GERIATRIC MEDICINE
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SUPERVISING COMMITTEE

DEFINITION OF SPECIALTY

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SPECIALTY SOCIETY

 Vocational Training
 Geriatric Medicine
Supervising Committee
Specialist Advisory committee (SAC) in Geriatric Medicine.

Definition of Specialty
Geriatric medicine is concerned with the medical care and social, preventative, and rehabilitative aspects of health and illness in older people.

General Principles of Training
The trainees should develop:
  1. a knowledge of the normal ageing processes;
  2. an understanding that geriatric medicine focuses on the chronic and acute diseases associated with ageing;
  3. an understanding of the management of complex, often multiple, medical problems which often requires a coordinated interdisciplinary approach;
  4. an ability to assess impairment, disability and handicap, and devise appropriate management strategies;
  5. an ability to use appropriate resources for rehabilitation;
  6. an understanding of the effect of physical illness, psychological illness, social and environmental factors on the health of an older person;
  7. judgment in the application of investigations and therapeutic procedures in the care of older patients;
  8. an understanding of the role of preventative approaches for older people, including health promotion;
  9. an understanding of principles of palliative care.

The body of knowledge that needs to be gained and applied lies largely within the scope of internal medicine and its subspecialties with particular contributions from the areas of neurodegenerative disorders, clinical pharmacology, psychiatry, rehabilitation medicine and palliative care. In addition to gaining experience in geriatric medicine and the principles of EBM, it is necessary for trainees to develop knowledge of:
  • the sociological and demographic aspects of ageing in our society;
  • the psychological and physical aspects of human ageing;
  • the special features of illness presentation in older people with regard to the common clinical syndromes such as confusion, falls, incontinence, impaired mobility and iatrogenic disorders;
  • the function and organisational aspects of the range of extended care services available for the care of dependent older people;
  • administration and management relevant to delivering medical services to older people;
  • educational methodology, research and statistical skills, and QA skills;
  • medical ethics pertaining to older patients.

Components of Training
Core Training
Core training will be for a minimum of 2 years, and will provide experience in:
  • acute, evaluation and management care;
  • rehabilitative care;
  • geriatric medical consultative care;
  • domiciliary consultations;
  • day and ambulatory (outpatient) care;
  • respite care;
  • long term care.
Non inpatient clinical care should constitute a minimum of 10 per cent of training over each of the 3 years of advanced training. A geriatrician (consultant physician in geriatric medicine) should be a member or leader of the geriatric medical unit, and the trainee should have regular contact with that geriatrician who would be the trainee's supervisor. It is recommended that the trainee be exposed to psychogeriatric medicine either as a part of the weekly timetable during core training, or up to a 6 months core training position, or as a non core posting. Up to 6 months of general medicine, rehabilitation medicine or psychogeriatrics in an approved post will be accepted as core training for geriatric medicine, but not exceeding 12 months in total.

Core Training at a Distance
There has been a precedent set of an advanced trainee undertaking core training in a rural setting where he/she was effectively providing a geriatric service in isolation. This has been done under the direct supervision of both the local rehabilitation specialist and physician. In addition, a geriatrician supervisor (located at a geographically distant site) was appointed at a distance. Monthly regular teleconferences were held with the availability for more frequent consultations if required. Several face-to-face meetings were arranged for the year.

The SAC is prepared to support this type of flexible training as a core year providing it accounts for only one year of training and the other core year of training is done under direct supervision of a practicing geriatrician, preferably at a major centre (regional or metropolitan). It would be preferable that this 'training at a distance' is the third year of advanced training. A trainee whose previous reports were only marginal would not be approved.

New Zealand trainees would need to discuss the possibility of undertaking core training at a distance with the Chair of the SAC prior to accepting such a position.

Non Core Training
One year of non core advanced training in an area related to geriatric medicine, e.g. clinical epidemiology, neurology, clinical pharmacology, rheumatology, rehabilitation medicine, palliative care, psychogeriatrics or age-related research may be approved for non core training as may a further period of mainstream geriatric medicine. It is possible to satisfy the requirements of another SAC/JSAC and the SAC in Geriatric Medicine with a 4-year program, including one year of post FRACP training. Generally this will include 2 core years of geriatric medicine training and 2 further years of core training in the second subspecialty.

Trainees interested in such a path need to discuss it carefully with the CAT in Australia or Chair in New Zealand of both SACs or the Training Section of the College.

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