Aging Clin. Exp. Res. 7: 1-2, 1995

EDITORIAL

The state of geriatric teaching in the universityT.F. WilliamsUniversity of Rochester, School of Medicine, Rochester, New York, U.S.A.

The key importance of educating present and futuregenerations of geriatricians and other health profes­sionals about aging and geriatric care should not needemphasis to the readers of this journal: the demo­graphic revolution in longevity and the related chal­lenges in the world-wide burgeoning of older and veryold persons is well known. From now on the majorityof all medical and related health care will be with old­er patients, and will involve physicians in essentially allspecialties as well as in general medicine. Even pedi­atricians and obstetricians, although not directly in­volved in treating older persons, will be dealingwith thegenetic, epidemiological, and psychosocial aspects ofthree-, four-, and even five-generation families.

Despite the examples in most European countriesof the development of systematic geriatric educationfor physicians over the past 20-30 years (see Ref. 1,for a careful description and evaluation of the devel­opments in Great Britain, for example), progress ingeriatric education in the United States has clearlylagged. Even though as early as 1978, a special studycommittee of the Institute of Medicine of the Na­tional Academy of Sciences chaired by Paul Beeson (2)called for serious commitments to geriatric medical ed­ucation in the United States, the response has beenspotty and slow. A number of the leading academicmedical institutions have indeed developed "Centersof Excellence" for education and training in geriatricsand in aging research, but these remain a minority ofthe medical schools. And, even in these settings, thecomprehensiveness of geriatric teaching and experi­ence for medical students and postgraduate residentphysicians is inconsistent and incomplete. For ex­ample, very few settings have obligatory clinical ro­tations in geriatrics; 5% or less of medicalstudents cur­rently receive any experience in home care for olderpeople.

Renewed awareness of the unmet educationalneeds and concern to address these needs can be seenin two recent studies and reports. In 1993, the Insti-

tute of Medicine again convened a Committee onStrengthening the Geriatric Content of Medical train­ing, under the chairmanship of Dr. John A. Ben­son, Jr., President Emeritus of the American Board ofInternal Medicine and former Dean of the Universityof Oregon School of Medicine.

Their report (3)and a related conference have alsobeen summarized elsewhere (4). This study was sup­ported by a special grant from the John A. Hart­ford Foundation. The second conference, held inSeptember 1993 and organized and conducted byChairpersons of the Department of Medicinewith thesupport of an educational grant from the Merck Com­pany Foundation, addressed geriatrics curriculum de­velopment in even greater detail (5). Both initiatives re­viewed the current range and types of geriatric edu­cational activities. Both emphasized the urgency ofproceeding to provide systematic education aboutaging and clinical geriatricsfor all medicalstudents andthorough clinical geriatric experience for postgraduateresident physicians. The need for continuing tostrengthen the academic base was emphasized interms of generating more academic leaders productivein both teaching and research.

Major requirements for further progress, in additionto increased numbers of well-qualified faculty, wereidentified as including obtaining unequivocal com­mitments to geriatrics as an academic priorityfrom thedeans and department chairpersons and other se­nior officials of the university medical schools, and ex­plicit requirements of the accrediting bodies for med­ical education and residency training for adequateaging and geriatric content. Steps already undertakenin this arena include the fact that residency trainingprograms in general internal medicine now require atleast a six-month experience in geriatrics. The Asso­ciation of American Medical Colleges is reviewingits requirements for content in the medical schools re­lated to basic biomedical aspects of aging and clinicalgeriatrics.

Correspondence: T.F. Williams, MD., University of Rochester, School of Medicine, Monroe Community Hospital, 435 East Henrietta Road,Rochester, N.V. 14620, U.S.A.

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T.F. Williams

Enhanced support from federal sources like theNational Institute on Aging and private foundationsand philanthropies is needed.

In this regard, it is encouranging to see the com­mitment of the John A. Hartford Foundation, theCommonwealth Fund, the Glenn Foundation, andother philanthropies, through such mechanisms as theAmerican Federation for Aging Research, to careerdevelopment awards for junior faculty in geriatrics, aswell as support for geriatric research experiences bymedical students and postgraduates.

It seems clear that the geriatric education in theUnited States is not likely to evolve in as uniform away as it appears to have done in a number of othercountries. But, at the same time, the variety of ap­proaches, built around similar basic principles andtaking advantage of the special strengths in differentsettings, may well lead to more innovative approacheswhich will be of interest worldwide as well as in theUnited States.

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As new efforts in geriatric education are under­taken, it will be important to have careful evaluativestudies of the actual outcomes and accomplishmentsof the educational initiatives.

REFERENCES1. Barker W.H.: Adding life to years: organized geriatric services

in Great Britain and implications for the United States. TheJohns Hopkins University Press, Baltimore and London,1987.

2. Institute of Medicine: Aging and medical education: Report ofa study. National Academy of Sciences, Washington DC,1978.

3. Institute of Medicine: Strengthening training in geriatrics forphysicians. National Academy Press, Washington DC, 1993.

4. WilliamsT.F.: Strengthening the geriatric content of medicaleducation (Editorial). J. Am. Geriatr. Soc. 42: 559-565,1994.

5. Hazzard W.R. (Guest Editor): Proceedings of a Conference:Geriatrics Curriculum Development Conference and Initiative.Am. J. Med. 97: 1S-59S, 1994.