It is an undeniable fact that our society is aging. And while some embrace aging with a mindset of optimism and gratitude for having longevity on their side, others dread aging and all the complications that can be associated with it. While the individual idiosyncrasies of aging are uncertain, there are a few things as certain as death and taxes: 1) our medical system needs to make more adjustments to prepare for the continued rise in the aging population and, 2) we need to better educate and inspire our budding health care professionals to take a vested interest in the care of older patients.
As a current third-year medical student at the University of North Carolina at Chapel Hill School of Medicine, I previously served as co-president of the UNC School of Medicine Chapter of the American Geriatrics Society and currently serve as one of the co-chiefs for a geriatric scholarly concentration program for medical students. More importantly, I came into medical school with a genuine interest in geriatrics and a vision of a future working as a physician with older adults. However, I can count on one hand the other individuals I have met who share my fervent passion for this population.
A recent article in JAMA dove further into this "paradoxical decline" in interest, highlighting how the number of board-certified geriatricians in the U.S. has fallen over the past 20 years, as well as noting recent studies indicating negative perceptions of older adults among medical students. While it may be paradoxical that we are noticing this decline as the number of aging individuals in the population rises, it is nonetheless predictable. Medical students are required to rotate through a variety of clerkships like pediatrics, surgery, etc., but unless they encounter fragmented experiences of care of older adults on outpatient or inpatient rotations or seek out a geriatrics elective (if their program even offers it), then they do not receive adequate exposure to geriatric medicine. Furthermore, accrediting organizations do not require medical students to learn about geriatrics at this time. Currently, medical students are required to complete a pediatrics clerkship and sit for a national pediatrics shelf exam, while the U.S. census recently noted that older adults are projected to outnumber children for the first time in U.S. history by 2034.
Given our current predicament, there is a valuable opportunity for medical schools to make adjustments to their curricula and clinical opportunities for students in an effort to intentionally build in opportunity for learning about polypharmacy, cognition, and multimorbidity in the care of older patients. Medical education can create opportunities for educating students about The Beers Criteria and geriatric syndromes early on in the classroom; organizing clinical opportunities through various geriatrics electives to engage students in care at skilled nursing facilities, outpatient clinics, and in the hospital setting during the third and fourth year of medical school; and largely focus on reframing current perceptions.
I am incredibly grateful to attend a medical school that has done all of the above and that can serve as exemplar to other medical education programs across the country. As I work alongside peers to strengthen our own efforts to promote geriatric education at my medical school, we must continue to think about this situation more broadly. Collectively, U.S. medical education needs better processes in place to increase interest among budding health care professionals. It is critical that we take steps to meet the growing demand of the geriatric population. We can start by better educating physicians-in-training to handle the nuanced and complex aspects of geriatric medicine. Otherwise, we will be ill-equipped for the "silver tsunami" and our health care system will be flooded by the increased demand and strain on resources.
Callan Loflin is a third-year medical student at the University of North Carolina at Chapel Hill School of Medicine and a 2022-2023 North Carolina Schweitzer Fellow. She serves as one of the co-chiefs of the Care of the Older Patient Scholarly Concentration Program at the UNC School of Medicine and leads a transitional care program for patients with traumatic brain injury.
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