The British Geriatrics Society Recommended Curriculum in Geriatric Medicine for Medical Undergraduates
In Tomorrow’s Doctors 2009, the GMC emphasised the need for medical graduates to meet the principles of professional medical practice as set out in "Good medical practice" and identified the knowledge, skills, attitudes and behaviour expected of all new graduates.
All undergraduate curricula must have a core consisting of the essential knowledge, skills and attitudes which students must have by the time they graduate, supported by student-selected components (special study modules) occupying a variable proportion of a five year curriculum depending on the medical school. These enable students to study topics in more detail, develop self-directed learning and become familiar with research and presentation skills.
In this document (currently undergoing review) the British Geriatrics Society Education and Training Committee (BGSETC) sets out what it believes should be the curriculum in Geriatric Medicine and Gerontology for all medical undergraduates. These learning outcomes have been derived from a review of the literature and subsequent expert content validation process1, and have been mapped to Tomorrow’s Doctors 20092.
It is important that all new medical graduates are prepared for life-long learning. The core undergraduate curriculum in Geriatric Medicine can be regarded as a basis upon which Foundation Year (FY1 and FY2) and Specialist Training (ST) doctors can build their educational objectives. However it cannot be assumed that doctors will have further education in Geriatric Medicine and the undergraduate curriculum is designed to ensure that all graduates have the essential knowledge and abilities to manage older people.
Learning outcomes
1. Students should be able to:
a. maintain a professional approach to the older person
b. give consideration to various myths and stereotypes related to older people
c. advocate against ageism and recognise that it can affect the optimal care of older patients
d. recognise the heterogeneity of older persons and that each person needs to be viewed as an individual
2. Students should be able to:
a. describe the contributions of the following professions allied to medicine: Occupational therapy, Physiotherapy, Nurses, Dieticians, Speech & language therapists, Social workers
b. explain how these professions can work together effectively as part of a multidisciplinary team.
3. Students should be able to describe / define:
a. biochemical, molecular, cellular, genetic theories of ageing
b. the anatomical and histological changes associated with ageing
c. the pathology associated with normal ageing and age associated disease processes
d. the physiology of ageing
e. the effect of ageing upon pharmacodynamics and pharmacokinetics
f. the diagnosis, pathophysiology, management and preventative strategies for specific disease processes: dementia, delirium, depression, continence, osteoporosis, falls, parkinsonism & movement disorders, pressure ulcers, cerebrovascular disease and stroke
4. Students should be able to describe the concepts of:
a. polypharmacy
b. the practice of safe prescribing in older adults, taking account of differing physiology, drug interactions and multiple pathologies
5. Students should be able to:
a. recognise the limitations of hospital-based care and value the contribution of Community Geriatrics in adequate assessment and management of patients
b. describe the concept of Rehabilitation
c. define the interaction between health and social services in the provision of long-term care for older adults and describe the following services; NHS continuing care, residential home care, nursing home care, community care at home, community nursing care, community matron service, intermediate care at home, residential intermediate care, interim care
6. Students should be able to describe ethical and legal issues including:
a. advance directives
b. euthanasia and assisted suicide
c. safeguarding
d. withdrawal and withholding of medical treatment
e. cardiopulmonary resuscitation decisions
7. Students should be able to describe:
a. the principles of autonomy, mental capacity to make decisions and the concept of “best interests”.
b. the legislation in each jurisdiction which outlines and protects these principles.
8. Students should be able to:
a. define the components of the International Classification of Function (ICF) and discuss its advantages and disadvantages in comparison to previously used classifications
b. define Comprehensive Geriatric Assessment (CGA) and list its main domains to incorporate medical, psychological, social, functional and environmental .
c. describe the process of Comprehensive Geriatric Assessment, including initial assessment, establishment of a problem list, management plan, goals and iteration. Describe the role of the multidisciplinary team in this process.
d. define the following specialties and relate their contribution to the care of older adults; continence services, falls services, intermediate care, old age psychiatry, orthogeriatrics, palliative care, stroke medicine.
9. Students should be able to describe:
a. recent and predicted trends in demography and epidemiology of ageing
b. the interaction between health and social services in the provision of long-term care of older adults
c. psychosocial theories of ageing
10. Students should be aware of the issues of: elder abuse: physical, psychological and financial
11. Students should be able to:
a. describe how to design research where the findings are applicable to older people including:
- issues of sampling and generalisability
- inclusion of participants with functional and cognitive impairment and the associated ethical issues
- issues of measurement and measurement bias due to ceiling and floor effects in the older population
b. discuss the generalisability of existing research studies to frail older people through consideration of these issues.
Learning Opportunities
Geriatric Medicine provides excellent learning opportunities for medical undergraduates. Good quality care of older people requires a multi-disciplinary approach and older people may be treated in a variety of different settings. Communication with patients, carers and other professionals is of paramount importance to the optimal care of older people and ethical dilemmas frequently occur in clinical practice. A number of innovative approaches to teaching geriatric medicine have been developed3 and geriatricians and gerontologists not involved in designing undergraduate curricula should liaise with those who are, promoting the many learning opportunities that the specialty offers.
It is important that the thread of ageing and the health of older people runs through an integrated medical undergraduate course. The curriculum in Geriatric Medicine can be adapted for different course modules, e.g. community or hospital based, or means of learning, e.g. problem-based.
The BGSETC recommends that all students should have the opportunity to learn about the treatment and care of older people in a module attached to a specialist department. The attachment should be long enough (at least four weeks) to enable students to see patients respond to treatment and progress with a multi-disciplinary approach to management.
Some medical schools have found that educating medical undergraduates about teamwork can be enhanced by learning in multi-disciplinary groups with students from other professions allied to medicine such as physiotherapy and occupational therapy.
Assessments
Methods of assessment should support the curriculum and undergraduates must demonstrate that they have met the curricular objectives. Students must be assessed in the core and student selected components of the curriculum.
There are a variety of different and complementary forms of assessment. The Objective Structured Clinical Examination (OSCE) is a particularly useful method and the Geriatric Medicine curriculum lends itself particularly well to this approach. Assessments can take place at the end of an attachment or module which includes Geriatric Medicine, and/or in the final examinations for a primary medical qualification. Different stations can be incorporated in the OSCE relevant to the specialty curriculum such as history and examination (including mental state), communication skills (using simulators), practical skills (using manikins), treatment/prescribing and discharge planning stations. Many aspects of the curriculum, especially knowledge, can also be assessed in medical or psychiatric written exams. A variety of assessment methods can be used, ideally in combination.
The BGSETC recognises that the curriculum objectives and design will differ between medical schools. The Geriatric Medicine curriculum should be regarded as a framework which can be adapted and modified to suit all undergraduate curricula.
References
- Blundell A, Gordon A, Gladman J, et al. Undergraduate teaching in geriatric medicine: the role of national curricula. Gerontol Geriatr Educ 2009;30:75–88.
- Forrester-Paton C, Forrester-Paton J, Gordon AL, et al. Undergraduate Teaching in Geriatric Medicine: Mapping the British Geriatrics Society Undergraduate Curriculum to Tomorrow’s Doctors 2009. Age Ageing 2013;In Press.
- Blundell A, Gordon AL, Masud T, et al. Innovations in teaching undergraduates about geriatric medicine and ageing - results from the UK National Survey of Teaching in Ageing and Geriatric Medicine. Eur Geriatr Med;2:12–4.