In the first part of our series on geriatric education, we explored the major shortage of geriatricians in the United States. Part II focuses on two academic medical centers that offer unique training programs for graduating medical students who are interested in a career in geriatric medicine: The Medical College of Wisconsin’s (MCW) Medicine-Geriatrics Combined Residency Program and Eastern Virginia Medical School’s (EVMS) Combined Internal Medicine & Geriatrics Residency Program.
We were fortunate to interview Dr. Kathryn Denson and Dr. Marissa Galicia-Castillo, the program directors at MCW and EVMS, respectively, to learn more about these programs.
A New Way to Train Geriatricians
The traditional path to a career in geriatrics involves four years of medical school, a three year Internal Medicine or Family Medicine residency, and a 1-2 year Geriatric fellowship. While this path mirrors those of many other medical fields, the result is geriatric-specific training that takes place largely in a physician’s last year of training. Most Internal Medicine and Family Medicine residency programs offer only one month of dedicated geriatric training in the first three years following medical school.
The Medical College of Wisconsin (MCW) decided there was a better way to train physicians who knew coming out of medical school that they were passionate about geriatrics. As a result, in 2000, they started the nation’s first Medicine-Geriatrics (Med-Ger) Combined Residency Program.
Similar to the traditional Geriatrics pathway, MCW’s Med-Ger program provides broad-based training that allows residents to sit for board certification in Internal Medicine after three years and for board certification in Geriatric Medicine after completion of the fourth year. Where the program differs, however, is in its focus on geriatric training in the first three years. While a traditional Internal or Family Medicine residency generally offers one month of training in geriatrics over three years, MCW’s program offers two months of geriatric training for each of the first three years, followed by dedicated geriatric training in the fourth year.
In 2004, Eastern Virginia Medical School (EVMS) created a similar Combined Internal Medicine & Geriatrics Residency Program (Ger-IMed). Like the MCW program, EVMS’s Ger-IMed program provides significant exposure to geriatric training in the first three years of residency training. Dr. Marissa Galicia-Castillo, the EVMS Ger-IMEd Program Director, has found that its combined residency program appeals to a wide array of physicians, but the “common thread is that they have had a great mentor in geriatrics; they love that population and they know early on that is where they want to focus.”
Beyond the greater number of hours residents at MCW and EVMS spend on geriatric care during their residency than would be the case in a traditional pathway, the geriatric residency programs also provide learning opportunities that are simply not possible in a one-year fellowship.
According to Dr. Denson, MCW’s residents “have longitudinal patients in nursing homes and clinics. They see these patients throughout the four years, allowing them to get to know their patients well. This gives the residents a continuity that you really cannot get in a one-year fellowship.” As a result, by the end of the fourth year, the Med-Ger residents “have had more of an opportunity to develop themselves as geriatricians and educators. They seem to have more of a connection to the field of geriatrics as a whole.” In addition, because geriatric residents are at the hospital longer, they have been able to conduct interesting research projects at MCW on matters of importance for seniors, including a focus on transitions of care and treatment of delirium in nursing home patients.
Similarly, EVMS’s residents spend a half day each month visiting patients in alternative care settings such as assisted living facilities, skilled nursing facilities, and memory care units. Dr. Galicia-Castillo says that “by allowing them to do that in their first three years, they are able to try these different settings where many geriatricians practice. In a traditional pathway, they never would have received that exposure at all.” By the time Ger-IMed residents reach their fourth year, they are “able to share their vast experience with the fellows [who have joined following a traditional Medicine residency].”
Combined Residencies Benefit All Involved
The combined residency programs at the Medical College of Wisconsin and Eastern Virginia Medical School have created a win/win situation for both aspiring geriatricians and academic medical centers. Not only do these programs allow residents who know they want to pursue a career in geriatrics to start doing so earlier, but they also provide unique training opportunities through their longitudinal focus and research opportunities. Residents get more exposure to the vast array of care settings available to geriatricians, and they leave their medical training with more experience and a better idea of how and where they want to practice.
The residents are not the only ones who benefit, however. By bringing in graduating medical students and keeping them as residents for four years, MCW and EVMS have physicians on staff who can help educate other students, residents, nurses and physicians in other medical specialties on the care of seniors. Given the shortage of geriatricians in the US, this sort of inter-disciplinary training is becoming an important part of geriatricians’ job descriptions. Having residents available to help with this work can increase the educational reach and scope of academic medical centers’ geriatrics departments. Importantly, geriatric residency programs also help ensure that these hospitals are better able to fill their fellowship positions. With only 57% of available geriatric fellowship positions filled nationwide in 2011, a geriatric residency program is an attractive way for hospitals to ensure they have the geriatrics-focused care they need to serve their patients.
The Medical College of Wisconsin’s and Eastern Virginia Medical School’s combined medicine and geriatrics residency programs are two unique examples of how academic medical centers are working to help train skilled geriatricians. As the US population continues to age, demand for geriatricians will only increase, and hopefully these two programs will serve as a model for other programs in the future.
Are you aware of other innovative programs underway which aim to improve care for elderly patients? Let us know in the comments below or at firstname.lastname@example.org. We may highlight the program in a future installation of our ongoing series on geriatrician education.
About Medical College of Wisconsin
The Medical College of Wisconsin is the state’s only private medical school and health sciences graduate school. Founded in 1893, it is dedicated to leadership and excellence in education, patient care, research and service. More than 1,200 students are enrolled in the Medical College’s medical school and graduate school programs. A major national research center, it is the largest research institution in the Milwaukee metro area and second largest in Wisconsin. Annually, College faculty direct or collaborate on more than 2,000 research studies, including clinical trials. Additionally, more than 1,350 physicians provide care in virtually every specialty of medicine for more than 425,000 patients annually. Learn more at www.mcw.edu.
About Kathryn Denson, M.D.
Dr. Denson is a graduate of St. Louis University School of Medicine. She first joined the Medical College of Wisconsin in 1996 where she completed her residency training in Internal Medicine. She completed her Geriatric Medicine fellowship at the University of Washington and rejoined the Medical College of Wisconsin in 2002 as an Assistant Professor and has since been promoted to Associate Professor. She is board certified in Internal Medicine, Geriatric Medicine and Hospice and Palliative Care. Her areas of interest include home and community care and palliative care.
About Eastern Virginia Medical School
EVMS opened in 1973, the result of a grassroots effort to improve health in the region of southeastern Virginia known as Hampton Roads. EVMS focuses on the needs of its community, but the impact of its innovative research and high-quality patient care is felt worldwide. The collaborative culture at EVMS draws like-minded students and faculty from all over the country, encourages a multidisciplinary approach to health care and emphasizes translational research. In just 39 years, the school has grown from 24 students to an economic footprint exceeding $824 million annually. EVMS’s vision is to become the most community oriented school of medicine and health professions in the nation. Learn more at www.evms.edu.
About Marissa Galicia-Castillo, M.D.
Dr. Galicia-Castillo is a graduate of Eastern Virginia Medical School. She remained at EVMS after graduation where she completed her residency training in Internal Medicine, including a year as Chief Resident. She went on to become the first Geriatrics Fellow to graduate from the EVMS Glennan Center for Geriatrics and Gerontology. Upon completion of her fellowship, Dr. Galicia-Castillo joined the EVMS faculty and has been actively involved in the school. She currently serves as Medical Director for Sentara Norfolk General Hospital’s Palliative Medicine Service, as well as Harbor’s Edge, a continuing care retirement community. She is board certified in Internal Medicine, Geriatric Medicine, and Palliative Medicine. Her research interests are in education and palliative care.