Email your comments

Click here to go straight to our online poll

When Prof Robert Stout first reported on the crisis in academic geriatric medicine in 2002, he identified deficiencies in postgraduate training for academics as a major contributor. A much heralded solution to this problem, academic clinical fellowships (ACFs), are the future of academic training under Modernising Medical Careers and are designed to recruit medical trainees as dedicated academics much earlier in their careers, as they complete their Foundation Programme.

The rationale is that it takes a long time to produce a clinical academic, so it’s best to start early and to provide highly structured, specific training. Yet we know the seed of “geriatricianly” enthusiasm is often slow to germinate – previous work has suggested that the majority of consultant geriatricians in practice today decided on the speciality late in their career, often having worked in other specialties first. The worry is, therefore, that ACFs will exclude exactly the sort of “late bloomer” who traditionally has migrated to a career in academic geriatric medicine after time spent at the clinical coalface. In fact, from the ACFs in ageing so far advertised, it is proving difficult to recruit candidates from a geriatrics background, with the posts going unfilled and therefore being lost (personal communication, Julia Newton). It has now been made possible to recruit non-geriatricians to ACFs in ageing. Such training will, undoubtedly, produce high quality researchers in ageing, but possibly not the academic geriatricians of the future.

Do we need academic geriatricians?
Is it possible that academics from other disciplines will provide us with the evidence upon which to base our practice – letting us get on with the critical job of providing care and services? I think not. I spend my days at the moment, gathering data from Care Home residents about their health care needs. As part of my preamble, I sometimes suggest that doctors in general (and researchers in particular) have so far failed to engage adequately with care home residents. Usually there is emphatic agreement, sometimes supported by anecdotes of just how disengaged some of our medical colleagues are (“It would be better to gas them all!” one colleague is alleged to have said). Occasionally there is just resignation. Nobody ever disagrees.

To research these types of issues properly, a geriatricianly perspective is required. So, how do we produce academic geriatricians? If we are to encourage geriatricianly ACFs then we’ll have to plant the slow-germinating seed of geriatricianly enthusiasm at an earlier stage. Undergraduates are increasingly required to participate in Bachelors’ or Masters’ degree research during their undergraduate programme. Existing research programmes in Geriatric Medicine need to engage with these students and show them, early in their careers, that research in our specialty is a truly academic, highly rewarding and worthwhile pursuit, with the possibility of having an impact on some of the big issues affecting the delivery of health care in the 21st century. We need to think, during the design stage of research, how undergraduate projects can be incorporated. We also need to look at ways of funding prizes and travel awards in geriatric medicine for undergraduates – something for them to put on their CV, whilst at the same time planting the seed that geriatric medicine is a desirable career path for high-achievers.

Later, during foundation training, we have to sell our specialty, not just as the “last bastion of true general medicine” and “common sense solutions for common problems” (quotes from recent StR recruitment interviews), but also as one in which huge academic challenges and rewards exist by grappling with the big issues facing medicine today.

Holding open doors for late entrants
We must also ensure that routes for late entrants into academic geriatric medicine are maintained. The Dhole, Warren and Dunhill fellowships are important in this, as are the numerous fellowships available from MRC and Wellcome. We need to lobby as a speciality to protect late entry into academic training and ensure that any attempt to close down such opportunities is fiercely opposed.

Every trainee should have an academic mentor who understands the opportunities available. Whilst not everyone will want to do a PhD, we need to ensure that academic time, which is obligatory for all trainees, is spent fruitfully. A recent survey of higher medical trainees by the BGS Trainees’ Committee revealed taught Masters’ to be the most popular postgraduate degree amongst those surveyed (poster to be presented at BGS Spring Scientific Meeting, Bournemouth). Masters degrees in Gerontology and Education were particularly popular. The body of literature and academic thought generated by these doctors is a potential asset to our specialty and we need to ensure that they are supported and directed in their studies. One current failing, across all specialties, is a lack of funding for colleagues undertaking these taught postgraduate degrees. We need, as a specialty, to consider how to remedy this for geriatricians.

There is also a wider battle for the hearts and minds of trainees to consider. In many areas, geriatricians do not see themselves as belonging to an academic specialty, in contrast with colleagues in respiratory medicine or cardiology, for example. We have to understand that this influences our trainees’ aspirations. We need to encourage Specialty Trainees to aim above “the occasional poster at the BGS” (as important as this is) and groom them for higher academic success from early in their Higher Medical Training. Five years as an StR is a short time and often, by the time that trainees are aware of the opportunities available, they find themselves under-prepared to apply for them. We need to ensure that high profile academic geriatricians are regularly lauded as role-models through BGS publications (and more widely) and that their every success arrives to a fanfare of publicity.

Whilst Googling “academic geriatric medicine”, I stumbled across the phrase “a chair should be a therapeutic tool”. I got very excited, before realising that the article referred, of course, to chairs of the four-legged variety and their role in physiotherapy! However, an academic chair, too, is a potent therapeutic tool. Only a geriatrician could engage with the issues of my care home residents, for example. The prevailing paucity of academic chairs in geriatric medicine, has left our specialty somewhat disarmed against the many challenges we face in dealing with our patients. Considering carefully how to educate and support the academic geriatricians of the future is one of the most important steps to dealing with the current crisis.

Adam Gordon
Clinical Lecturer in Medicine of Older People University of Nottingham

BGS Newsletter, March 2009
Issue 20 ISSN 1748-6343 20