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Editorial: Does the Training in Geriatrics Affect a Doctor's Decision to Care for the Elderly?

Three facts are already well-known: the aging of the Canadian population and the impact it is having on the health care system at the administrative, financial, and ethical levels; the shortage of doctors interested in practising geriatric medicine; the lack of training for doctors in geriatrics. Indeed, Quebec has not been very successful in recruiting physicians who wish to practise geriatric medicine in homes for the aged or within the framework of home care community programs. As a specialty in medicine, geriatrics remains unappealing to future doctors (Duthie et al., 1987). As Somers observed, the teaching of geriatrics has long qualified as one of the four 'orphans' within medicine, along with preventive medicine, health management, and medical ethics (Somers, 1987). This is reflected in the difficulty which doctors experience in detecting and diagnosing certain problems affecting the aging population within their practice (loss of autonomy, dementia, incontinence, or depression) (Siu et al., 1988; Beaulieu and Leclere, 1991), or in investigating (Radecki et al., 1988) and treating certain ailments (Larson et al., 1991; Greenfield et al., 1987). In an article published in this issue, Judith Globerman discusses the factors which have a bearing on a doctor's decision to commit him/herself to delivering health care to the elderly. She focusses on the doctor's personality and style of practice, his/her personal contacts with the elderly, as well as his/her educational experiences. Many questions arise. Do the attitudes and the knowledge pertaining to the aged influence the future doctor's decision to deliver care to the elderly? Can the knowledge and the attitudes of medical students be altered through the training programs in geriatrics? Which factors determine the success of the training programs? A survey of publications written by Coccaro, Adelman and Beissner is particularly revealing (Coccaro and Miles, 1984; Adelman and Albert, 1987; Beissner, 1990). The conclusions are sometimes contradictory, or they serve to show that education has in fact very little impact on the student's attitudes and on his/her desire to enter into geriatric medicine. These results were strongly influenced by the methodology and measuring tools utilized. The tools most commonly used to evaluate the level of knowledge and the attitudes towards the elderly were somewhat inadequate: the concepts measured varied from one instrument to another, thereby making it difficult to draw any kind of comparison; the content measured was sometimes dated; the instruments utilized were not particularly sensitive to changes;