October 2, 2009
Researchers Incorporate Multisite Geriatric Clerkship
As the population ages, it is imperative that medical students are prepared to treat older adults, regardless of their specialty. Researchers at Boston University School of Medicine (BUSM) report that an interdisciplinary multisite fourth-year geriatrics clerkship, has successfully met all the ambulatory core geriatric competencies as outlined by the Association of American Medical Colleges (AAMC) working group. This report appears in the October Journal of the American Geriatrics Society.
Individuals 65 years and older are the fastest-growing segment of the U.S. population. To this end, the AAMC and the John A. Hartford Foundation have established core competencies in geriatrics for all graduating medical students and recently released 26 minimum geriatrics competencies. This includes medication management, cognitive and behavioral disorders, self-care capacity, balance and gait disorders, healthcare planning and hospital care for older adults. These competencies address the need for all physicians to recognize the unique health concerns that the elderly face.BUSM researchers incorporated these competencies into a clerkship for fourth-year medical students. The students spend one month, accompanying clinicians on visits to skilled nursing facilities, clinics and home care settings. Under the supervision of a member of the interdisciplinary team, students are assigned two to three patients. The patients span a broad range of diagnoses, health status and goals of care including palliative and end-of-life care. Medical students are exposed to the interdisciplinary model that is central to geriatrics. The goal is to provide skills and knowledge ensuring that graduating students can provide appropriate care in a variety of settings.
The BUSM curriculum employs multiple teaching methods, such as lectures, online materials and interactive workshops. A weekly geriatrics conference series uses evidence-based reviews, a geriatric fellow-led journal club and outside speakers who address new research and clinical updates focuses on geriatrics.
At the end of the clerkship all fourth-year med students' can evaluate and manage syndromes and diseases common in older patients, possess working knowledge of aging, provide physical examinations and history taking of older patients with sensory, functional and cognitive impairments.
Students are assessed using quizzes based on the online dementia and delirium curriculum. At the end of the clerkship, they are given an exam covering the core lecture series and are also required to submit a write up of an Evidence Based Medicine paper. The BUSM fourth-year graduating class's response rate for the AAMC graduation questionnaire was 78.5 to 90.8 reporting that they agree or strongly agree they had learned the key geriatric concepts.
"Since its inception, the clerkship has met all of the ambulatory core geriatric competencies," explained lead author Daniel J. Oates, MD, MSc, an assistant professor of medicine at BUSM Geriatrics Section. "Students' in the program mastered the core competencies as shown by their responses to the questionnaires," he adds.
This study was funded by the Donald W. Reynolds Foundation.
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