ACGME requirements for geriatrics medicine curricula in medical specialties: progress made and progress needed

In the recent past, most physician visits by older adults were with a primary care physician, with less than 40% of ambulatory visits to other specialists. Since 1991, that trend has reversed. In 2001, 53% of ambulatory visits by patients aged 65 years or older were to nonprimary care specialists. Demographic trends and an expanding geriatrics medicine knowledge base require that every physician develop skills specific to the care of older adults. There are concerns that physicians-in-training are not learning adequate specific geriatrics medicine content to prepare them for the rapidly expanding numbers of older adults who will be seeking medical care. Training standards to prepare residents and fellows for practicing medicine are established by experts in the various medical specialties serving on individual residency review committees (RRCs) of the Accreditation Council for Graduate Medical Education. In 2002 (with a follow-up in 2003), the Association of Directors of Geriatric Academic Programs' team at the University of Cincinnati School of Medicine's Institute for Health Policy and Health Services Research reviewed all 91 nonpediatric specialties' RRC program requirements to identify the specific curriculum requirements related to geriatrics medicine training. As of 2003, 27 of the 91 RRC-accredited specialties have specific geriatrics training requirements; the other 70% of these specialties did not specifically mention geriatrics training. Even among the specialties with specific geriatrics training requirements, curriculum expectations are modest. The geriatrics-specific descriptions within the program requirements of the 27 specialties are presented in this article. The authors encourage the RRCs for all nonpediatric specialties to update their program requirements to ensure that future physicians graduating from their graduate medical education programs are adequately prepared to care for older adults.