Bragg Elizabeth J, Warshaw Gregg A
Institute for Health Policy and Health Services Research, University of Cincinnati, PO Box 670840, 3202 Eden Avenue, Suite 275, Cincinnati, OH 45267-0840, USA.
Acad Med. 2005 Mar;80(3):279-85. doi: 10.1097/00001888-200503000-00014.
In the recent past, most physician visits by older adults were with a primary care physician, with less than 40% of ambulatory visits to other specialists. Since 1991, that trend has reversed. In 2001, 53% of ambulatory visits by patients aged 65 years or older were to nonprimary care specialists. Demographic trends and an expanding geriatrics medicine knowledge base require that every physician develop skills specific to the care of older adults. There are concerns that physicians-in-training are not learning adequate specific geriatrics medicine content to prepare them for the rapidly expanding numbers of older adults who will be seeking medical care. Training standards to prepare residents and fellows for practicing medicine are established by experts in the various medical specialties serving on individual residency review committees (RRCs) of the Accreditation Council for Graduate Medical Education. In 2002 (with a follow-up in 2003), the Association of Directors of Geriatric Academic Programs' team at the University of Cincinnati School of Medicine's Institute for Health Policy and Health Services Research reviewed all 91 nonpediatric specialties' RRC program requirements to identify the specific curriculum requirements related to geriatrics medicine training. As of 2003, 27 of the 91 RRC-accredited specialties have specific geriatrics training requirements; the other 70% of these specialties did not specifically mention geriatrics training. Even among the specialties with specific geriatrics training requirements, curriculum expectations are modest. The geriatrics-specific descriptions within the program requirements of the 27 specialties are presented in this article. The authors encourage the RRCs for all nonpediatric specialties to update their program requirements to ensure that future physicians graduating from their graduate medical education programs are adequately prepared to care for older adults.
在最近，老年人看医生大多是去看初级保健医生，去看其他专科医生的门诊就诊比例不到40%。自1991年以来，这一趋势发生了逆转。2001年，65岁及以上患者的门诊就诊中有53%是去看非初级保健专科医生。人口趋势和不断扩大的老年医学知识库要求每位医生培养针对老年人护理的特定技能。有人担心，正在接受培训的医生没有学习足够的特定老年医学内容，无法为即将寻求医疗护理的大量老年人做好准备。为住院医师和专科医师制定行医培训标准的是研究生医学教育认证委员会各专科住院医师评审委员会（RRC）的专家。2002年（2003年进行了跟进），辛辛那提大学医学院健康政策与健康服务研究所以及老年学术项目主任协会的团队审查了所有91个非儿科专科的RRC项目要求，以确定与老年医学培训相关的具体课程要求。截至2003年，在91个经RRC认证的专科中，有27个有特定的老年医学培训要求；这些专科中的其他70%没有特别提及老年医学培训。即使在有特定老年医学培训要求的专科中，对课程的期望也不高。本文列出了这27个专科项目要求中与老年医学相关的描述。作者鼓励所有非儿科专科的RRC更新其项目要求，以确保从其研究生医学教育项目毕业的未来医生有足够的准备来照顾老年人。
