You can't be what you can't see: A systematic website review of Geriatrics Online‐Visibility at US medical schools

Abstract

Background Graduating US medical students must build strong skills in caring for older adults, necessitated by shifting population demographics. Little is known, however, about current medical student exposure to geriatrics on a national scale. This systematic website review characterizes geriatrics opportunities at US medical schools, seen through the lens of publicly available information online. Methods Reviewers searched for 18 online Geriatrics Elements, in the domains of Information Prevalence, Geriatrics Environment, and Geriatrics Education, for all 191 US medical schools accredited as of January 2020. Latent Class Analysis was used to classify schools according to their publicly visible geriatrics opportunities. Results Schools had a median of 7 Geriatrics Elements identified online [IQR 4–10]. Optional geriatrics clinical activity was the most prevalent (76%), while fewer than half of all schools had online evidence of required geriatrics clinical activity (45%). A profile of the three groups of schools identified by Latent Class Analysis, termed Geriatrics Online‐Visibility groups (High n = 39, 20%; Medium n = 90, 47%; Low n = 62, 32%), is presented. Online evidence of geriatrics‐specific funding was the greatest distinguishing factor among the groups. Conclusions Examining US medical school websites collectively and comparatively across Geriatrics Online‐Visibility groups can ground discussions of geriatrics education in current national data. Though many school websites present optional geriatrics activities, far fewer specify geriatrics requirements. High Geriatrics Online‐Visibility schools present an array of both optional and required geriatrics opportunities on their websites, but this cohort comprises only 20% of schools. Recommended next steps are proposed to guide schools inspired to enhance their Geriatrics Online‐Visibility.

How often do medical students change career preferences over the course of medical school?

“…Many may have never considered pain medicine, anesthesiology, or vascular surgery and so it would not cross their minds to carve out elective time for some specialties. For example, low visibility of geriatrics in the curriculum has been associated with low interest as a specialty [ 20 ]. Mandatory participation in a broad range of elective experiences interspersed throughout the third year would accomplish this with the added benefit of building knowledge and understanding for colleagues in other fields of medicine.…”

Medical students applying the 4Ms during their first week of school

“…However, in a study of 191 allopathic and osteopathic medical schools, only 45% had required a geritatic rotation for all students. 2 In 2017, the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association and the Catholic Health Association of the United States developed the "Age-Friendly Health Systems" with the dissemination of evidence-based care, known as the 4Ms. The 4Ms (What Matters Most, Mobility, Mentation and Medication) include a framework for history taking of older adults.…”

“…Given this dramatic increase, medical students' education compels training in communicating with older adults. However, in a study of 191 allopathic and osteopathic medical schools, only 45% had required a geritatic rotation for all students 2 …”

Preparing for the Needs of Our Aging Population

“…One such challenge is a lack of attention to the topic of geriatric medicine in the undergraduate curriculum in most medical schools in the United States. A recent systematic review of the websites of 191 MD-granting and DO-granting schools in the United States 18 found that only 45% of these schools included clinical activities related to geriatric medicine as part of their required curricula. The amount of attention in graduate medical education given to the care of older individuals depends certainly on the particular medical specialty, but the topic has been identified as a gap for resident and fellow training 19,20 .…”