Juniors have inadequate training in geriatrics

Doctors are qualifying to practise medicine without the skills or training to give frail elderly patients the respect and treatment they deserve, a study claims.

The NHS is failing to train undergraduate medical students adequately to deal with the complex needs of older patients despite two-thirds of acute hospital admissions are those of people over 65, according to research for the British Geriatrics Society.

The study, which included a major poll of British medical schools, reveals there is a “consummate mismatch between the proportion of the medical workloads made up by diagnosis and management of frail older people and the amount of undergraduate teaching devoted to it”.

The report’s author, Dr Adam Gordon, a consultant and lecturer in medicine of older people at the Nottingham University Hospital, said: “Many of the difficulties we have face in the past 10 years around the management of frail elderly patients are caused by inadequate communication, poor recognition of problems and by difficulties around communication on end-of-life, resuscitation and dementia.”

The main reason, he said, was “a consequence of the fact that doctors are not receiving the right sort of training at the right sort of intensity”.

Some medical undergraduates receive as little as 55 hours of specialist training in this field over their five-year courses. As recently as 2008, key areas, including elderly abuse and pressure sores, were not on many medial school curriculums, despite being major NHS issues.

“Most medical school curriculums evolved in the last century, when the type of medicine we practised was very different. And the way to teach doctors of old was to teach them about the heart, lung and liver and hope that they’ll somehow learn to join up the dots,” said Dr Gordon.

“We know that this is where new doctors tend to fail in pulling those loose ends together and where we subsequently see scandals in older patient treatment.”

This “disjointed, poorly co-ordinated and often poorly communicated care” results in distress and older patients “spending a lot time waiting around for various aspects of their care to come together”.

Published in the journal Age and Ageing, the research goes on to present an alternative curriculum of what “medical undergraduates ought to be taught about ageing” and explores how “to close the gap between aspiration and current practice”.