Should geriatrics be mandatory in medical school?

in Education | 25 responses

Generally, all third-year American medical students rotate in medicine, surgery, OB/GYN, pediatrics, and psychiatry.

Should geriatrics be added to that list?

After all, patients aged 65 years and older make up more than 40 percent in medical specialty care, and over 30 percent in surgical care. For instance, heart attacks present differently in the elderly, and confusion can be due to infection or a drug reaction.

Most doctors do not receive formal training in geriatrics, and as geriatrician Rosanne M. Leipzig writes, “Often even experienced doctors are unaware that 80-year-olds are not the same as 50-year-olds. Pneumonia in a 50-year-old causes fever, cough and difficulty breathing; an 80-year-old with the same illness may have none of these symptoms, but just seem ‘not herself’ — confused and unsteady, unable to get out of bed.”

I was lucky that, at Boston University School of Medicine, geriatrics was a required course during the 4th year of medical school.

Perhaps more medical schools should follow that lead.

Comments

Min Ji Kwak
I totally agree. Geriatrics are neccessary. If we don’t understand polypharmacy, depression or sequential collapsing of organs, it is harder to treat an older patient. Furthermore, people live longer than they used to in the past.
http://www.mehmet.com/ Dr. Mehmet Karaca
It is estimated that by 2020 21-25% of the U.S. population will be over the age of 65. I think it is very crucial that medical schools introduce geriatrics into their core curriculum. Providing quality care to geriatric patients requires teamwork and a solid understanding of the diminished homeostatic reserve in this age group.
I was lucky enough to do a geriatric medicine fellowship. During the initial stages of my fellowship I was puzzled by how something as simple as an uncomplicated urinary tract infection or a foley catheter left in place for couple of hours longer than it should can cause altered mental status and even delirium, how even the smallest dose of a medication with even the mildest anticholinergic properties (even eye drops!) can cause urinary retention! Then there are all sorts of psychosocial areas such as independent living, elder abuse, dementia…
Lori Graham MSLS
That is interesting that Geriatrics is not tought. In the Diploma RN program at my institution, it is the first thing the student nurses learn. Wonder if that is true for the D.O.s as well.
family practitioner
Oh, come on.
Geriatrics was covered quite well in my medicine and family practice clerkships.
We do not need to train more geriatricians. We need to train more primary care internists and family practitioners who can do geriatrics well, and discourage the elderly from seeing so many specialists.
Cole
As a pediatric emergency medicine physician, geriatrics is not a regular portion of my professional life. That being said, I (along with my classmates) were required to participate in a 4 week geriatric rotation in the 4th year of medical school.
My rotation was after I had already matched into a pediatrics residency – making it not very applicable in my opinion for my future career. However, the rotation was interesting and well-constructed.
Dr. Mary Johnson
From a Pediatrician: I second and raise the “O come on”.
Like Neonatology as an off-shoot of Pediatrics, Geriatrics should (and can) be taught as part and parcel of an Internal Medicine rotation . . . and/or as an elective that students can choose if they are interested.
daisyduck
Internal Medicine and Family Medicine clerkships essentially ARE geriatrics rotations. This is a stupid argument.
ninguem
I second “oh come on” and the rest.
Geriatrics is taught. We will produce more geriatricians when we stop punishing practitioners of geriatrics. The geriatrics training programs not only sit unfilled, but doctors who have taken geriatrics fellowships have removed the fact of their training from their advertisements. They don’t want to be overrun with geriatrics because of the punishment that goes along with it. Low pay, massive paperwork, families with unrealistic expectations, and the creative trial bar finding new legal theories to sue doctors.
But the principles of geriatrics are well-taught in all medical schools, allopathic and osteopathic. The nurse can rest assured. I was on-call last weekend in my hospital. I can believe that geriatrics was the first thing taught in a diploma RN program, because it was obvious that taking vital signs was not.
Though I did get to demonstrate a 25-point difference in blood pressure numbers using the proper extra-large-size bp cuff in that 450-lb patient compared to the too-small “normal” size cuff they were using. Ran a little informal inservice……..
It’s not that geriatrics isn’t taught. It’s taught. And medical students learn to stay away.
http://www.susanbirk.com Susan Birk
I’m not a doctor, but I’m adding my two cents. I believe training in geriatrics–sorting through, understanding and managing the comprehensive and complex array of medical and psychosocial factors that uniquely affect older patients–should be an integral part of every physician’s training. With the aging of the population, how can it be otherwise?
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Joan S.
If the House bill that passed today makes it through the Senate, this’ll become a non-issue. It basically revamps Medicare. Seniors, who have for years had unlimited access to healthcare, will now find themselves on the short end of the stick.
VK
Or perhaps the unspoken truth, medical work done in a geriatric population isn’t as valuable as that work done in a child/normal adult population. Curing a 40 year old with 40 years left of life saves more years of life and is a lot more satisfying than “curing” an 80 year old who’s on their last few years.
Moreover, it might be smart. Some point out that geriatricians are going to be needed as America gets older. But have you considered the fact that as health care costs keep spiraling forward, whenever we get realistic about cutting costs, geriatric care will probably be one of the biggest chopping blocks? After all, we spend the most on them, and medicine on them, practically by definition, results in the least amount of years added per dollar spent.
Andy
You can argue that this may not be an applicable field under Obamacare
Family Doc
There has been much discussion of this article among my colleagues. All of us went to different medical schools and residencies, and all of us feel this was covered quite well. Family medicine residency requires a geriatrics rotation, geriatrics lectures in teaching sessions, and having continuity patients in a nursing home. While I agree that it’s important, I disagree with the author’s premise that it is not sufficiently taught.
dt
As noted by prior commenters, Geriatrics is well-covered by M3 Internal medicine and family medicine rotations. If geriatrics was specifically tested on USMLE Step 2, perhaps a required elective would be worthwhile. However, as it stands, addition of a required geriatrics rotation to the medical school curriculum would displace more important fundamentals.
As a current fourth-year medical student, I am strongly averse to having geriatrics as a required fourth-year elective, in lieu of electives like emergency medicine or epidemiology (which are both highly tested in standardized NBME examinations, but lack a required medical school elective)
Paul DeGregorio
I went to Boston University School of Medicine myself. Geriatrics is so well imbricated into the clerkships of medicine, surgery and the Home Medical Service that it would be a redundant burden to formalize it further as a required fourth year clerkship. Enough.
SmartDoc
Redundant, unnecessary training to be an underpaid, mistreated slave to breathtakingly crooked federal politicians & bureaucrats?
No thanks.
ninguem
My bailiwick of medicine is the most important in the world. The whole of medical education should bow to me. Teach my subject, in which I am expert of course. Teach it to the detriment of other fields of medicine, not as important as mine.
Oh, and since it’s my “home field”, I get the political power, the budget, and the corner office. Typical academic power fight if you ask me.
MS4
As a medical student I feel that my internal medicine and family practice rotations encompassed an immense amount of geriatric care. I don’t feel that an extra geriatric rotation would be an effective use of my time. It should be left as an elective.
HospiceDoc
The article is full of fear-mongering. By her estimates doctors have killed off all the elderly on purpose, so they should be extinct…
In medical school we had geriatrics in Internal Medicine, Family Medicine and our required Community Medicine. Then in Internal Medicine residency we had a required month of Geriatrics. Then in my fellowship we had a required month of Geriatrics. I think that was plenty.
IVF-MD
We had lots of special Geriatrics training in my medical school and it does no good in my practice today. In fact, if I ever gave medical care to someone over 65, I’d be forced to defend my actions.
another MS4
At least half of my medicine patients were >65, a significant number of my surgery patients were elderly, many of my family medicine patients were, lots of the emergency medicine patients were, lots of the anesthesia patients were, and lots of the gyn, psych and neuro patients were too. The only rotations that didn’t have elderly patients were peds and OB. I really don’t need another required rotation.
ninguem
You get this sort of stuff at the state level as well. This article is medical faculty with a pet peeve. The victim of all this, of course, is the poor medical student.
At the state level, the political types get fired up about the cause du jour. Next thing you know, there’s mandatory continuing education on that politician’s pet cause. Domestic violence. Child abuse. Pain management. Risk management. Elder abuse, HIV, on and on.
Oregon mandates education in “pain management”. They’ve even gone to requiring an Oregon-specific pain course. Oregon pain being different from Washington pain I guess. You could be a pathologist looking at tisue slides all day, doesn’t matter. You have to take the pain course. Now maybe the pathologist would be better off with a course on reading PAP smears, no matter. Take the pain course, put off the PAP smear course.
Of interest, Oregon does not have a CME requirement generally for license renewal. Likely there is CME required for maintenance of board certification, hospital privileges, specialty certification, etc., but not for the state.
So no general continuing education required, just one politician’s pet cause. Keeps Audio-Digest in business, they can create packages of lectures to keep Florida happy or Texas or Georgia or whatever state and pet cause the doc needs for licensure.
Roger
Geri was a mandatory rotation in my third year at an Osteopathic school. Of course, most of my IM patients were older as well, but the principles of the geriatric assessment were different from what I was taught of a general medicine ward service. I think those principles are valuable, and worthy of a mandatory rotation. BTW, they also applied to children with multiple chronic and severe illnesses, such as CF, DM, etc.
joe blow
This is a stupid thread. Everybody wants their pet subjects to get more play in med school:
1. HIV
2. Geriatrics
3. Domestic violence
4. Child abuse
5. Cultural competence
6. Breaking bad news
7. Diabetes management
8. Genetics
9. Epidemiology
10. Team-building exercises w/ nurses
Med students get a brief surveillance to all these issues, but we have all these idiots with their special pet projects who think they know what all their med students need, and seem to think they should hvae months of dedicated blocks to the subjects above. Whats even worse is that most of this pushback comes from “concerned public officials” who are not even doctors and have no clue as to what med school entails.

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