Teaching geriatric assessment: use of a hybrid method in a family medicine clerkship.

The number of older adults in the United States is increasing. The number of Americans over 65 tripled from 1900 to 2004, and the number of Americans 85 and over increased 40 times in the same time period. In 2005, people over 65 years of age accounted for more than 25% of physician office visits, and between 1995 and 2005 there was a significant increase in visits made by persons 75 years and over, from 11.4% of all visits in 1995 to 13.4% in 2005.1 While fellowship-trained geriatricians have an important role, most older adults receive primary care from family physicians and general internists. Medical education has not kept pace in the training of physicians to care for an aging population. While more medical schools include geriatric content in their curricula, the educational hours and scope of content are limited.2 This training gap has led to poor quality of care. For example, though the prevalence of dementia reaches 30% in people over 85,3 clinicians often miss the diagnosis of dementia.4 Easy-to-use standardized tools have been developed that can increase diagnostic accuracy, but these are rarely put into practice because of perceived lack of time and training.5 It has been argued that mental status examinations should be as familiar as chest auscultation to primary care physicians.4 The historical emphasis of medical education has been on a model of acute care, suited to advances in infectious disease, traumatic injuries, and younger patients. In contrast, older individuals more often require management of multiple chronic diseases, as well as attention to functional status and quality of life issues.6 While the Family Medicine Curriculum Resource Project has included geriatrics competencies in their list of special topics,7 less than one third of family medicine clerkships have incorporated a formal geriatrics curriculum.8 To address this deficiency in our clerkship curriculum, we identified four areas that have a disproportional effect on the health and quality of life of older AmeriTeaching Geriatric Assessment: Use of a Hybrid Method in a Family Medicine Clerkship