Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-24T03:01:28.150Z Has data issue: false hasContentIssue false
  • English
  • Français

Teaching and learning geriatric medicine

Published online by Cambridge University Press:  26 January 2011

Inder Singh  and
Ruth E Hubbard
Inder Singh*
Affiliation:
Department of Geriatric Medicine, University Hospital of Wales, Wales, UK
Ruth E Hubbard
Affiliation:
School of Medicine, Cardiff University, Wales, UK
*
Address for correspondence: Dr Inder Singh, Department of Geriatric Medicine, Academic Centre, University Hospital Llandough, Penarth CF64 2XX, UK. Email: Inder.Singh@wales.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Summary

Populations throughout the world are ageing, with the oldest old the most rapidly growing segment of society. Caring for this ageing population, some of whom have multiple chronic and disabling diseases, will be challenging to healthcare systems. Current training programmes are generating relatively low numbers of geriatricians, largely because students and residents lack interest in a career in geriatric medicine. Therefore, specialists in geriatric medicine cannot directly provide care for all older people. There is a responsibility to ensure that successful practices and essential skills are shared.

Here we explore negative attitudes towards geriatric medicine and contrast these with factors motivating change. Educational theories are discussed to investigate how processes of learning and the personal development of students can be optimized. An understanding of geriatric medicine is important for undergraduates, postgraduate trainees in geriatric medicine, general practitioners and allied health professionals. The different challenges presented by each group are reviewed, accompanied by recommendations to enhance learning and examples of effective teaching practices.

Keywords

geriatric medicinemedical educationmedical student teachingpostgraduate training
Type
Education and training
Information
Reviews in Clinical Gerontology , Volume 21 , Issue 2 , May 2011 , pp. 180 - 192
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Louria, DB. Extraordinary longevity: individual and societal issues. J Am Geriatr Soc 2005; 53: S317–19.Google Scholar
2World Health Organisation. Active Ageing: A Policy Framework. Geneva: World Health Organization, 2002. Available at: http://whqlibdoc.who.int/hq/2002/who_nmh_nph_02.8.pdf (accessed 23 August 2010).Google Scholar
3Ebrahim, S. Demographic shifts and medical training. BMJ 1999; 319: 1358–60.Google Scholar
4Stähelin, HB, Beregi, E, Duursma, SA, Evans, JG, Michel, JP, Ruiz-Torres, A, Steen, B. Teaching medical gerontology in Europe. Group of European Professors in Medical Gerontology (GEPMG). Age Ageing 1994; 23: 179–81.Google Scholar
5Michel, J, Huber, P, Cruz-Jentoft, AJ. Europe-wide survey of teaching in geriatric medicine. J Am Geriatr Soc 2008; 56: 1536–42.Google Scholar
6Gordon, AL, Blundell, AG, Gladman, JRF, Masud, T. Are we teaching our students what they need to know about ageing? Results from the UK national survey of undergraduate teaching in ageing and geriatric medicine. Age Ageing 2010; 39: 385–88.Google Scholar
7Gross, J. Geriatrics lags in age of high-tech medicine. New York Times, 18 October 2006. Available at: www.nytimes.com/2006/10/18/health/18aged.html?_r=2&pagewanted=1 (accessed 23 July 2010).Google Scholar
8Brotherton, SE, Etzel, SI. Graduate Medical Education, 2005–2006. JAMA 2006; 296: 1154–69.Google Scholar
9Hirth, VA, Eleazer, GP, Dever-Bumba, M. A step toward solving the geriatrician shortage. Am J Med 2008; 121: 247–51.CrossRefGoogle ScholarPubMed
10Alliance for Aging Research. Medical never-never land: 10 reasons why America is not ready for the coming age boom. Washington DC: Alliance for Aging Research, 2002. Available at: http://www.agingresearch.org/content/article/detail/698 (accessed 28 July 2010).Google Scholar
11Arai, H. Geriatrics in the most aged country, Japan. Arch Gerontol Geriatr 2009; 49 (suppl 2): S1–2.CrossRefGoogle Scholar
12Bartram, L, Crome, P, McGrath, A, Corrado, OJ, Allen, SC, Crome, I. Survey of training in geriatric medicine in UK undergraduate medical schools. Age Ageing 2006; 35: 533–35.Google Scholar
13Bartram, L, McGrath, A, Crome, P, Crome, I, Corrado, OJ, Allen, S. Geriatric medicine training in UK undergraduate medical schools. Rev Clin Gerontol 2005; 15: 237–43.CrossRefGoogle Scholar
14Denaro, CP, Mudge, A. Should geriatric medicine remain a specialty? No. BMJ 2008; 337: 515.Google Scholar
15Diachun, LL, Hillier, LM, Stolee, P. Interest in geriatric medicine in Canada: how can we secure a next generation of geriatricians? J Am Geriatr Soc 2006; 54: 512–19.CrossRefGoogle ScholarPubMed
16Hughes, NJ, Soiza, RL, Chua, M, Hoyle, GE, MacDonald, A, Primrose, WR, Seymour, DG. Medical student attitudes toward older people and willingness to consider a career in geriatric medicine. J Am Geriatr Soc 2008; 56: 334–38.Google Scholar
17Fitzgerald, JT, Wray, LA, Halter, JB, Williams, BC, Supiano, MA. Relating medical students’ knowledge, attitudes, and experience to an interest in geriatric medicine. Gerontologist 2003; 43: 849–55.CrossRefGoogle Scholar
18Album, D, Westin, S. Do diseases have a prestige hierarchy? A survey among physicians and medical students. Soc Sci Med 2008; 66: 182–88.Google Scholar
19How ageist is Britain? London: Age Concern England, 2005. Available at: http://policy.helptheaged.org.uk/NR/rdonlyres/445DCD9D-4293-4716-9C5B-BB63F838A519/0/pstateageequality.pdf (accessed 23 July 2010).Google Scholar
20Jolly, P. Medical school tuition and young physician indebtedness. An update to the 2004 Report. Washington, DC: Association of American Medical Colleges, 2007. Available at: http://services.aamc.org/publications/showfile.cfm?file=version103.pdf&prd_id=212&prv_id=256&pdf_id=103 (accessed 19 July 2010).Google Scholar
21American Medical Group Association Compensation Survey Data, 2008 Report. Available at: https://www.cms.gov/AcuteInpatientPPS/Downloads/AMGA_08_data.pdf (accessed 23 July 2010).Google Scholar
22Le Couteur, DG, Bansal, AS, Price, DA. The attitudes of medical students towards careers in geriatric medicine. Australasian J Ageing 1997; 16: 225–28.Google Scholar
23Hoffman, SB, Brand, FR, Beatty, PG, Hamill, LA. Geriatrix: A role-playing game. Gerontologist 1985; 25: 568–72.Google Scholar
24Bachelder, J. Effectiveness of a simulation activity to promote positive attitudes and perceptions of the elderly. Educ Gerontol 1989; 15: 363–75.Google Scholar
25Kishimoto, M, Nagoshi, M, Williams, S, Masaki, K, Blanchette, PL. Knowledge and attitudes about geriatrics of medical students, internal medicine residents, and geriatric medicine fellows. J Am Geriatr Soc 2005; 53: 99–102.Google Scholar
26Lee, M, Reuben, DB, Ferrell, BA. Multidimensional attitudes of medical residents and geriatrics fellows towards older people. J Am Geriatr Soc 2005; 53: 489–94.CrossRefGoogle Scholar
27National Beds Inquiry 2000. London: Department of Health, 2000. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009394 (accessed 17 July 2010).Google Scholar
28Adams, WL, McIlvain, HE, Geske, JA, Porter, JL. Physicians’ perspectives on caring for cognitively impaired elders. Gerontologist 2005; 45: 231–39.CrossRefGoogle ScholarPubMed
29Tanner, CE, Eckstrom, E, Desai, SS, Joseph, CL, Ririe, MR, Bowen, JL. Uncovering frustrations. A qualitative needs assessment of academic general internists as geriatric care providers and teachers. J Gen Int Med 2006; 21: 51–55.CrossRefGoogle ScholarPubMed
30Schigelone, AS, Ingersoll-Dayton, B. Some of my best friends are old: a qualitative exploration of medical students’ interest in geriatrics. Educ Gerontol 2004; 30: 643–61.Google Scholar
31Teaching Geriatrics in Medical Education (TeGeMe), World Health Organisation. Available at: http://www.who.int/ageing/projects/tegeme/en/index.html (accessed 29 July 2010).Google Scholar
32General Medical Council. Tomorrow's Doctors. Available at: http://www.gmc-uk.org/TomorrowsDoctors_2003.pdf_27493401.pdf (accessed 29 July 2010).Google Scholar
33Geriatrics Instruction in the Medical School Curriculum. Washington DC: AAMC, 2003. Available at: www.aamc.org/data/aib/aibissues/aibvol3_no2.pdf (accessed 30 July 2010).Google Scholar
34From hospital to home: Improving care outcomes for older people. National Action Plan, 2004. Available at: http://www.health.vic.gov.au/acute-agedcare/hosptohome-anrep0607.pdf (accessed 30 July 2010).Google Scholar
35Department of Health. A new ambition for old age: next steps in implementing the National service framework for older people. London: Department of Health, 2006. Available at: http://www.psige.org/psigepdfs/A%20New%20Ambition%20for%20Old%20Age.pdf (accessed 30 July 2010).Google Scholar
36Bonin-Guillaume, S, Kressig, RW, Gavazzi, G et al. Teaching the future teachers in geriatrics: The 10-year success story of the European Academy for Medicine of Aging. Geriatrics Gerontol Int 2005; 5: 82–88.CrossRefGoogle Scholar
37Bruner, JS. Toward a theory of instruction. Cambridge, MA: Harvard University Press, 1966.Google Scholar
38Russell, IJ, Henricson, WD, Herbert, RJ. Effects of lecture information density on medical student achievement. J Med Educ 1984; 59: 882–89.Google Scholar
39Torre, DM, Daley, BJ, Sebastian, JL, Elnicki, DM. Overview of current learning theories for medical educators. Am J Med 2006; 119: 903–7.Google Scholar
40Colliver, JA. Educational theory and medical education practice: a cautionary note for medical school faculty. Acad Med 2002; 77: 1217–20.Google Scholar
41Skinner, BF. About behaviorism. New York: Knopf, 1974.Google Scholar
42Quinn, FM, Hughes, S. Principles and Practice of Nurse Education, 5th edn. Cheltenham: Nelson Thornes Ltd, 2007.Google Scholar
43Supiano, MA, Fitzgerald, JT, Hall, KE, Halter, JB. A vertically integrated geriatric curriculum improves medical student knowledge and clinical skills. J Am Geriatr Soc 2007; 55: 1650–55.Google Scholar
44Knowles, M. The Adult Learner: a neglected species. Houston: Gulf Publishings, 1973.Google Scholar
45O'Connell, MT, Rivo, ML, Mechaber, AJ, Weiss, BA. A curriculum in systems-based care: experiential learning changes in student knowledge and attitudes. Fam Med 2004; 36: S99–104.Google ScholarPubMed
46Thomson M. A nursing assistant training program in a long term care setting. Gerontol Geriatr Educ 1998; 19: 23–35.Google Scholar
47Pacala, JT, Boult, C, Hepburn, K. Ten years’ experience conducting the aging game workshop: was it worth it? J Am Geriatr Soc 2006; 54: 144–49.Google Scholar
48Varkey, P, Chutka, DS, Lesnick, TG. The Aging Game: improving medical students’ attitudes toward caring for the elderly. J Am Med Dir Assoc 2006; 7: 224–29.Google Scholar
49Alfarah, Z, Schünemann, HJ, Akl, EA. Educational games in geriatric medicine education: a systematic review. BMC Geriatr 2010; 10: 19.Google Scholar
50Peters, M. Does constructivist epistemology have a place in nurse education? J Nurs Educ 2000; 39: 166–72.CrossRefGoogle ScholarPubMed
51Howe, A, Billingham, K, Walters, C. In our own image – a multidisciplinary qualitative analysis of medical education. J Interprof Care 2002; 16: 379–89.CrossRefGoogle ScholarPubMed
52Rull, G, Rosher, RB, McCann-Stone, N, Robinson, SB. A simulated couple aging across the four years of medical school. Teach Learn Med 2006; 18: 261–66.Google Scholar
53Schon, DA.The Reflective Practitioner. New York: Basic Books, 1983.Google Scholar
54Jarvis, I. Reflective practice and nursing. Nurse Educ Today 1992; 12: 174–81.Google Scholar
55Cooney, A. Reflection demystified: answering some common questions. Br J Nurs 1999; 8: 1530–34.CrossRefGoogle ScholarPubMed
56Atkins, S, Murphy, K. Reflection: a review of the literature. J Adv Nurs 1993; 5: 135–42.Google Scholar
57Duque, G, Bonnycastle, M, Nazerali, N, Bailey, R, Ferrier, C, Heilpern, P, Gold, S. Building a learning experience: the implementation of a clerkship in geriatric medicine. Educ Gerontol 2003; 29: 671–83.Google Scholar
58Del Duca, D, Duque, G. A reflection on aging: A portfolio of change in attitudes toward geriatric patients during a clerkship rotation. Educ Gerontol 2006; 32: 605–10.CrossRefGoogle Scholar
59Duque, G, Finkelstein, A, Roberts, A, Tabatabai, D, Gold, SL, Winer, LR. Learning while evaluating: the use of an electronic evaluation portfolio in a geriatric medicine clerkship. BMC Med Educ 2006; 12: 4.Google Scholar
60Bandura, A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, New Jersey: Prentice-Hall, Inc. 1986.Google Scholar
61Kenny, NP, Mann, KV, MacLeod, H. Role modelling in physicians’ professional formation: reconsidering an essential but untapped educational strategy. Acad Med 2003; 78: 1203–10.CrossRefGoogle ScholarPubMed
62Oliver, D. ‘Acopia’ and ‘social admission’ are not diagnoses: why older people deserve better. J R Soc Med 2008; 101: 168–74.CrossRefGoogle Scholar
63Pack, L, Fuller, R, Pell, G, Roberts, T. Training in geriatric medicine in UK undergraduate medical schools. Age Ageing 2007; 36: 230.CrossRefGoogle ScholarPubMed
64Jones, S, Crome, P, Panayiotou, P. Do Trainees in Other Medical Specialties Receive Sufficient Education in Elderly Medicine? London: British Geriatrics Society, 2006.Google Scholar
65Crome, P, Jones, S, Panayiotou, B. Postgraduate training in geriatric medicine – British perspective. J Am Geriatr Soc 2007; 55: 805–6.Google Scholar
66Bassan, N, Soldano, OR, Vinuesa, MA, Sebastian, M, Venezia, SM, Di, Sipio. Geriatric medical education: An unclosed loop. Rev Fac Cien Med Univ Nac Cordoba 2006; 63: 71–75.Google ScholarPubMed
67Majumder, AA, Rahim, AFA, Rahman, S. Geriatric training in problem-based Learning: an Asian perspective. J Am Geriatr Soc 2004; 52: 1038.Google Scholar
68Habot, B, Leibovitz, A, Gil, I, Lubart, E, Segal, R. The impact of a rotation in geriatrics during the internship on young doctors. Arch Gerontol Geriatr 2000; 31: 115–19.Google Scholar
69The Medical Undergraduate Curriculum in Geriatric Medicine. British Geriatrics Society. Available at: http://www.bgs.org.uk/index.php?option=com_content&view=article&id=306:undergraduatecurriculum&catid=49:generalinfo&Itemid=171 (accessed 17 September 2010).Google Scholar
70Weiss, BD, Fain, MJ. Geriatric education for the physicians of tomorrow. Arch Gerontol Geriatr 2009; 49 (suppl 2): S17–20.Google Scholar
71James, OFW. Training in geriatrics and gerontology. Geriatr Gerontol Int 2004; 4: S2.CrossRefGoogle Scholar
72George, J, Young, JB, Tucker, JS. Senior house office training in geriatric medicine. Age Ageing 1987; 16: 111–14.Google Scholar
73Specialty training curriculum for geriatric medicine curriculum. Joint Royal Colleges of Physicians Training Board, August 2010. Available at: http://www.jrcptb.org.uk/specialties/ST3SpR/Documents/2010%20Geriatric%20Curriculum.pdf (accessed 12 September 2010).Google Scholar
74Rubenstein, LZ. Geriatric assessment: an overview of its impacts. Clin Geriatr Med 1987; 3: 1–15.Google Scholar
75Rubenstein, LZ, Wieland, D. Comprehensive geriatric assessment. Ann Rev Gerontol Geriatr 1989; 9: 145–92.Google Scholar
76Lally, F, Crome, P. Undergraduate training in geriatric medicine: getting it right. Age Ageing 2007; 36: 366–68.Google Scholar
77Bell, DS, Fonarow, GC, Hays, RD, Mangione, CM. Self-study for Web-based and printed guideline materials. A randomized, controlled trial among resident physicians. Ann Intern Med 2000; 132: 938–46.Google Scholar
78Cook, DA, Dupras, DM, Thompson, WG, Pankratz, VS. Web-based learning in residents’ continuity clinics: A randomized, controlled trial. Acad Med 2005; 80: 90–97.Google Scholar
79Westmoreland, GR, Counsell, SR, Tu, W, Wu, J, Litzelman, DK. Web-based training in geriatrics for medical residents: A randomized controlled trial using standardized patients to assess outcomes. J Am Geriatr Soc 2010; 58: 1163–69.Google Scholar
80Department of Health. Joint guidelines with the Department of Health and British Geriatric Society on the Appointment of General Practitioners with Special Interests in the Delivery of Clinical Services: Care of Older People, April 2003. London: Department of Health, 2003. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082869.pdf (accessed 12 September 2010).Google Scholar
81Department of Health. National Service Framework for Older People. Modern standards and service models. London: Department of Health, 2001. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4066978.pdf (accessed 7 August 2010).Google Scholar
82Department of Health. Guidelines for the appointment of general practitioners with special interest in the delivery of clinical services intermediate and continuing care for older people. London: Department of Health, 2002. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4020413.pdf (accessed 5 August 2010).Google Scholar
83Siegel, BS. Developing the interdisciplinary team. The clinical care of the aged person: An interdisciplinary perspective. New York: Oxford University Press, 1994, 404–25.Google Scholar
84Reuben, DB, Levy-Storms, L, Yee, MN, Lee, M, Cole, K, Waite, M, Nichols, L, Frank, JC. Disciplinary split: A threat to geriatrics interdisciplinary team training. J Am Geriatr Soc 2004; 52: 1000–6.Google Scholar
85Fulmer, T, Hyer, K, Flaherty, E, Mezey, M, Whitelaw, N, Jacobs, MO, Luchi, R, Hansen, JC, Evans, DA, Cassel, C, Kotthoff-Burrell, E, Kane, R, Pfeiffer, E. Geriatric interdisciplinary team training program: Evaluation results. J Aging Health 2005; 17: 443–70.CrossRefGoogle ScholarPubMed
86Hubbard, RE. Education in Geriatric Medicine. In Fillit, H, Rockwood, K, Woodhouse, K (eds). Brocklehurst's Textbook of Geriatric Medicine and Gerontology, 7th edn.Philadelphia: Elsevier, 2010.Google Scholar