29: 378 5.

TRANING

IN GERIATRIC

MEDICINE

IN UNITED

KINGDOM

John L.C. Dall, O.B.E., O.ST.J., M.D.

(Jpn J Geriat 29: 378-380, 1992)

Academic Deparatments

of Geriatric Medicine

Undergraduate training in Geriatric Medicine followed the development of Teaching Departments of Geriatric Medicine in several University Schools of Medicine in 1958 and 1959. Over the next ten years, the development of 18 full Departments of Geriatric Medicine with Professorial Heads of Departments has left only two schools of Medicine lacking a Professor but having an Academic Department to Senior Lecturer standard. Most Departments have a small number of academic staff (average three) to support the Professor and rely for the bulk of the teaching on Honorary Senior Lecturer and Honorary Lecturer Staff who are for the most part, the National Health Service consultant Clinicians involved in Geriatric Assessment Units in the main teaching hospitals. Teaching methods vary and review in 1987 by Williams and Smith of 18 Medical Schools, showed that a combination of Lectures, Seminars, Tutorials and Clinical bedside teaching was most frequently employed.In some Medical Schools, pre-clinical classes in Physiology and Pathology are used to underline Aging change. Similarly, where Public Health Medicine is taught as a separate speciality, the influence of demographic change on communities is taught to permit the understanding of the importance of support services in the community the place of family medicine and its essential role in supporting the elderly in their own home. Geriatric Medicine is an essential part of the Final Undergraduate Exam and teachers of Geriatric Medicine participate in the Final Examination in General Medicine.

Consultant

Physician

in Geriatric

Geriatric

Unit, Glasgow,

Honorary

Senior Lecturer,

sity of Glasgow.

Victoria

Medicine,

Victoria

Postgraduate

Training

Postgraduate training is available in three component parts. Those doctors intent on practising Family Medicine can do six months of Geriatric Medicine as part of a four-year Training Programme for Vocational Trained Family Physicians. At the end of this six months, they can participate in an exam-the Diploma in Geriatric Medicine. This is a qualification indicating experience but not to specialist standards. Training Programmes for this are available in every Geriatric Assessment Unit and there are approximately 840 posts in the hospitals in the National Health Service in which family doctors may receive this Module of Training. Family doctors with this Diploma in Geriatric Medicine qualification are suitable for employment as part-time Medical Officer basis in Longterm Hospitals and Nursing Homes. Other medical graduates who wish a qualification in Geriatric Medicine but are from overseas and do not wish to sit a Membership of the Royal College of Physicians Exam, can have training on a two-year basis to have a Master Degree in Medical Science (M. Med. Sc.). For this degree, a two-year Clinical attachment to a teaching Geriatric Unit is required and organised seminars and tutorials are arranged. The candidate attends Ward Wounds, Clinics, Day Hospital and goes on Domiciliary Visits to patients' homes with the attending tutor who is normally a Professor or Consultant Physician in Geriatric Medicine. A book of twelve case reports is produced by the candidate for inspection by the examiners and a short written paper and oral, is conducted at the end of each twelve months. A satisfactory progress results in graduation in the M.Sc. Specialist Vocational Training in Geriatric Medicine

U.K. Geriatric Geriatric

Medicine, Unit, U.K.

Univer-

Candidates are postgraduate and will have completed between one and three (usually two years) of

5. TRANING

IN GERIATRIC

general professional training to the level of the College of Physicians Exam, i.e. each person will now be Member Royal College of Physicians. They are appointed to a Registrar grade post in the Geriatric Assessment Units. There are 84 approved Units for Training in the United Kingdom. The Registrar experience may account for up to two years of what is a four-year Training Programme, provided the Unit is a Teaching Unit and there are established training programmes in action. Promotion to Senior Registrar usually comes two to four years after starting in a Registrar Grade and is the post held for the completion of the Specialist Training Programmes. Exceptional candidates may transfer into Geriatric Medicine from other Specialities at Senior Registrar level and would then require to construct a four-year training programme in Geriatric Medicine but some allowance would be made for the amount of General Medical Training already undertaken so it would be unlikely that full four years of training would be required. Of the four years Vocational Training in Geriatric Medicine, three years must be spent working in a Geriatric Unit in some capacity, either as a Registrar or Senior Registrar. One year may be spent away from Geriatric Medicine in Associated Specialties, including Psychiatry, Rehabilitation Medicine, Rheumatology, Neurology, etc. The completion of four years is acknowledged by the Principal Supervising Tutor, completing Specialty Forms which allows Registration of the candidate as a Trained Specialty Forms which allows Registration of the candidate as a Trained Specialist with the General Medical Council. It is possible to train in both General Medicine and Geriatric Medicine. There are now a limited number of posts at Senior Registrar level in which people may have two years in each discipline and be given Vocational Registration both as a General Physician and as a Geriatric Physician. Both component parts of the job must be carried out in approved Teaching Departments and the post occupied must be an approved training post. For hospitals outwith the main teaching circuit such as a District General Hospital, there are many attractions to having Dually Registered Specialists so that a Specialist in General Medicine/Rheumatology, General Medicine/Cardiology, General Medicine/Geriatrics, would make an excellent three-man team for a small District General Hospital and provide a wide range of expertise. There is no Specialist Exam at the end of the four-

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KINGDOM

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year training programmes but the Supervising doctor to whose Department the trainee is appointed, is expected to make ongoing reports on the progress of the candidate throughout the four-year training period. The Specialty Advisory Committee of the Joint Committee in Higher Medical Training is an organisation set up by the Royal Colleges of Physicians in United Kingdom. The Committee comprises representatives from the Colleges and representatives from the Specialty Organisation, in this case the British Geriatrics Society. The Specialty Advisory Committee is responsible for Registering of Training Departments, inspecting Training Departments on a five-year basis to ensure that training programmes and the amount of tutorial time being received by the trainees is appropriate. Accreditation when completed, is granted by the General Medical Council which holds a Register of all approved Medical Degrees. This summary of the Training of Geriatric Physicians will serve to illustrate how well organised this discipline has become in a relatively short time as a Specialist subject. Approval by peer groups have led to recognition of Geriatric Medicine as an equivalent Specialty compared with Cardiology, Gastroenterology and the other sub-divisions of General Medicines. Training in Gerontology as a scientific discipline has received less emphasis and is not the subject of Specialist Training Programmes. There are Centres of Psychology and also Social and Behavioural Studies (The Institute of Gerontology, King's CollegeHospital, London)where training programmes are being evolved but these are of recent development and will concentrate predominantly on Social and Behavioural Aspects of Aging Populations. A Centre for Aging Studies has existed for the last ten years at the University of Wales in Cardiff. A University Chair of Aging Studies exists at Stirling University in Scotland for the last five years and the team are predominantly concerned with Social Programmes in support of Alzheimer's disease and caring relatives. An Institute of Aging Studies has been developed at the University of Liverpool and has, over the last four years, published extensively in the field of Scientific Gerontology and Social Gerontology and, therefore, provides a more general view of aging as a specialist subject. Scinetists who are involved in Aging Studies in each of the Universities, have the opportunity of joint collaboration and conference exchange of ideas through the British Society for Research in Aging. This Society

29:

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29: 378 5. TRANING IN GERIATRIC MEDICINE IN UNITED KINGDOM John L.C. Dall, O.B.E., O.ST.J., M.D. (Jpn J Geriat 29: 378-380, 1992) Academic De...
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