geriatric content.
 

Harvard University, Boston, MA – $2,000,000

 

The Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School have expanded and improved the geriatrics education of their students, residents in general surgery, emergency medicine and internal medicine, and practicing physicians. The Advancement of Geriatrics Education (AGE) Project employed high-fidelity medical simulators to incorporate geriatrics cases into required courses and add geriatric content to core first- and second-year student courses. Third-year students encounter new geriatrics experiences in a year-long course that includes weekly conferences, medical simulation cases and interactive, web-based cases. AGE employs a train-the-trainer approach to enable academic hospitalists and key faculty in the internal medicine, emergency medicine and surgery departments to enhance residency training in geriatrics. The electronic health record at BIDMC was enhanced with education tools and prompts to teach residents “on the job.” Interactive web-based teaching modules were created for the education of physicians around the world via the Harvard CME Online web platform. All products were evaluated and disseminated to other Harvard-affiliated teaching hospitals and beyond.

 

Texas Tech University Health Sciences Center, Lubbock, TX – $ 1,999,947

 

Texas Tech has a multi-campus medical school that serves diverse and rural communities.  Students complete two years of medical education in Lubbock, then select campuses in Lubbock, Amarillo or El Paso for third- and fourth-year training.  Texas Tech built a five-part program.  First, it implemented a required Geriatrics Track in its four-year undergraduate curriculum to teach the knowledge, skills and attitudes required to care for senior citizens.  Second, it offers a series of optional programs such as student groups, lunchtime roundtables, a geriatrics mentor program and summer research programs, to stimulate medical student interest in geriatrics. Third, it has created an integrated geriatrics track for primary care residents in internal medicine and family medicine and residents in neuropsychiatry.  The track features, among other things, twice-monthly geriatric podcasts for residents and practicing physicians.  Fourth, the project offers geriatric training to medical and surgical specialty residents, fellows and faculty, beginning with the departments of surgery and orthopedics.  Finally, it established a Geriatrics Faculty Development Program to provide new formats for faculty and practicing physicians to improve their practice and teaching of geriatrics.

 

University of Arizona, Tucson, AZ – $1,975,236

 

Arizona is the second-fastest-growing state, with growth among older age groups and older ethnic minorities especially pronounced. Thus the University of Arizona developed the Arizona Reynolds Program of Applied Geriatrics, a competency-based teaching program that emphasizes the practical application of geriatric knowledge to provide safe and quality care for frail elders. It integrates required and optional geriatrics into four years of the new medical school curriculum in Tucson and the new Phoenix Campus. The faculty development program prompts non-geriatricians, including faculty from selected subspecialties and surgery and related specialties, to integrate geriatrics into their specialty training. The Reynolds Scholars in Aging (RSIA) serves as change agents and mentors for peers, junior faculty, residents, and medical students, and develops and implements physician-directed quality improvement projects. Residents in internal and family medicine, emergency medicine, and numerous subspecialty and surgery and related specialties, as well as chief residents, learn geriatrics through case-based teaching sessions, self-directed learning, morning report, seminars, web-based modules, and through participation in the RSIA quality improvement projects. Physicians in the Indian Health Service, the Veterans Administration hospitals, and in the community benefit from site-specific, self-directed learning that integrates geriatrics into their practices. 
 

University of California, San Francisco, San Francisco, CA – $2,000,000

 

The University of California, San Francisco is a leader in the rapidly growing hospitalist movement, whereby physicians work solely in the hospital, making them the most frequent and influential teachers of medical students and residents in inpatient settings.  It focuses on two geriatric issues related to hospitalists: transitions of care, and care of hospitalized elders.  Two geriatrician hospitalists were recruited to run an Acute Care of the Elderly (ACE) unit and provide teaching and faculty development.  In addition, hospitalists were selected as Reynolds Hospitalist Scholars to learn geriatrics, improve teaching techniques, and develop geriatrics curriculum.  And the program offers a 40-hour train-the–trainers experience for all interested hospitalists at any of the UCSF-affiliated teaching hospitals. Thus within UCSF’s two themes, every medical student: experiences a transitional care experience and accompanying curriculum; participates in, receives feedback on and is tested on a geriatrics case experience; and has a mentored home visit.  Residents in internal medicine, ophthalmology, orthopedic surgery, anesthesiology, emergency medicine and family medicine also learn from new and expanded geriatrics curricula. 

 

University of Kansas, Kansas City, KS – $2,000,000

 

To address a dearth of practicing geriatricians in the state of Kansas, the University of Kansas strengthened geriatrics in all of its training programs for physicians.  It annually provides comprehensive training in geriatrics to 700 undergraduate medical students, more than 223 medical residents, and 4 faculty to optimize the quality of health care for vulnerable older adults.  All of its educational activities are guided by the principle of providing the trainee with an appropriate, broad-based foundation for managing the health care needs of older adult patients, with and without complex chronic illness, across the continuum of care.  It integrates quality indicators from the Assessing Care of Vulnerable Elders (ACOVE) project, and basic geriatric medicine content in the areas of improving functional independence, avoiding medical errors, appropriate pharmacy use, understanding system efficiencies, and transitions of care into all of its educational materials and methods.  The project employs innovative technology including CD-ROMs, computerized patient simulations and web-based training modules.

 

University of Utah, Salt Lake City, UT – $2,000,000

 

The University of Utah recently reconfigured and expanded its Center on Aging. The university project created an educational program to impact geriatrics training for all students in its School of Medicine, primary care internal medicine and family medicine residents and faculty, and primary care physicians across the state of Utah and the surrounding region along two specific themes.  First, the team of a medical student or resident and a non-geriatrician (hospitalist, general internal medicine, or family medicine) preceptor functions as the target of educational programs. Faculty development for these preceptors is an important component as is required geriatrics content for medical students that has been integrated into all four years of the curriculum and tracked using an individualized portfolio system.  Second, geriatrics education has been delivered to practicing physicians in the context of developing a quality improvement program for their practices. More than 100 primary care providers from across the state from University of Utah-affiliated Community Clinics, VA-affiliated Community Based Outpatient Clinics, and the Intermountain Healthcare group received this educational program focused on incorporating principles of geriatric assessment into primary care practice.

 

Vanderbilt University, Nashville, TN – $1,999,844

 

Vanderbilt University’s Informatics Center leads the nation in adapting informatics (the sciences concerned with gathering, manipulating, storing, retrieving and classifying recorded information) to improve medical systems.  Thus its Vanderbilt-Reynolds Geriatrics Education Center (VR-GEC) built upon Vanderbilt’s many successful informatics efforts, including electronic capture and concept-based indexing of all medical school curricular content, effective delivery of educational decision support at the point of care through both electronic medical record and computerized physician order-entry systems.  These systems provide a platform to deliver and reinforce geriatrics content that strengthens geriatrics training of virtually 100 percent of trainees and faculty, providing ongoing education during potentially every geriatric patient encounter.  Using these systems, the VR-GEC integrates geriatrics into all four years of the medical school curriculum, allowing it to identify individual students’ exposure to geriatrics and geriatrics knowledge gaps to permit timely supplemental instruction.  It also enhances medical and surgical residency training programs in geriatrics with specialty-appropriate training, and creates a Geriatrics and Gerontology Advisory Service to develop content and continuing medical education programs in geriatrics “best practices” for more than 1,000 faculty and affiliated community physicians. 

 

Yeshiva University, Bronx, NY – $1,997,826

 

Located in the Bronx, New York, Albert Einstein College of Medicine of Yeshiva University is set in a poor and medically underserved community.   Its main teaching hospital, Montefiore Medical Center, provides care for 1.5 million people and is home to one of the largest residency programs in the United States.  It created a GeriEd Program to emphasize the complex medical and neuropsychiatric geriatric syndromes of dementia, falls and delirium as a paradigm for geriatric medicine.  The original goals of the program were to develop expertise managing geriatric conditions, understand interactions between aging and disease, recognize the effects of aging and other conditions on physical and mental function, identify medication issues, coordinate care, preserve independence and assist families with decision-making.  It targets157 practicing physicians, 257 residents, and 750 medical students annually, relying on training strategies that include the use of quality-improvement methods, local expertise, “geriatrics champions” who serve as recourses, one-on-one teaching, conferences and web-based training.