Updating the BGS recommended curriculum in geriatric medicine: Workforce planning for the ageing population should involve optimising medical education in geriatrics

Dr Grace Pearson (she/her) is a Clinical Research Fellow in the Ageing and Movement Research Group at Bristol Medical School. Her research interests are in undergraduate medical education, specifically curriculum development, evaluation, and geriatrics education. Grace graduated from Bristol Medical School with distinction in 2017 (MBChB), and since then has worked as a junior doctor in Severn Deanery, with a recent focus on Hospital at Home at the Royal United Hospital, Bath. Twitter via @GraceInvaders @GerisMedEd

There is a national shortage of geriatricians¹, with just 1 consultant geriatrician per 8,031 patients aged over 65 in the UK ². This ratio is set to deteriorate further; the ageing population will increase the denominator, whilst there is little to no projected increase in the numerator. Over 60% of junior doctors choose not to enter specialty training post-foundation³, and a recent survey found that 40% of junior doctors are actively seeking work outside of the NHS⁴. Gordon and Dhesi highlight the precarious, system-level decompensation, resulting from under-staffing and under-funding of the NHS, which has caused harm⁵. We are balanced on a knife-edge, facing the very imminent reality that we have insufficient specialty workforce to care for an ageing population unless drastic changes are made to medical education and training. Successfully educating and inspiring healthcare professionals in the care of older patients is now paramount, regardless of their chosen specialty or grade.

It is therefore also imperative that we look ahead to tomorrow’s doctors, making alterations now to optimise the future workforce to care for older people with complex needs. Currently, 27% of the world’s medical schools and 15.8% of UK medical schools do not teach geriatric medicine⁶. Subsequent work by the British Geriatrics Society (BGS) has found that UK medical school programmes (usually 5-6 years long) only contain, on average, 49-56 hours of teaching in ageing and geriatrics^7,8. Moreover, in this current crisis with very high incidence of delayed discharges and ‘corridor medicine’, students are being exposed to large volumes of patients in whom iatrogenic harm is prevalent, with high rates of delirium and deconditioning resulting from prolonged hospitalisation⁹. Arguably, learning cannot be achieved in an environment where optimal care cannot be modelled, and patient care is frequently compromised. Indeed, student attitudes towards older patients have been shown to deteriorate during clinical placement years¹⁰, but can be improved with positive role-modelling ^11,12.

We are at a key juncture, where innovative services such as virtual wards and Hospital at Home are being widely and rapidly implemented across the country, and new opportunities for education should be integrated from the outset. This coincides with a time of change in medical education also, with the imminent launch of the Medical Licensing Assessment requiring UK medical schools to modify curricula and re-evaluate teaching to meet new General Medical Council standards ^13,14. We must take these opportunities to identify and effect positive experiences for students in geriatric medicine, including outside the usual remit of hospitals and GP surgeries, recognising that students who receive higher quality undergraduate education in geriatrics are more likely to consider a career as a geriatrician ^6,15.

Faced with these clear deficiencies in the way in which geriatric medicine is currently taught to undergraduate students ^16,17, the BGS proposed 4 ways to improve this, the first of which was a national curriculum ^18,19. The BGS recommended undergraduate curriculum in ageing and geriatric medicine was first written based on expert consensus in 2008, and subsequently updated in 2013 based upon reviews of national guidance ²⁰. With the majority of this work having been published a decade ago, it is timely and necessary that undergraduate education in geriatric medicine is underpinned with up-to-date research and guidance. Our specialty has evolved over the intervening decade, with the widespread understanding, acceptance and adoption of frailty syndromes, and the development of new sub-specialties and models of care. Coinciding with new GMC requirements for medical school graduates ^13,14, it is important that these changes be reflected in the BGS recommended curriculum.

Our team, led by Dr Grace Pearson and Dr Emily Henderson from the Ageing and Movement Research Group at the University of Bristol, aimed to identify emergent learning outcomes (LOs) and establish expert consensus around core outcomes for inclusion in the updated BGS recommended undergraduate curriculum. We mapped the previously published BGS curriculum²⁰ to the GMC’s MLA content map ¹⁴, as the standard to which new graduates will be held, and to the European curriculum²¹ as the up-to-date pan-European specialist consensus. We then conducted a Nominal Group Technique (NGT) - an established consensus method for writing and updating guidance ²² - with key stakeholders. The result is a curriculum updated by robustly cross-matched expert consensus, bringing the BGS recommendations in line with GMC MLA requirements. It provides a blueprint for medical schools as they update their curricula in preparation for the forthcoming MLA launch and consider placements for students in innovative care services.

• Read our published paper on the curriculum update in Age & Ageing (Volume 52, Issue 2, Feb 2023, https://doi.org/10.1093/ageing/afac325.
• Read our rapid response to Gordon & Dhesi’s BMJ article: How can medical schools help in this ‘crisis of care’? https://www.bmj.com/content/380/bmj.p97/rr-1

We’re still looking for responses to our national survey of medical education in geriatric medicine – you can submit for your medical school here: https://socs.onlinesurveys.ac.uk/bgs-national-curriculum-survey

We are especially seeking responses from the following institutions:

• University of Buckingham
• University of Cambridge
• Imperial College
• Keele University
• University of Leeds
• Queen Mary University London
• Swansea University
• University College London
• Hull/York Medical School

If you have any queries about the national curriculum survey, feel free to contact Grace by email – grace [dot] pearson [at] bristol [dot] ac [dot] uk

References

1. British Geriatrics Society, Arora A, Greenbrook S. The Geriatric Medicine Workforce 2022., 2022.

2. Royal College of Physicians. RCP warns the UK is facing a crisis in care for older people. 2022.

3. Moberly T, Stahl-Timmins W. More doctors are taking a break from training after foundation programme. BMJ 2019;364, DOI: 10.1136/BMJ.L842.

4. British Medical Association. Four in ten junior doctors plan to leave the NHS as soon as they can find another job, BMA council chair reveals in New Year’s message. 2022.

5. Gordon AL, Dhesi J. Resolving the health and social care crisis requires a focus on care for older people. , DOI: 10.1136/bmj.p97.

6. World Health Organization Department of Ageing and Life Course, International Federation of Medical Student Associations. Teaching Geriatrics in Medical Education II. Geneva, 2007.

7. Gordon AL, Blundell AG, Gladman JRF et al. Are we teaching our students what they need to know about ageing? Results from the UK national survey of undergraduate teaching in ageing and geriatric medicine. Age Ageing 2010;39:385–8.

8. Gordon AL, Blundell A, Dhesi JK et al. UK medical teaching about ageing is improving but there is still work to be done: The second national survey of undergraduate teaching in ageing and geriatric medicine. Age Ageing 2014;43:293–7.

9. British Geriatrics Society, Royal College of Physicians London, Royal College of Physicians Edinburgh. Protecting the rights of older people to health and social care. 2023.

10. McCarthy F, Winter R, Levett T. An exploration of medical student attitudes towards older persons and frailty during undergraduate training. Eur Geriatr Med 2021;12:347–53.

11. Nimmons D, Pattison • T, O’neill • P. Medical student attitudes and concepts of frailty and delirium. Eur Geriatr Med 1999;9, DOI: 10.1007/s41999-017-0018-y.

12. Meiboom A, Diedrich C, Vries H De et al. The hidden curriculum of the medical care for elderly patients in medical education: a qualitative study. Gerontol Geriatr Educ 2015;36:30–44.

13. General Medical Council. Outcomes for Graduates., 2020.

14. General Medical Council. Medical Licensing Assessment [online]. 2021.

15. Meiboom AA, De Vries H, Hertogh CMPM et al. Why medical students do not choose a career in geriatrics: a systematic review. BMC Med Educ 2015;15, DOI: 10.1186/S12909-015-0384-4.

16. Tullo E, Allan L. What should we be teaching medical students about dementia? Int Psychogeriatrics 2011;23, DOI: 10.1017/S1041610211000536.

17. Winter R, Al-Jawad M, Wright J et al. What is meant by “frailty” in undergraduate medical education? A national survey of UK medical schools. Eur Geriatr Med 2021;12:355–62.

18. Oakley R, Pattinson J, Goldberg S et al. Equipping tomorrow’s doctors for the patients of today. Age Ageing 2014;43:442–7.

19. Blundell A, Gordon A, Gladman J et al. Undergraduate teaching in geriatric medicine: The role of national curricula. Gerontol Geriatr Educ 2009; 30:75–88.

20. The British Geriatrics Society Education and Training Committee. The British Geriatrics Society Recommended Curriculum in Geriatric Medicine for Medical Undergraduates. 2013.

21. Masud T, Blundell A, Gordon AL et al. European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique. Age Ageing 2014;43:695.

22. Murphy MK, Sanderson C, Black NA et al. Consensus development methods, and their use in clinical guideline development: a review. Health Technol Assess (Rockv) 1998;2, DOI: 10.3310/HTA2030.