Prod medical schools as population ages
By Kay Lazar, Globe Staff | November 16, 2009
Doctors who specialize in treating the elderly are calling on the nation’s medical schools to require all students to demonstrate competence in treating senior citizens, a change in century-old teaching standards.
With the first of the 78 million baby boomers nearing retirement age, the American Geriatrics Society is proposing that elder care be added to the list of six core areas that have long been the focus of medical school training.
While many schools are integrating more geriatrics into courses, the training varies greatly and less than 1 percent of the faculty responsible for teaching future doctors are experts in geriatrics, according to a 2008 report from the Institute of Medicine, a nonprofit that advises the federal government on health issues.
Medical students and doctors-in-training “are getting exposed in a very haphazard way,’’ said Stuart Altman, a coauthor of the report and a national health policy professor at the Heller School for Social Policy and Management at Brandeis University.
The report forecasts an impending health care crisis if significant changes aren’t made to ensure that more doctors and other caregivers are trained to handle the complex health needs of older patients.
Older minds and bodies function differently than those of younger adults, said Dr. John B. Murphy, board chairman of the American Geriatrics Society.
“For instance, the level of alcohol that causes inebriation at age 40 is different than at age 80 because of metabolic changes in the liver,’’ said Murphy, who is also a geriatrician and professor of family medicine at Brown University’s Warren Alpert Medical School. “The same is true for dosing of medications and how they are absorbed and metabolized in older people.’’
Just 7,128 physicians nationwide are certified geriatricians, the Institute of Medicine found. That translates to one specialist on aging for every 2,546 older Americans. By 2030, that disparity will nearly double, the group forecasts, noting that the relatively low pay and status of geriatricians within the medical community is a major reason for the shortage.
The scarcity of geriatricians is what prompted the American Geriatric Society to call on medical schools at their national conference in Boston last week to make the health needs and care of seniors a core part of medical education. It wants to add a stint of hands-on geriatric care to the “rotations’’ all students now do in family medicine, internal medicine, pediatrics, psychiatry, surgery, and obstetrics/gynecology.
The Association of American Medical Colleges has taken a different approach, however, because schools lack the time and money to add a separate rotation to the core areas, said a leader of the group.
Over the past decade, the association has awarded $5 million to 40 schools to instead integrate geriatrics training throughout the four years of medical school so that, for instance, students learning about prescribing medications will meet seniors who take 20 prescriptions a day and hear how that affects daily spontaneity, said the association senior director, Brownell Anderson.
In a parallel initiative, the Donald W. Reynolds Foundation, a Las Vegas-based philanthropy, has awarded nearly $80 million to 40 medical schools – including those at the University of Massachusetts, Brown, Harvard, and Boston University – to strengthen geriatric training for both medical students and practicing physicians.
“The AAMC thinks [geriatrics] is a critical issue,’’ Anderson said. “We are trying to encourage the schools to make it relevant, so it is not siloed from the rest of the program.’’
That is the approach taken by Tufts University School of Medicine in its revamped curriculum, which debuted this fall. In designing it, “The first thing we wanted to think about was meeting the needs of society, and caring for an increasing elder population is a big part of that,’’ said Dr. Wayne Altman, an associate professor of family medicine.
One key addition is an 11-week course in which first-year students practice taking patient medical histories. Half the time is spent with hospitalized patients, but the other weeks students go to the Jewish Community Housing for the Elderly in Brighton, where they meet with residents in their own living rooms.
“We find that when students talk to patients in their homes,’’ said Altman, who directs the new course, “it helps them understand better who people are and what their stories are.’’
One recent afternoon, first-year medical student Michael Castellot, 27, sat awkwardly, at first, on the edge of a chair as he listened to Tatyana Faynberg, 74, a Russian immigrant, describe through a translator the elation tinged with sadness she felt when she moved to the United States in 1995. A former journalist, Faynberg said she loved her work but struggled with years of censorship under the communist regime. The fallout has been lasting bouts of depression and crippling migraines.
“Do you mind,’’ Catellot tentatively asked about 20 minutes into his 30-minute session with Faynberg, “if I ask you about your medical history?’’ She nodded, provided animated answers to his questions, and later thanked him profusely for visiting.
Afterward, Castellot said the weekly journeys to the senior community had been a singular experience. Other than conversations with his parents and grandparents, he said, it was the first time he had conversed at length with much older people.
Geriatric instruction will be most effective if it is part of schools’ core offerings, said officials of the American Geriatrics Society. The schools would be more diligent in teaching the specialty because they would know that the committee that accredits schools will be looking for it, said Nancy Lundebjerg, who oversees the geriatric society’s education division: “If someone knows they are going to be tested on something, and if someone knows they will be reviewed based on how they performed against the standard, they will make sure they address whatever is in the standard.’’
Kay Lazar can be reached at klazar@globe.com.
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