National survey of geriatric psychiatry fellowship programs: comparing findings in 2006/07 and 2001/02 from the American Geriatrics Society and Association of Directors of Geriatric Academic Programs' Geriatrics Workforce Policy Studies Center

A Survey of Geriatric Psychiatry Fellows and Program Directors: Specialty Choice, Program Choice, and Program Quality

OBJECTIVE

This study explored factors influencing a physician's choice to pursue geriatric psychiatry fellowship training from fellow and program director perspectives to improve recruitment into this critical need specialty.

METHODS

Questionnaires were sent to the 54 fellows and 79 fellowship program directors of programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) available through the American Association for Geriatric Psychiatry (AAGP) listserv. A 5-point Likert scale (strongly disagree, disagree, neutral-undecided, somewhat agree, strongly agree) was used to score and rank these questionnaires.

RESULTS

Thirty-three program directors (42%) on the AAGP listserv and 24 (44%) of all ACGME accredited fellows responded. The clinical quality of the faculty (Fellows 92%, Program Directors 92%) and the fellowship's national reputation (Fellows 75%, Program Directors 88%) were most highly ranked by both. Fellows ranked proximity to family (79%) high (2nd) in their program choice, while ranking workload, salary, and visa issues as low.

CONCLUSION

This study emphasizes that family and cultural/ethnographic considerations, along with the core values of a training program, remain highly valued by trainees, and should inform structural changes to incentivize training, and enhance the inherent quality of fellowship programs.

Spotlight on the Challenges of Depression following Retirement and Opportunities for Interventions

As a major life transition characterized by changes in social, behavioral, and psychological domains, retirement is associated with numerous risk factors that can contribute to the development of depression in later life. Understanding how these risk factors intersect with overall health and functioning can inform opportunities for mental health promotion during this transition. The objective of this review is to summarize the literature on risk and protective factors for depression during retirement transitions, discuss challenges related to appropriate management of depression in later life, and describe opportunities for prevention and intervention for depression relating to retirement transitions, both within and beyond the health care system. Key implications from this review are that 1) the relationship between depression and retirement is multifaceted; 2) while depression is a common health condition among older adults, this syndrome should not be considered a normative part of aging or of retirement specifically; 3) the existing mental health specialty workforce is insufficient to meet the depression management needs of the aging population, and 4) therefore, there is a need for interprofessional and multidisciplinary intervention efforts for preventing and managing depression among older adults. In sum, both healthcare providers, public health practitioners, and community organizations have meaningful opportunities for promoting the mental health of older adults during such major life transitions.

Predictors for Matriculation into Geriatric Psychiatry Fellowship: Data from a 2019-2020 National Survey of U.S. Program Directors

OBJECTIVE

With the number of geriatric psychiatry fellows declining from a peak of 106 during 2002-2003 to 48 during 2020-2021, this study aims to investigate characteristics of the geriatric psychiatry training requirement across U.S. psychiatry residency programs and to identify specific factors which may influence residents to pursue geriatric psychiatry subspecialty training.

METHODS

The authors queried the American Medical Association's Fellowship and Residency Electronic Interactive Database Access system to compile a list of program directors from the Accreditation Council for Graduate Medical Education sponsored general adult psychiatry residency programs. Program directors were emailed an anonymous multiple-choice survey to ascertain specific characteristics of their program's geriatric psychiatry training experiences. This study's primary outcome was the percentage of residents entering geriatric psychiatry fellowship after completion of general psychiatry training. Linear regression analysis determined which variables may be associated with this primary outcome.

RESULTS

Of 248 surveyed, 60 programs (24%) responded to the survey. Only one of the independent variables revealed a statistically significant association with the percent of residents that became geriatric psychiatry fellows: the number of geriatric psychiatrists at the residents' home institution (p=0.002).

CONCLUSIONS

Consistent with previous data, the presence of geriatric psychiatry faculty members is strongly associated with the decision to pursue subspecialty training in geriatric psychiatry.

Advice on How to Choose a Geriatric Psychiatry Fellowship

The population of older adults with mental health and substance use disorders in the United States is increasing at a significant rate. This growth creates a critical need for trained geriatric psychiatrists. Unfortunately, the number of psychiatrists choosing to receive subspecialty training in geriatric psychiatry has not kept pace with the growing needs of society. Many different methods for enhancing the recruitment of physicians interested in subspecialty training are being discussed nationally. One way to improve recruitment is to provide prospective residents a clear understanding of the process by which one may apply to and select a fellowship program. In this article, we discuss the process by which physicians interested in pursuing fellowship training in geriatric psychiatry can make an informed decision to apply to and choose programs that best fit their needs.

Mobile Health Technology in Late-Life Mental Illness: A Focused Literature Review

OBJECTIVE

In an era of rising geriatric mental health care needs worldwide, technological advances can help address care needs in a cost-effective fashion. Our objective in this review was to assess whether mobile health technology, such as tablets and smartphones, are feasible to use in patients with late-life mental and cognitive disorders, as well as whether they were generally reliable modes of mental health/cognitive assessment.

METHODS

We performed a focused literature review of MEDLINE, PsychInfo, and Embase databases, including papers specifically assessing the implementation of mobile health technologies: electronic tablets (e.g., iPad), smartphones, and other mobile computerized equipment in older adults (age ≥65 years) diagnosed with or at risk of a mental and/or cognitive disorder.

RESULTS

A total of 2,079 records were assessed, of which 7 papers were of direct relevance. Studies investigated a broad variety of mobile health technologies. Almost all examined samples with dementia/cognitive dysfunction or at risk for those disorders. All studies exclusively examined the use of mobile health technologies for the assessment of cognitive and or mental illness symptoms or disorders. None of the studies reported participants having any difficulties using the mobile health technology assessments and overall reliability was similar to paper-and-pencil modes of assessment.

CONCLUSION

Overall, mobile health technologies were found to be feasible by patients and had promising reliability for the assessment of cognitive and mental illness domains in older adults. Future clinical trials will be necessary to assess whether portable communication interventions (e.g., symptom tracking) can improve geriatric mental health outcomes.

Practice eligible route for certification in geriatric psychiatry: why some Canadian psychiatrists are disinterested in writing the RCPSC subspeciality examination?

Geriatric psychiatry was officially recognized as a subspecialty by the Royal College of Physicians and Surgeons of Canada (RCPSC) in 2009, with the first RCPSC exam written in 2013 (Andrew and Shea, 2010). The unique mental health needs of Canadians' seniors requires geriatric psychiatrists trained to address them (Herrmann, 2004), but current rates of recruitment in informal fellowship programs have been inadequate (Bragg et al., 2012). One hope of subspeciality recognition was to increase recruitment in Canada, but there have been some challenges in accrediting psychiatrists already caring for older adults. Many currently practicing geriatric psychiatrists have elected to take the Royal College examination, with >120 graduates in the first year, 2013, but others have been more ambivalent. In this letter, we perform a preliminary exploration of the prevalence and correlates of disinterest in completing the RCPSC geriatric psychiatry examination.

The development of a geriatric postgraduate education assessment instrument using a modified Delphi procedure

There is currently wide variation in the structure and content of higher medical training in geriatric medicine across Europe and no common framework within which existing efforts can be compared. We set out to develop an audit tool to compare training between countries. An initial review of indexed and grey literature was used to develop an audit tool which was used as the basis of an Internet-based modified Delphi process incorporating the views of 14 expert geriatricians from across Europe. Items in the audit tool were included or excluded when supported by ≥75% or <50% of respondents, respectively. Items supported by 50-74% of respondents were carried forward with additional suggestions and modifications included following Round 1. Thirteen experts representing 12 countries responded to both rounds. 40/45 items were supported at Round 1. Five items were carried forward. A further 13 elements were introduced for consideration at Round 2. Consensus was gained after the second round. The final tool describes 52 items across four domains: general considerations, topics referring to knowledge in patient care, different roles that should be considered in medical training and topics regarding assessment. The resulting tool can be used as a basis for comparing higher medical training programmes in geriatric medicine between countries. Individual countries can use this to audit current practice. At an European Union level, the insights gained through such audit will form the basis of future work to develop an agreed postgraduate curriculum in the specialty.

What Makes Residents Interested in Geriatric Psychiatry? A Pan-Canadian Online Survey of Psychiatry Residents

OBJECTIVES

In spite of a rapidly increasing need, there remains a shortage of geriatric psychiatrists in North America. The factors associated with psychiatric residents' interest in geriatric psychiatry have not yet been examined in a nationally representative sample.

DESIGN

Cross-sectional study.

SETTING

Web-based online survey of Canadian psychiatry residents.

PARTICIPANTS

207 psychiatry residents (24.3% response rate).

MEASUREMENTS

The main outcome was interest in becoming a geriatric psychiatrist. Bivariate and multivariate analyses were performed to better understand what demographic, educational, and vocational variables were associated with interest in becoming a geriatric psychiatrist.

RESULTS

A number of respondents had an interest in becoming a geriatric psychiatrist (29.0%, N = 60); in doing a geriatric psychiatry fellowship (20.3%, N = 42); or an interest in doing geriatric psychiatry as a part of the clinical practice (60.0%, N = 124). Demographic characteristics (age, gender, ethnicity) did not correlate with interest in geriatric psychiatry. The variables most robustly associated with interest in geriatric psychiatry were: 1) completion of geriatric psychiatry rotation(s) before the third year of residency (OR: 5.13, 95% CI: 1.23-21.4); 2) comfort working with geriatric patients and their families (OR: 18.6, 95% CI: 2.09-165.3); 3) positive experiences caring for older adults prior to medical school (OR: 12.4, 95% CI: 1.07-144.5); and 4) the presence of annual conferences in the resident's field of interest (OR: 4.50, 95% CI: 1.12-18.2).

CONCLUSION

Exposing medical students and junior psychiatry residents to clinical geriatric psychiatry rotations that increase comfort in working with older adults may be potential future strategies to improve recruitment of geriatric psychiatrists.

Psychosomatic medicine training as a bridge to practice: training and professional practice patterns of early career psychosomatic medicine specialists

BACKGROUND

The number of interested candidates for psychosomatic medicine (PM) training programs has not matched the growing need for psychiatrists trained to care for complex medically ill patients. The reasons for this lack of growth may be found in the experience of new entrants into the subspecialty.

OBJECTIVE

To investigate this issue, we conducted a survey of early career psychiatrists (ECPs) practicing PM to identify the personal and professional characteristics of ECP PM specialists and to examine the relevance of PM training to professional practice.

METHODS

ECPs who attended the 2012 Academy of Psychosomatic Medicine annual meeting or who were registered members of the Academy of Psychosomatic Medicine completed a survey on training and work experiences. Decisional factors associated with pursuit of subspecialty fellowship education and professional practice patterns were identified using descriptive statistics and chi-square tests.

RESULTS

A total of 102 ECPs completed the survey. Of the respondents, 67 (67%) had completed a PM fellowship. Motivating factors for pursuing fellowship training included (1) obtaining additional clinical training, (2) developing a special interest in PM training, and (3) improving job candidacy. Overall, 80% of ECPs desired inpatient consultation-liaison positions at the time of fellowship graduation. Overall, 22% reported difficulty in obtaining employment in PM after training. Chi-square tests between subjects who pursued a PM fellowship and those who did not proved nonsignificant.

CONCLUSIONS

PM fellowship training remains relevant and important to ECPs in this sample. The survey results can be used to shape institutional and professional supports to better meet early career transition needs for PM psychiatrists.

[Hospitalization and dementia: what was new in 2012?: literature review]

The present work provides a review of literature published in 2012 that were found in a PubMed search with the terms "hospitalization and dementia. Further information was obtained from personal contacts. The rate of publications was ten times higher in 2012 as in previous years. Frequency of dementia, hospital admission, acute coronary syndrome, femoral neck fracture, stroke, complications during hospital stay, outcomes after hospitalization, prediction, rehabilitation, and training are the common topics.

Late-life mental health education for workforce development: brain versus heart?

PURPOSE

There is a shortage of mental health professionals to care for a growing geriatric population. Though not mutually exclusive, clinical and didactic educational experiences promote cognition, whereas affective knowledge (attitude) is promoted through nonclinical exposure to seniors. This study evaluates the relative impact of cognition and attitude on career interests among healthcare students.

METHODS

We developed 13 interactive, video documentary "lessons" on late-life mental health presenting didactic material along with stories of actual patients and families. Four of these lessons were viewed at 1-week intervals by 42 students from medical school and graduate programs of social work, psychology, and nursing. Knowledge, attitudes, and inclinations toward working with seniors were assessed.

RESULTS

Both cognition and attitudes toward seniors improved. Linear regression shows that change in attitude, not cognition, predicts interest in working with seniors.

CONCLUSION

Educational experiences that promote affective learning may enhance interest in geriatric careers among healthcare students.

Geriatric workforce capacity: a pending crisis for nursing home residents

INTRODUCTION

The nursing home (NH) population in the US has grown to 1.6 million people and is expected to double by 2030. While 88.3% of NH residents are over 65, the elders aged 85 and more have become the principal group. This demographic change has increased the already high rates of chronic diseases and functional disabilities in NH residents.

METHODS

This study reviewed the supply of geriatricians in addressing the growing healthcare needs of NH residents.

RESULTS

English-written articles between 1989 and 2012 were reviewed. Trend data demonstrate that the geriatrician workforce has decreased from 10,270 in 2000 to 8,502 in 2010. Further, the pipeline analysis of physicians projected to receive board certification in geriatrics (and maintain this certification) indicates a worsening of the already insufficient supply of geriatricians for this vulnerable population.

CONCLUSION

Strategies to attract and maintain a geriatrician workforce are imperative to avert a mounting crisis in the geriatric care in NH and, by extension, other living settings.