At UTMB, geriatrics content is woven throughout the 4-year undergraduate medical school curriculum. Multiple modalities teach and provide experiences to support geriatrics learning objectives. The geriatrics curriculum is comprised of a series of lectures, PBL cases, standardized patient encounters, and community experiences incorporated throughout the curriculum. The Office of Education (OED) has helped develop geriatric curriculum and is currently developing a geriatric week rotation in conjunction with the 4th year Neurology clerkship, to be implemented June 2004.
Curriculum management and governance structure
The 4-year curriculum is under the Dean of the School of Medicine, with assistance of Associate Dean for Educational Affairs, Associate Dean for Regional Medical Education and Director of Clinical Assessment and Professional Development, and Assistant Dean for Educational Affairs. Additionally, the curriculum committee provides curricular oversight and governance with assistance from these committees: 1) Curriculum Research, 2) Operations, 3) Course Directors, and 4) Clerkship Directors.
Following an institutional retreat and task force reports, the following objectives for geriatrics and gerontology education, adapted from the 8 learning objectives of the American Geriatrics Society Core Competencies, were delineated (See Figure 1).
Integrated Curriculum Educational Goals & Learning Objectives for Geriatric and Gerontology Medical Curriculum
Objective 1: Understand the biology of aging including the impact of gender and ethnic variability
Objective 2: Understand the psychosocial aspects of aging across ethnic groups
Objective 3: Understand the financing and systems of health care available to older persons
Objective 4: Identify basic principles of geriatric medicine, including unique aspects of disease presentation, and geriatric pharmacology
Objective 5: Describe the role of geriatric assessment, health promotion, palliative care, and rehabilitation in patient management
Objective 6: Understand the diagnosis and management of geriatric syndromes, including dementia, delirium, urinary incontinence, malnutrition, osteoporosis, falls, pressure ulcers, pain, dysphasia, dizziness, and polypharmacy
Objective 7: Understand state-of-the-art approaches to geriatric care including care in hospital, office practice, nursing home and home care settings
Objective 8: Understand the importance of geriatric problems and issues to internal medicine, neurology, psychiatry, dermatology, gynecology, and surgery
Additional goals of the geriatric/gerontology content infusion include increasing geriatric community experiences in the Practice of Medicine course and clinical clerkships, improving the quality and quantity of problem-based cases portraying persons over the age of 65 years, enhancing clinical skills assessments in geriatric areas, and increasing students' interest in geriatric care.
Themes for geriatrics programs
UTMB has specifically taken an integrative approach to geriatrics in the undergraduate medical school curriculum. The core of geriatric medicine is an emphasis on interdisciplinary teamwork.
Seniors/mentor program - In 2001, UTMB introduced a Family Home Visit Program as part of the community learning experience in the Practice of Medicine 1 Course. In this program, medicine, OT and PT students visit multigenerational community families in their homes. At least one family member must be over age 65.
Geriatric standardized patients/simulations - Geriatric Standardized Patients are used for teaching and assessment. In the Practice of Medicine POM 1 & 2 (first and second year courses), students practice history taking and physical exam skills with geriatric standardized patients. In the clinical years, as well as for POM 1 & 2, assessment of student competency occurs with patients of all ages. All students must successfully complete a 4th year competency exam, which includes a minimum of at least 1 geriatric patient scenario.
Faculty development programs for geriatrics curriculum - UTMB's Office of Educational Development sponsors an 18-month Scholars in Education program for faculty that focuses on teaching methods and curriculum development. Each session, geriatric faculty participate as scholars. Additionally, three geriatric faculty have been awarded academic development awards in clinical geriatric education.
Student interest group - UTMB started a Geriatric Student Interest Group on campus in 2001. Activities include movie night (movies with seniors as main characters), learning lunches, dinner lectures, grand rounds, and local and national conferences. In 2002, the Geriatric Student Interest Group was chartered as an official campus student organization.
Palliative care and end of life courses - UTMB does not teach palliative care or end-of- life courses per se. End-of-life issues are part of the Practice of Medicine 2 course, and part of ethics modules presented throughout the curriculum. Three end-of-life care web-based cases have been used in various courses.
Geriatrics serves as a model for discipline-specific content to be integrated at UTMB. This required recognition of the importance of geriatrics so content was readily accepted within courses and/or clerkships. The template and learning objectives are applicable across the curriculum, and have been applied by other disciplines.
Computer technology in the geriatrics program
Geriatric content has been presented technologically in the curriculum through geriatric web-based interactive cases. Nine cases are completed and four more are near to completion. These cases are leveled for the learner and used in both the courses and clerkships. As the geriatrics rotation week is being developed for implementation in the 4th year Neurology clerkship, additional cases and web-based instructional media will be employed.
Changes in assessment
Students are responsible for more geriatric-related knowledge and skills on OSCE's and exams. A requirement for graduation is successful completion of a geriatric integrated clinical skills assessment exam. Additionally, data is collected on three cohorts, three data points each, on student attitudes and knowledge towards aging. This instrument was developed at SIU and adopted for use at UTMB in the ongoing administration of longitudinal measures within the School of Medicine.
Students rotate through the Acute Care of the Elderly (ACE) unit, the geriatric specialty clinics (osteoporosis, falls, incontinence), and county geriatric clinics with geriatric faculty.
For more information on geriatric education at UTMB, please visit http://www.utmb.edu/geriatrics/Education/Fellowship/index.htm or contact the Office of Education Development, directed by Dr. Ann Frye, at (409) 772-2791.