The University of California Academic Geriatric Resource Program

Update on Recent Program Activities - July 2001

UC and Geriatrics Education

In September 1984, the California State Legislature authorized the establishment of the UC Academic Geriatric Resource Program (AGRP) as a mechanism for developing, within the University and community at large, new educational initiatives in geriatrics, gerontology, and other disciplines related to aging. The goals reflected in the enabling legislation for the Program included: the establishment of new Academic Geriatric Resource Centers (AGRCs) on UC health sciences campuses; promotion and improvement of geriatrics education and training for health sciences students, faculty, and staff; education and service for the general public; and research on health care practices in nursing homes. Since its creation, and within the limits of its current $1.2 million annual budget, this program has been a successful catalyst for advancing the quality of geriatrics education and for promoting faculty development, service to the elderly, and research in health and aging.

The Geriatric Medical Education Act of 2000

In September 2000, California Governor Gray Davis signed Assembly Bill 1820 enacting the Geriatric Medical Training Act of 2000. This legislation contains findings regarding the aging of the California population and expresses the Legislature's intent that UC increase its emphasis on geriatrics education for health sciences students and undertake new initiatives to meet the needs of California seniors. Within this context, the measure expresses the Legislature's intent that UC medical students, and medical residents in certain specialties, complete a definable curriculum in geriatric medicine that meets recognized core competencies for the care of older persons. These and other initiatives called for in AB 1820 are intended to promote and "...instill the attitudes, knowledge, and skills that physicians need to provide competent and compassionate care for older persons..."

A one-time budget augmentation of $2 million dollars was provided for the University's AGRP in FY 2000-01 to support development activities consistent with AB 1820. In addition, a total of $4 million dollars in one-time funding was provided to the University by the State to support two new endowed chairs at UC medical school campuses at a level of $2 million per chair. The intent of the Legislature is also expressed in AB 1820 that the faculty filling these chairs provide leadership in undertaking future initiatives to meet the goals of the same legislation.

Over the past year, UC health sciences campuses, in coordination with the Office of the Vice President for Health Affairs and systemwide AGRP, have responded to the goals of AB 1820 in a variety of innovative ways. Systemwide highlights are as follows:

• New efforts have been undertaken to add geriatric content to the curriculum through development of new geriatric teaching modules, standardized patient exercises, and Web-based curriculum training.

• New geriatric clinical experiences have been developed for primary care residents and medical students at UC medical schools.

• A new geriatric medicine/psychiatry clinic has been organized at a homeless shelter.
• New community service and education programs have been created to provide aging-related health information to the public through interactive Web sites, newsletters, community lectures and conferences.

• Medical consultations by UC faculty continue to be provided to community-based agencies and organizations serving older adults.

• Several faculty development programs were conducted to increase the geriatric knowledge for generalist, non-geriatrician faculty, and to address geriatric home assessment for clinical faculty in family and community medicine.

• Collaborative interdisciplinary geriatric and gerontology programs in the other health professions were developed, including new efforts in dentistry, nursing, public health, and social welfare. Planning for the future of geriatrics training in the other health professions has been initiated.

UC Berkeley

The UC Berkeley AGRC is administratively located in the School of Public Health. Consistent with the overall goals of the AGRP, it serves as the focus for coordination of campus-wide education and training activities in geriatrics and gerontology for UC Berkeley's graduate schools of Public Health, Social Welfare, and Optometry. A central goal of the AGRC is to develop and sustain a coordinated, multidisciplinary educational approach to addressing the health and social needs of California's elderly.

Recent activities funded by the AGRP and related to AB 1820 are as follows:

• Planning has begun for several new initiatives including: a summer Institute on Curriculum Development in Aging, a teaching nursing home based on the Eden Alternative, and a "Graduate Group" in Aging.

• An active campus planning process has begun to add new curricular learning objectives in aging and geriatrics for medical students in the UCB-UCSF Joint Medical Program.

• A two-semester undergraduate course "Introduction to Aging" is being planned and will be offered in fall and spring of 2001 - 2002.

• An Interdisciplinary Working Group on Aging comprised of scholars, practitioners, and graduate students in the health sciences, health professions, social sciences, the humanities, and law has been convened.

• A new scholar-in-residence program in aging has been established. Dr. Lawrence Branch of Duke University visited as the first scholar and lectured to the public, students and faculty.

• The UC Berkeley AGRC Website continues to be updated and incorporates an e-mail newsletter with resource information on aging for the community, professionals and academics.

• New interdisciplinary aging programs and special projects were created to better serve the community, professionals working in the field, students, faculty and staff.

The UC Davis AGRC is located in the Center for Aging and Health in the Department of Family and Community Medicine, School of Medicine. The Center addresses the goals of the systemwide AGRP program through the development and coordination of health sciences education and community service programs that address the needs of the elderly.

Recent activities funded by the AGRP and related to AB 1820 are as follows:

• A three-part faculty development program was initiated to increase the geriatric knowledge and content expertise among generalist, non-geriatrician faculty. These efforts included sending five UC Davis faculty members to the comprehensive, five-day UCLA Intensive Review Course in Geriatrics and ten faculty members to a three-month series of noon lectures focusing on ethical issues in caring for the elderly.

• A series of twenty-minute geriatric teaching modules is being developed for inclusion in the existing medical school curriculum. These will address major topics of importance in the care of older patients, including:
  Decubitus Care
  Advanced Directives
  Mini-Mental Status Examination
  Aging Skin
  Parkinson's Disease and Other Movement Disorders
  Behavioral Management of Patients with Alzheimer's Disease
  Diagnosis and Treatment of Depression in the Elderly
  Dementia and Delirium

• Faculty and technology experts (including the Dean of the School of Medicine) have been identified to develop video presentations for medical students addressing geriatric clinical care with respect to:
  Thyroid Disorders
  Depression
  Aging and Sexuality
  Pain Control
  Coping with Illness
  Elder Abuse
  Medications Management
  Falls and Gait Disturbances
  Osteoporosis

• Curriculum changes for medical students have occurred through the addition of new or expanded geriatric content in three courses in the medical school curriculum. Geriatric cases were also developed and added to the curriculum where problem-based discussions are used as the primary teaching method.

• Continuing education programs were developed through partnerships with community agencies and organizations in the Sacramento area. To benefit a broader audience, a five-module, Web-based course is being developed for physicians on ways to assess, diagnose and manage patients with Alzheimer's disease in a primary care setting.

• Efforts to recruit students into geriatrics as a field of study have been enhanced through the development of the first-ever UCD Student Interest Group in Gerontology and Geriatrics.

• Community and public education programs were initiated that focus on aging-related health and coping issues for caregivers and the general public. Other aging-related information was disseminated through newsletters and the Center's Web site.

The UC Irvine AGRC develops, coordinates, and evaluates geriatric education activities through the College of Medicine. As part of these efforts, faculty members are involved in professional and community education, clinical research, and service to the local community.

Recent activities funded by the AGRP and related to AB 1820 are as follows:

• A new evaluation specialist and a part-time physician/education specialist have begun to develop a four-year integrated geriatrics curriculum for medical students. To date these experts have examined the first two years of the basic sciences curriculum, identified changes to improve geriatrics education, and established baseline data that will be used longitudinally to measure the outcomes of the new four-year integrated curriculum.

• Faculty are developing two new tools for testing medical student knowledge and skills in working with older adults that include a standardized patient case, and an Objective Structured Clinical Examination for testing communication skills, professional behavior, and clinical competency.

• UCI geriatricians have been consulted to assist in "revamping" the internal medicine program in geriatrics. As part of this effort they will develop three new clinical experiences for medical students that involve experiences with older adults.

• A Geriatrics Interest Group for UCI medical students has been created.

• A Web site and a Geriatric Education Library have been developed for student, resident, and community education.

• Several UCI projects focused on medical education. The existing curricula have been analyzed to determine the need for modification and to identify long-term goals and plans for curriculum and faculty development. The structure of the required second-year family medicine residency rotation was redesigned and improved and a planned third-year rotation in long-term care facilities has been implemented.

• Increased efforts were made to encourage the recruitment of students and residents into geriatrics. Presentations on geriatrics were given at student orientation and throughout the academic year, and new opportunities were made available for medical student participation at community service events for older people. New efforts were also made to enable students to spend time with geriatricians during patient visits and elective rotations.

• Community education continued with the implementation of courses for older adults and programs on mental health topics and elder abuse. Community service was provided through ongoing medical consultations to individuals affiliated with local organizations, and a co-sponsored flu vaccination program was offered where faculty and students went door-to-door giving care to seniors.

• Medical students gained experience in long-term care research through a project focusing on patterns of bruising in the geriatric population at a skilled nursing facility.

The AGRC programs at the UCLA campus are coordinated and implemented within the four health science schools (Dentistry, Medicine, Nursing, and Public Health), and in the Department of Social Welfare within the School of Public Policy and Social Research. Initiatives in aging and geriatrics developed at the undergraduate level are administered within the College of Letters and Sciences, the Center on Aging, and through the Multicampus Program in Geriatric Medicine and Gerontology (MPGMG). The overall goal of the Center is to promote intra- and inter-disciplinary training in geriatrics and gerontology.

Recent activities funded by the AGRP and related to AB 1820 are as follows:

• Under the guidance of the Senior Associate Dean for Medical Education, faculty geriatricians and directors of required courses are developing a coordinated series of lectures, video vignettes, problem-based case discussions, multimedia computer programs, standardized patient exercises, and structured patient care experiences. The collective goal of these efforts is to ensure that UCLA students possess core competencies for the care of older patients. This model has been extended to the UC Riverside/UCLA Biomedical Sciences Program and the Drew/UCLA Medical Education Program.

• Seven new hours in geriatrics have been added to the third-year curriculum. Four hours of case discussions and lectures addressing falls and gait assessment, incontinence and pain have been developed for the new Ambulatory Care Clerkship. Three hours of case discussion have been developed for the new Inpatient Medicine Clerkship addressing ethical issues in end-of-life decision making and palliative care. This information will be repeated for each new rotation until all students in the third-year class have completed the course.

• Six new hours of geriatric curriculum are currently under development. Two new hours of lectures on geriatrics are being developed as part of the first-year Human Physiology course given for the first time in April of 2001. Four new hours of case discussion have been added to the second year Pathophysiology course, and a teaching guide has been prepared for the faculty to highlight issues in geriatrics.

• A geriatric case will be added to the clinical performance examination taken by all seniors as part of the California Consortium for Clinical Performance Assessment.

• Five affiliated residency programs in internal medicine, family medicine, and psychiatry have received "seed funding" for development and implementation of educational curricula in geriatrics.

• To enrich undergraduate education and training, eight gerontology courses have been offered since spring 2000, and two new geriatric courses were approved for the next semester.

• Medical education and training efforts were enhanced through the recruitment of seven new faculty in geriatric medicine for 2000-2001. Two additional faculty will be hired in the next academic year.

• Increased training was provided at community nursing homes for residents in medicine, and clinical trials are being conducted at nursing homes that will serve as training sites for geriatric fellows.

• To maintain continuing education opportunities and to reach a broader audience, programs have been implemented on a variety of aging-related topics for physicians.

• Comprehensive and collaborative interdisciplinary geriatric and gerontology programs in the other health professions were developed, including components in dentistry, nursing, public health, and social welfare.

The UC San Diego AGRC is located within the Stein Institute for Research on Aging, and serves as the central body for the development and coordination of geriatric educational activities within the School of Medicine. The overall goal of the AGRC is to address the health care needs of a rapidly growing population of older persons in California by developing, implementing, and evaluating programs to educate and train geriatric health care providers.

Recent activities funded by the AGRP and related to AB 1820 are as follows:

• Eight hours per week of geriatric training have been added to both medical student and residency training programs through the establishment of a geriatric medicine/psychiatry clinic at the St. Vincent de Paul Homeless Shelter. Trainees include medical students; residents in family medicine, internal medicine, psychiatry, and neurology; fellows in geriatric psychiatry and geriatric medicine; and other trainees in multidisciplinary evaluation and management of geriatric patients.

• A comprehensive geriatric curriculum is being developed for the Family Medicine Residency Program, which is expected to be fully implemented in July 2001. Changes will include combined clinical and didactic training to provide a longitudinal geriatric experience for the second- and third-year residents. Trainees will visit their patients at home or in long-term care facilities under the supervision of a UCSD faculty member. This learning experience will also include a core curriculum of reading materials and organized lectures.

• An additional change for internal medicine residents will involve a new integrated nursing home experience.

• Web-based curriculum training is underway with a focus on geriatric assessment and neurological assessment of the elderly. Two to three learning modules will be developed in 2001. These will be made available to all of the AGRP member schools and will be placed on the School of Medicine's Web site for educational use worldwide.

• The long-standing UCSD Mini-Grant Program was able to provide seed money for educational projects in aging, and is available to both faculty and students. Examples of this year's projects include the development of a free, student-run geriatric clinic; development and use of standardized patients for residency training; and efforts to enhance communication during end-of-life care.

• Clinical training in geriatrics is being added to the Family Nurse Practitioner Program. Family nurse practitioner graduate students now have a supervised clinical training experience with elderly persons to learn how to screen, educate, refer, and follow-up as necessary to help elderly patients gain control of chronic disease.

• The new UCSD School of Pharmacy will incorporate a curriculum that is under development to train pharmacists to address the special needs of the elderly.

• The Preceptorship in Geriatric Psychiatry is an elective course for first- and second-year medical students. This broad-based program provides medical students with exposure to the continuum of care required by geriatric patients with mental disorders.

• The Mini-Residency in Geriatrics is an ongoing two-week, intensive clinical training program for physicians in the evaluation and care of the elderly. Special attention is given to the diagnosis and care of the demented patient.

• A student interest group was created to attract students into the study of geriatrics and gerontology.

UC San Francisco

The UC San Francisco AGRC serves as the resource and coordination locus for campus-wide education and training activities in geriatrics and gerontology in the five health science graduate schools: Medicine, Pharmacy, Dentistry, Nursing, and the Social and Behavioral Sciences. The overall goal of the Center is to address the health workforce needs for the care of older persons.

Recent activities funded by the AGRP and related to AB 1820 are as follows:

• Geriatrics faculty members have identified the core content in geriatrics to be integrated into the pre-clinical education of medical students.

• The SAGE (Students and Great Elders) program, a buddy system to pair medical students with an older adult, has been created as an option for a required early longitudinal patient experience.

• Three Objective Structured Clinical Examinations in geriatrics have been developed for second-year medical students.

• Content on geriatric home assessment has been integrated into the Family and Community Medicine clerkship at the San Francisco General Hospital (SFGH).

• The geriatric home care elective has been expanded to include all primary care interns.

• A new continuity clinic in geriatrics has been established for primary care residents, including a pre-clinic conference one day per week.

• Three core geriatric training modules have been developed: "General Care of the Hospitalized Elder," "Management of the Geriatric Surgical Patient," and "Geriatric Post-Acute Care" for the Hospitalist Residency Track. These will be used to support the teaching of approximately 140 residents, interns, and medical students each year.

• Faculty development efforts have been initiated at SFGH, including 10 hours of training in geriatrics for teaching faculty in general internal medicine, and a preceptor-training seminar about key issues in geriatric home assessment for clinical faculty in family and community medicine.

• A continuing medical education program in geriatric cardiology for family practitioners, internists, and practicing cardiologists is being planned for November 2001.

• A Web-based Curriculum was created, which developed modules ranging from introductory aging concepts and demographics for beginning students to more advanced levels for health professionals.

• The Experiential Clinical Curricula in Geriatrics initiative has been developed to promote the implementation of the AGRC goals in geriatric education and training on campus. This is a model that encompasses complementary didactic (e.g., class lectures) and experiential curricula including "hands-on" experiences at clinical sites.

Ongoing AGRP Systemwide Initiatives

In addition to activities through the FY 2000-01 one-time augmentation for AGRP, two projects continue from FY 1999-2000 that involve special systemwide initiatives focusing on pain management for the elderly and minority aging. These efforts work to enrich the curriculum and provide forums to improve knowledge and skills in these areas for UC faculty. Recent activities include: a "train-the-trainer" course for physicians and other health professionals on pain management; the development of a syllabus in pain management for the elderly that can be broadly distributed for use at other locations; and planning for a future faculty development program on minority aging.

Future Goals

The UC AGRP has a history of innovation and success in promoting new teaching and public service initiatives in aging and geriatrics. Maintenance of existing efforts and development of new ones will require an adequate, ongoing resource base that is sufficient for sustaining programs at six participating UC campuses, which together are committed to addressing the needs of elderly Californians. The University recognizes the importance of this program and looks forward to meeting future needs and expectations.

Budget
University of California's Expenditures on AB 1820
(Chapter 440)

Total amount of new UC funding in FY 2000-01:
$6 million (one-time funding) divided to support two related initiatives in geriatrics:
$2 million augmentation of Academic Geriatrics Resource Program (AGRP)
$4 million to support new endowed chairs in geriatrics

AGRP Augmentation (by campus)

UC Berkeley	$ 150,000
UC Davis	$ 315,000
UC Irvine	$ 315,000
UC Los Angeles	$ 430,000
UC San Diego	$ 315,000
UC San Francisco	$ 375,000
UC Office of the President	$ 100,000
Total	$2,000,000

Medical student and residency education	$1,300,000
Other health profession education	$ 390,000
Service to community	$ 60,000
Research/Evaluation	$ 150,000
Administration (5%)	$ 100,000
Total	$2,000,000