Background The Emory Reynolds Program is an innovative program developed to strengthen physician training in geriatrics. Implemented in 2003, the program is designed, in part, to expose medical students to key concepts and principles of geriatric medicine. The 10 key principles that form the core of the program are the Basics in Geriatrics 10 ("Big 10 "). During their third year medical students receive an orientation to the BIG 10 and are asked to reflect on these principles during their internal medicine rotation.
Objective To qualitatively analyze experiences of third-year medical students with geriatric patients, using the "BIG 10 " principles, and to determine the impact on student awareness of these issues.
Methods From August 2004 until July 2005, students were required to submit paragraphs about geriatric patients whose care they had participated in and to describe how these patients exemplified one of the "BIG 10 " principles. All were analyzed for content, frequency of "BIG 10 " principles, and common themes. Questionnaires at the end of the clerkship were given to all students to assess their attitudes and behavior related to geriatrics.
Results 982 paragraphs were reviewed from 105 students. Recurring themes included the following: (1) Are physicians too aggressive in the diagnosis and treatment of geriatric patients leading to iatrogenic illness and decreased functional capacity? (2) Discussion of end-of-life issues should take place early while patients are competent to make their own decisions; (3) Diagnosis and treatment of acute problems is complicated by chronic medical conditions; (4) Elderly patients are often the caregivers for other elderly patients, creating a new set of social and ethical issues; (5) There is tremendous variability amongst the elderly; (6) Information from primary caregivers is vital and often difficult to obtain; (7) Polypharmacy is the most common cause of iatrogenic illness; (8) Quality is more important than quantity of life; (9) Family members disagree among themselves and with medical staff regarding end-of-life issues; (10) Family support significantly decreases length of stay. 127 students completed questionnaires at the end of the clerkship. Of those students 25% reported that they were more interested in the problems of older patients as compared to before the clerkship; 80.5% reported that the "BIG 10 " assignments made them think more about the problems of older patient; and 86.5% reported that they learned more about the special issues in the care of older patients through the combined curriculum elements.
Conclusions A core curriculum of geriatrics that revolves around key basic principles is an effective tool in increasing medical student awareness of geriatric medicine and helps uncover important learning issues that can be incorporated into future curricular innovations.
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