Last updated: 13 February 2013
Geriatric medicine covers all aspects of medicine in elderly people, encompassing acute emergency medicine, rehabilitation and some intermediate/long-term care. It is practiced in wards, out-patients and day hospitals, in teaching, district general and community hospitals, and in the community itself.
Geriatric medicine is now the largest specialty within general medicine, as measured by the number of consultants.
Attractions of the Specialty
Geriatric medicine appeals to those who like breadth and variety in their professional work. It is regarded by many as the last remaining bastion of general medicine, covering all medical specialties. Geriatricians work in settings as diverse as acute admissions units, clinical laboratories or investigation units, and the patient's own home. Elderly patients have multiple pathologies, often presenting in non-specific ways which present a challenge in diagnosis and necessitate good judgement in treatment.
The specialty is developing its own sub-specialisms. Some match the sub-specialties found in general medicine, for example diabetes and gastroenterology. Some geriatricians are involved in practical techniques such as endoscopy or echocardiography. The lead doctor for stroke medicine in a trust is frequently a geriatrician. Other sub-specialties are specific to geriatric medicine, some geriatricians having expertise in syncope, falls or Parkinson's disease, for example. Others specialise in liaison work with either old age psychiatrists or orthopaedic surgeons (orthogeriatrics). Community geriatricians have now been appointed in some districts, concentrating their work on community hospitals, residential and nursing homes and domiciliary visiting.
The geriatrician works as part of a large multi-disciplinary team, working closely with nurses, physiotherapists, occupational therapists, speech therapists, dieticians, social workers and many others.
With the undoubted increase in the numbers of very elderly people over the next few decades, the specialty seems set for a long period of expansion.
The programme offers training in both geriatric and general medicine for all trainees (except part-time trainees who may opt for geriatric medicine alone). The Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's) and the Norfolk & Norwich University Hospital NHS Foundation Trust are teaching hospitals and eight district hospitals in East Anglia are utilised. Trainees will usually spend time in three different Trusts, through agreement with the programme director. To minimise house moves, most trainees remain in either the eastern or the western half of the region. In some hospitals geriatric and general medical experience are gained in separate posts; in others they are gained simultaneously in integrated departments.
The Department of Gerontology at both the Cambridge Univeristy Hospitals NHS Foundation Trust (Addenbrooke's) and the School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, (Norwich) are available for advice on research, and may be able to offer research experience, dependent on grants being obtained.
There is an established regional teaching programme in geriatric medicine, with ten meetings annually, taking place in each hospital in turn. The curriculum is covered in two and a half years enabling a trainee who misses one session first time round, to experience it during the next cycle.
Essential Qualifications for entry
- Completion of a core medical training programme or equivalent.
- Documented evidence of achievement of level 1 competencies in general internal medicine (acute) and generic curricula.
- MRCP Part I, but note that full MRCP with PACES is highly desirable, and essential for progression from ST3 to ST4.
The geriatrician must have an empathy with elderly people and must act as their champion to ensure equitable and appropriate access to health services. He or she must enjoy working as part of a large team, often co-ordinating their actions to optimise management of elderly patients. Excellent communication and management skills are essential.
The geriatrician needs the ability of patience to communicate with patients who may have communication problems due to cognitive decline or sensory impairment. Good and timely communication with other professionals, both medical and non medical are also pivotal to effective elderly care.
A broad knowledge of general internal medicine is an essential foundation on which to build additional specialist skills to provide an holistic service for elderly patients.
Stamina and capacity for hard work are essential as inpatient numbers tend to be consistently high with additional peaks of activity related to acute general emergency take and provision of both rehabilitation, community hospital and other community services. An ability to think through and deal with difficult ethical issues is another rewarding challenge.
Teaching, research, audit and service development are also important responsibilities.
|Dr Peter Woodhouse||Training Programme Director |
& Consultant Physician
|The Norfolk & Norwich University |
Hospitals NHS Foundation Trust
|Dr Claire Nicholl||Training Committee Chair|
& Consultant Geriatrician
|Cambridge University Hospitals |
NHS Foundation Trust
|Dr Ian Barton||Head of School of Medicine|
& Associate Postgraduate Dean
|East of England |
Detailed guidance on the Geriatric Medicine assessment blueprint and curriculum is available from the JRCTPB website.
Please follow this link for the Geriatric medicine 2012 GMC National Training Survey report of trainee satisfaction.