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Geriatric Emergency Medicine for Students, Residents, and Physicians

2017-03-05T14:18:41+00:00

geriatricsWe all know the population of the United States is aging. We know emergency physicians need to be prepared and trained to care for older adults. But how can you dive into the world of geriatric EM to learn more, to research, to gain additional training? In this post, we have gathered the wisdom of leaders in geriatric EM across the country, to share their recommendations, inspiration, and motivation.

Why Geriatric EM is Important

The population of older adults (age 65 and over) in the U.S. is projected to be greater than 70 million in 2030, up from 40 million in 2010. 1 Older adults currently account for 15% of ED visits per the CDC, but this number is projected to increase to 25% by 2020. 2 Geriatric emergency medicine is a field that is evolving and growing rapidly, with the goal of taking care of this expanding population of older adults. Physicians, residents, and students need to receive adequate training in how to care for older adults and to understand some of the unique challenges their care presents. In addition, we need to train up the next generation of researchers, administrators, and policy makers with an appreciation for the importance of geriatric care and its broad social, medical, and financial implications. Fortunately there are geriatric emergency physician-researchers across the country who are passionate about working to address these challenges.

Dr. Timothy Platts-Mills (University of North Carolina), who conducts research with older adults following MVCs to try to understand the development of chronic pain syndromes, says one of the reasons he remains excited about the field is the possibility of making a difference for these patients. Dr. Christopher Carpenter (Washington University in St. Louis), a national leader in geriatric EM was first motivated to pursue geriatric emergency medicine after observing his grandparents’ medical care:

The long-distance experience of miscommunication, inappropriate assumptions of illness goals of care and baseline functional status, and incomplete assessment of geriatric syndromes motivated me to view geriatric emergency medicine clinical education, research, and policy initiatives as the focus of my career.

Training in Geriatrics

Competencies in geriatrics have been defined for medical students 3 and EM residents, 4 but these are the minimum standards that all trainees should receive. If you are interested in gaining more expertise in geriatrics, there are a number of opportunities.

For Medical Students:

  • If your medical school does not have a mandatory geriatrics clerkship, consider doing one as an elective.
  • If you are able to choose your inpatient service during your medicine months, consider choosing the geriatrics service.
  • Rotate or shadow at a primary geriatrics clinic, a skilled nursing facility, or an assisted living facility.
  • If you rotate on Physical Medicine and Rehab, try to spend time with the stroke patients or on the stroke service if your hospital has one.
  • Try out research in geriatrics. You can apply for the summer MSTAR (Medical Student Training in Aging Research) program to carry out research in a broad range of disciplines with older adults. You can pick a mentor at a number of institutions from among the leaders in geriatrics research. When choosing a mentor, Dr. Carpenter advises:

Select a mentor whom you trust and with whom you can work for a long period of time (decades).

For EM Residents:

  • If you have elective time consider spending some of it in a setting caring for older adults.
  • When you have to give talks at your weekly resident lectures, pick topics related to older adults such as trauma in the elderly, stroke, sepsis in the elderly, etc. Researching and presenting a topic will help you gain expertise and confidence.
  • Ask your conference organizer for more geriatrics-focused lectures, and for simulation sessions that bring out the clinical nuances involved in caring for critically ill or injured older patients.
  • Find a faculty mentor who is interested and do your quality improvement (QI) or research project related to the care of older adults to fulfill your residency scholarly project requirement.
  • Seek out a mentor who is involved in geriatric EM. If there are none at your institution, contact the leaders of the SAEM or ACEP geriatrics communities (see below) to help connect you with a mentor.
  • Consider applying for a geriatric EM fellowship. There are currently 4 geriatric emergency medicine fellowship programs listed with SAEM, with additional new programs forming. Fellowships are typically 1 or 2 years long, and some can involve an additional degree such as an MPH.

For Physicians and Fellows:

  • Attend the geriatrics related lectures and sessions at ACEP and other national conferences
  • Consider becoming a champion of clinical geriatric EM within your ED. Guidelines for geriatric EDs were released in 2014, 5 and provide a framework for ways that any ED, whether it has a separate geriatric area or not, can become better equipped to provide care for older adults. The guidelines include models for staffing, ideas for training and education of existing staff, as well as structural or equipment changes that can help make any ED safer, more comfortable, and a higher-yield environment for older adults. See this earlier post for more on the topic of geriatric EDs.
  • Through funding from the John A. Hartford foundation, a group of leaders in geriatric EM are putting together ‘bootcamps’ for practicing physicians to help provide intensive training and practical advice on how to make any ED more geriatric-friendly. Bootcamps have already been piloted in two locations, with hopes to spread more broadly. Consider attending one. See this article for more info.
  • If you are interested in carrying out research in geriatrics, there is funding available specifically for those beginning a career in or entering the field of aging research in the GEMSSTAR grant, funded by the National Institute on Aging with additional funding available from the Jahnigen foundation. For those interested in a research career, Dr. Carpenter advises:

“Develop a toolbox of skills that you can use outside of geriatrics and your own research so that you can build bridges and seek secondary funding opportunities – this will be crucial if your research objectives are less successful than anticipated or unexpected funding droughts occur.”

The Community of Geriatric EM Physicians

Anyone interested in GEM should consider joining the Academy for Geriatric Emergency Medicine (AGEM) through SAEM, and the ACEP Section for Geriatric Emergency Medicine. Both of these organizations have geriatric-focused sessions at their annual meetings. The groups help to promote the importance of GEM and to connect members with similar interests. There are leadership positions specifically for medical students and residents, as well as the physician leaders. Dr. Marian Betz (University of Colorado School of Medicine) said of AGEM:

It’s a dynamic group of passionate, committed, and fun people who really helped me during the early steps of my career.

Finding Your Path

Because geriatric EM is a relatively new field, you may not have been aware of it, or know anyone who has chosen it as a career. As you look ahead to the rest of your career, think about whether becoming more involved in the field of geriatric EM might be right for you. Dr. Adit Ginde (University of Colorado) reminds us all:

Be open to different possibilities, try things out, don’t be afraid to change your mind, and follow gut instincts.

Older adults will become a larger part of your practice in the coming decades. We hope that this has piqued your interest and helped you see some of the opportunities available in geriatric EM.

 

Image Credit [1]

1.
Committee on the Future Health Care Workforce for Older Americans, Institute of Medicine. Retooling for an aging america, building the health care workforce. 1st ed. Washington, DC: National Academic Press; 2008:316.
2.
Wilber S, Gerson L, Terrell K, et al. Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system. Acad Emerg Med. 2006;13(12):1345-1351. [PubMed]
3.
Leipzig R, Granville L, Simpson D, Anderson M, Sauvigné K, Soriano R. Keeping granny safe on July 1: a consensus on minimum geriatrics competencies for graduating medical students. Acad Med. 2009;84(5):604-610. [PubMed]
4.
Hogan T, Losman E, Carpenter C, et al. Development of geriatric competencies for emergency medicine residents using an expert consensus process. Acad Emerg Med. 2010;17(3):316-324. [PubMed]
5.
Carpenter C, Bromley M, Caterino J, et al. Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine. Acad Emerg Med. 2014;21(7):806-809. [PubMed]
Christina Shenvi, MD PhD
ALiEM Associate Editor
Assistant Professor
Assistant Residency Director
University of North Carolina
www.gempodcast.com
Katie Hunold

Katie Hunold

University of Virginia medical student, and student representative to the Academy of Geriatric Emergency Medicine (AGEM)
Katie Hunold

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  • Don Melady

    Great primer for Geriatric EM, Christina! Thanks. To add an international quality, the Canadian Association of Emergency Physicians also has a GEM Clinical Committee. If you’re wanting free AMA-accredited continuing education in GEM, check out http://www.geri-EM.com The University of Leicester (UK) also offers fellowship training in Geri EM and Australia has just added similar training http://www.smh.com.au/nsw/australian-first-hornsby-hospital-creates-trainee-position-in-geriatric-emergency-medicine-20150331-1mc436.html

    • Christina Shenvi

      Thanks for the links to our international counterparts! I did recently see that the first program had started in Australia. That is exciting. All of us around the world will be facing many of the same issues, so I look forward to reading about how other countries solve their challenges when it comes to the care of older adults and the training of residents/students.

  • I think this is a great article … I would say this should be sent to every ED trainee if not all Med students ..
    thanks for taking time to put it together

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