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By Nancy Kinnally
July 30, 2003
TALLAHASSEE, Fla.-Florida ranks near the bottom when it comes to having enough doctors certified as specialists in caring for the elderly, a recent study shows, but the Florida State University College of Medicine is out to change that.
One of the nation's most popular retirement destinations, Florida has just 3.4 certified geriatricians for every 10,000 residents over the age of 75, according to a study published this month in the Journal of the American Geriatrics Society. Only six states have fewer geriatrics experts per elderly resident.
The FSU College of Medicine was founded in 2000 with a mission of addressing the state's most pressing physician shortages. The medical school recently became the first in the state - and one of only four in the country - to devote an entire department to geriatric medicine.
"Although older people make up only about 13 percent of the U.S. population, and 18 percent of Florida's, they consume 30 to 40 percent of all health care services and use 36 percent of all drugs prescribed," said Dr. Ken Brummel-Smith, chair of the new department.
"Many physicians spend the majority of time with older patients, and yet still in most medical schools all students have required pediatric rotations but no required geriatric rotation."
In fact, according to a November 2002 report by the Gerontological Society of America and the Merck Institute of Aging and Health, only 14 of the nation's 145 medical schools include geriatrics in their required courses, and only
3 percent of medical students choose geriatrics electives at the 86 medical schools where they are offered.
By contrast, FSU's medical students will experience and study a wide range of aging issues, not just in their required fourth-year geriatrics rotation, but as an integral part of all of their courses.
Former president and chairman of the American Geriatrics Society and the author of several leading geriatrics textbooks, Brummel-Smith is working with other faculty in his department to develop an innovative combination of high-tech and high-touch learning methods to give students new insights into the care of the elderly throughout their four-year education.
Via the Internet, the program links faculty and students at the school's three regional campuses in Tallahassee, Pensacola and Orlando to the school's geriatrics experts and to customized online resources designed to help the students achieve required clinical competencies in the care of the elderly. Topics include how to handle falls, incontinence, dementia, pain management and elder abuse.
Students will be able to post clinical questions to a site that is monitored by one of the department's geriatricians or sit in on an online "Geri-chat," in which students and faculty review and discuss interesting cases the students have seen via an online chat group.
Dr. Jacqueline Lloyd, geriatrics education director, said that having students spread out at the medical school's regional campuses with their varied patient populations gives students a great opportunity to compare notes.
"One of the advantages about having the technology and having students in all kinds of practices all over the state is that they can dialog with each other, and their experiences are multiplied," Lloyd said.
But it's not all about discussing diagnoses and treatment plans. In their second-year Psychosocial Aspects of Medicine course, students were asked to find and interview an elderly person in the community who was an example of successful aging and then post their observations about the encounter to an online bulletin board.
"We seek opportunities to have students encountering older adults in the community, not in acute care hospitals or nursing facilities but anywhere else they might be," Lloyd said.
Medical student Lorna Fedelem, who wants to be a geriatrician, said the exercise taught her a lot about how to approach older patients.
"I have always known that our older generations have so much wisdom and wonderful stories to offer us young people, but a lot of people my age don't see it that way," Fedelem said. "What a shame. They are really missing out."