Geriatrics Fellowship Training in Taiwan: What Has Been Achieved So Far
Liang-Kung Chen is the Director for the Center for Geriatrics and Gerontology, Taipei Veterans General Hospital and Associate Professor of the Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan and is International Advisory Panel member for Age and Ageing journal.
Taiwan became an ageing country in 1993 and is estimated to become an aged country by 2017, which makes it one of the fastest ageing countries in the world. By 2025, the percentage of people aged 65 years and older will be 20%, corresponding to an increase in the elderly population from 2.5 million to nearly 5 million within 15 years. This rapid demographic transition has had a huge impact on our country, especially the healthcare systems.
Taiwan is famous for her National Health Insurance Program, which provides good, efficient and inexpensive health care. However, the Taiwanese healthcare system is dominated by acute care-oriented, organ specialty-based clinical practice, and the lack of a well-established referral system between primary and secondary care. These issues have resulted in fragmented health care services, which are a particular disadvantage for older people due to the complexity of the conditions with which they present. We believe that some of these shortcomings may be overcome by the relatively recent introduction of geriatric medicine to Taiwan.
In 2004, the Taiwan National Health Research Institute launched the first Geriatric fellowship training program with active assistance from the Mt. Sinai University Hospital of the United States. The fellowship training program followed the scheme of the United States, which consists of 12-month training in acute geriatrics, neurology, old age psychiatry, rehabilitation medicine and long-term care. Like the training programs in the United States, geriatrics is considered a subspecialty of internal medicine, family medicine, neurology, psychiatry and rehabilitation medicine. After the success of this pilot program, the Taiwan Association of Gerontology and Geriatrics formally took over the management of specialty training program between hospitals in Taiwan. Currently, there are 13 geriatric medicine specialty training programs which receive around 20-25 trainees per year.
In 2006, Taipei Veterans General Hospital started a geriatric medicine fellowship training in affiliation with the British Geriatrics Society (BGS). The BGS helped to identify teachers to visit Taiwan in order to provide lectures, group discussion and bedside teaching for the trainees. On average, for each rotation, there are four teaching blocks provided by BGS teachers, with each block lasting one week. This collaboration between Taipei Veterans General Hospital and the BGS has successfully trained 30 geriatricians and will continue to operate. In addition to receiving visitors from the UK, we have also sent our fellows to the UK hospitals of BGS teachers as clinical observers, to experience how geriatrics is practiced there. In the past few years, not only British teachers, but also teachers from Canada, Japan and the United States have participated in this international geriatrics training program.
As part of the training program, we also encourage our trainees to conduct their own research and to publish their work. Overall, they have published 1.01 papers in SCI-indexed journals, with an average impact factor of 2.20 and many continue research in geriatric medicine after their training.
Taipei Veterans General Hospital has become an active member in the international geriatrics community. We organise the Asia Pacific League of Clinical Gerontology and Geriatrics and published a quarterly journal, the Journal of Clinical Gerontology and Geriatrics. We worked with the International Association of Gerontology and Geriatrics to start the Master Class on Ageing in 2011, which was the first international intensive course for young geriatricians. In the Master Class, 8 international teachers (Taiwan, Hong Kong, China, Japan, Korea, France, Switzerland and Australia) spent 3 days with 25 international students from Taiwan, China, Hong Kong, Japan, Korea, India, Indonesia, and Australia. The success of this Master Class encouraged other countries to host other Master Classes. Up to now Hong Kong, Beijing and Kyoto have each hosted Master Classes and Seoul is planning to organize a further one in June 2014.
This BGS-affiliated Geriatrics fellowship training program has successfully promoted the development of Geriatrics in Taiwan and helped to link Taiwan to the world. Through this international network, we have also developed intermediate care and orthogeriatric services, and these trained geriatricians had become the strongest support to these new health service models.