Rosen Tony, Liu Shan W, Cameron-Comasco Lauren, Clark Sunday, Mulcare Mary R, Biese Kevin, Magidson Phillip D, Tyler Katren R, Melady Don, Thatphet Phraewa, Wongtangman Thiti, Elder Natalie M, Stern Michael E
Department of Emergency Medicine Weill Cornell Medicine/New York-Presbyterian Hospital New York NY.
Department of Emergency Medicine Massachusetts General Hospital/Harvard Medical School Boston MA.
AEM Educ Train. 2020 Jan 21;4(Suppl 1):S122-S129. doi: 10.1002/aet2.10428. eCollection 2020 Feb.
Improving emergency department (ED) care for older adults is a critical issue in emergency medicine. Institutions throughout the United States and Canada have recognized the growing need for a workforce of emergency physician (EP) leaders focused on clinical innovation, education, and research and have developed specialized fellowship training in geriatric emergency medicine (GEM). We describe here the overview, structure, and curricula of these fellowships as well as successes and challenges they have encountered. Seven GEM fellowships are active in the United States and Canada, with five offering postresidency training only, one offering fellowship training during residency only, and one offering both. The backbone of the curriculum for all fellowships is the achievement of core competencies in various aspects of GEM, and each includes clinical rotations, teaching, and a research project. Evaluation strategies and feedback have allowed for significant curricular changes as well as customization of the fellowship experience for individual fellows. Key successes include an improved collaborative relationship with geriatrics faculty that has led to additional initiatives and projects and former fellows already becoming regional and national leaders in GEM. The most critical challenges have been ensuring adequate funding and recruiting new fellows each year who are interested in this clinical area. We believe that interest in GEM fellowships will grow and that opportunities exist to combine GEM fellowship training with a focus in research, administration, or health policy to create unique new types of highly impactful specialized training. Future research may include exploring former fellows' postfellowship experiences, careers, accomplishments, and contributions to GEM to better understand the impact of GEM fellowships.
改善急诊科对老年人的护理是急诊医学中的一个关键问题。美国和加拿大各地的机构已经认识到，越来越需要一支专注于临床创新、教育和研究的急诊医师（EP）领导者队伍，并开展了老年急诊医学（GEM）的专门 fellowship 培训。我们在此描述这些 fellowship 的概况、结构和课程，以及它们所遇到的成功与挑战。美国和加拿大有七个 GEM fellowship 项目在开展，其中五个仅提供住院医师培训后的培训，一个仅在住院医师期间提供 fellowship 培训，还有一个两者都提供。所有 fellowship 课程的核心是在 GEM 的各个方面实现核心能力，每个项目都包括临床轮转、教学和一个研究项目。评估策略和反馈使得课程有了重大改变，并能根据个别学员的情况定制 fellowship 经历。主要成功之处包括与老年医学教员建立了更好的合作关系，这带来了更多的倡议和项目，而且以前的学员已经成为 GEM 领域的地区和国家领导者。最关键的挑战一直是确保有足够的资金，并每年招募对这个临床领域感兴趣的新学员。我们相信，对 GEM fellowship 的兴趣将会增加，而且有机会将 GEM fellowship 培训与专注于研究、管理或卫生政策相结合，以创造新型的具有高度影响力的专门培训。未来的研究可能包括探索以前的学员在 fellowship 结束后的经历、职业、成就以及对 GEM 的贡献，以便更好地理解 GEM fellowship 的影响。
