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STRENGTHENING THE GERIATRIC CONTENT OF MEDICAL EDUCATION

A extended summary of the recently published Report on Strengthening the Geriatric Content of Medical Education, prepared by a special committee convened by the Institute of Medicine (10M) of the National Academy of Sciences, is published in this issue.' The report warrants the close attention and support of everyone interested in the future of medicine in general and the further development of the role of geriatric medicine in particular. Preparation of the Report by a distinguished committee included evaluation of previous and current studies, a I-day workshop of a larger group, and realistic appraisals of the needs for the future and the challenges we face to meet these needs. This is, of course, not the first serious look at defining and strengthening geriatric medical education. The Institute of Medicine itself has published at least five previous studies, from 1977 to 1991, that address this challenge in whole or in part,2-6and there are a number of others. It is sobering to review these earlier reports, especially AgingandMedical Education, chaired by Paul Beeson (1978), which make a number of almost identical recommendations to those in this current publication. As summarized in this new report, progress in incorporating aging-related and geriatric content into medical education at all levels, and in generating the clinical and academic leadership clearly needed, has been slow and spotty. It is to the credit of the current committee, and the Institute of Medicine, that the critical issues involved are addressed frankly and with specific positive recommendations. The report correctly establishes the fact that the bulk of medical practice, of primary care and all specialties other than pediatrics and obstetrics, in the future will be with older patients. It appropriately emphasizes that the inherently interdisciplinary approach of geriatrics is fundamental to medical practice. Proposed models for organizing care in health reform, including the leading roles for primary care and use of physicianextending professionals, will be dependent upon the type of leadership that geriatrics can give. The report reviews initiatives that have already been taken to strengthen development of academic and clinical geriatric leadership, and it explores the reasons why these have been, at best, only modestly successful. In my judgment, a failing hinted at in the report, and emphasized even more in the I-day workshop the committee held, is the lack of full commitment of medical leadership to this challenge, in medical schools and in professional societies and accrediting organizations. There have been some important advances in this type of commitment: most medical schools now have some identifiable geriatric content in their curricula, and some professional accrediting bodies now state