Geriatric Education for Medical Students

As one of the first medical schools in the nation to implement a required geriatric medicine clerkship and the first to develop a competency-based geriatric curriculum for medical students, our institution has been a visionary leader in geriatric education for decades. In the early 2000s, faculty members in our division led the statewide effort by the Florida Consortium for Geriatric Medical Education to develop medical student competencies for core geriatric syndromes. Building on this initial regional collaboration, our educational faculty were involved in a national AAMC sponsored effort to identify and define geriatric-specific competencies that would set a performance benchmark for graduating medical students to prepare them to care for geriatric patients on their first day of residency. This consensus-based effort resulted in a set of 26 competencies covering eight domains: Medication Management, Self-Care Capacity, Falls, Balance and Gait Disorders, Hospital Care for Elders, Cognitive and Behavioral Disorders, Atypical Presentation of Disease, Health Care Planning and Promotion, and Palliative Care.

Our current longitudinal medical student curriculum in Geriatrics, Pain Management, and Palliative Care is directed by Maria (Rose) van Zuilen, PhD, Juan Carlos Palacios, MD, and Joel Danisi, MD. The curriculum spans all four years of training and targets the national AAMC Geriatrics competencies. In the first and second year curriculum, the focus is on teaching the students the basics of a comprehensive geriatric assessment with well elderly and elderly developing dependencies. Students learn how to perform a multidimensional assessment of the medical, functional, socio-economic, and psychological domains. The curriculum features an innovative home visit program in which students are partnered with active older adults in the community. During their home visits, students receive hands-on practice obtaining a comprehensive geriatric history and performing elements of the geriatric assessment. Students also learn about important palliative care and end-of-life care topics such as discussing advanced directives and delivering serious news. They are then given an opportunity to practice their communication skills.

In their third or fourth year of training, students complete a 4-week geriatric medicine clerkship. In the clerkship, students assume responsibility for the care of older patients under the supervision of board-certified geriatricians and palliative care physicians, geriatric and palliative medicine fellows, and members of the interdisciplinary care team. The patients are elderly with significant dependencies and those with the need for long-term care services. Students receive clinical exposure to different levels of care including geriatrics primary care, subacute care, consultative care, long-term care, and hospice care. Our primary clinical training venues are the Miami Veterans Affairs Medical Center and the University of Miami Hospital and Clinics. Students become active members of the interdisciplinary team and learn about the interdisciplinary approach to care planning for our older patients. Students have access to the Online Geriatrics University (www.geriu.org) which houses a range of training modules and other learning resources. The clerkship promotes self-directed learning and encourages the application of principles of evidence based practice.

Students who seek to gain more in-depth training in the clinical and/or research aspects of aging can sign up to complete a 2 or 4 week senior-level elective in Geriatric Medicine. Training opportunities for this elective are tailored to the student’s interests.