A Thematic Summary of the Geriatrics Curricula at 40 U.S. Medical Schools

It is widely acknowledged that there are not enough physicians who are selecting the specialty of geriatrics even as the number of people living longer lives continues to increase. While it is true that there are few physicians with the specialty training dedicated to treating geriatric patients, the purpose of the Association of American Medical Colleges (AAMC)/Hartford Geriatrics Curriculum Program was not to create entire classes of students that would select geriatrics as their specialty, but rather to ensure that all medical students graduate with a fundamental set of attitudes, knowledge, and skills that will enable them to provide excellent care to older adults. If the goal of medical school is to provide a general, professional education to prepare the physician to practice medicine, a broad exposure to the concepts and current practices of geriatrics should be standard in every medical school curriculum. The reports in this supplement show how one third of U.S. medical schools are striving to meet this goal. The reports give a sense of the variety and scope of the educational programs at those schools; a glimpse into how educational change occurs and is managed; and some understanding of the barriers that faculty face when attempting to make necessary changes to their curricula. These documents represent the work of hundreds of those faculty, all of whom are dedicated to giving medical students the tools to understand and treat our country's aging population. The Supplement and its Origins When the John A. Hartford Foundation staff approached us at the AAMC about managing a program to enhance geriatrics curricula in medical schools, they proposed that five or six medical schools be funded with as much as $1 million per school. We suggested that there would be much more value in funding more schools for less money per school because that would increase the number of students exposed to geriatrics curricula and would provide far more examples from which other schools could benefit. Foundation officials agreed with our proposal, and even though the original plan was to fund 20 schools total, ultimately we were given enough money to fund 40. A key goal of the grants program was to disseminate the results of the schools’ efforts. The grant recipients agreed from the outset to share the products of their curriculum development. With this in mind, in June 2003 I sent a letter to individuals at each of the grant recipient schools asking them to answer a set of questions about their geriatrics programs. I thought it would be more useful to compare and contrast the schools’ approaches if their responses were presented in a similar manner, so I provided a template for their responses. That is why all of these responses are presented in the reports within identical (in most cases) categories (e.g., “Special Programs”) that correspond to the topics covered by the questions sent to the schools. The schools took slightly different approaches to responding to my questions, but I tried to include in the reports most of what the authors sent. It was necessary to edit in every case to fit the schools’ responses to the categories that organize each report's information. Some of the schools did not include information for all categories; some included more than we could use. Highlights from the Reports Short explanations of what the categories mean and highlights from the reports are summarized below. Overview of the Geriatrics Curriculum Each school was asked to provide an overview of the geriatrics curriculum it developed. The information is at varying levels of detail, but typically provides an outline of the types of courses in which the geriatrics content is included. It is important to remember that no school created a separate course on geriatrics alone. Rather, they were expected to weave geriatrics content into existing courses throughout the four years of medical school. Accordingly, the content and learning activities for geriatrics/gerontology at each school were integrated throughout the medical school curriculum. Most of the schools describe this as vertical integration. There is a wide variety of teaching strategies: formal lectures, one-on-one precepting in clinics and long-term care units, standardized patients, Web-based technology, small-group discussions, case studies, self-directed learning, and interdisciplinary team interactions. The goal of the integrated geriatrics curricula at almost all of the schools is to prepare all medical students to diagnose, treat, and interact with senior adults and their families and caregivers in ways that communicate expertise, understanding, and respect for their personal, physical, cultural, psychological, and social conditions. At least five of the curricula are organized as longitudinal experiences, and most take the students through increasingly challenging learning activities that begin with well elders and progress to frail patients. The curriculum is organized around a “doctoring,” or Introduction to patient care, curriculum in seven schools. Twelve schools developed their curricula based on one or both of two published statements of competencies recommended by the American Geriatrics Society,1,2 and one school incorporated appropriate objectives from the Medical School Objectives Project (MSOP).3 The basic science courses provide relevant information, and several schools have taken innovative approaches with their pharmacology courses, including the seniors who serve as mentors to the students in lectures on drug–drug interaction and the demands on aging patients of taking a large number of medications. Most of the schools have developed programs that involve students with well elder mentors from the community (see the chart that follows this essay), and a number of schools have organized their curricula with a senior mentor program as the focus. 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