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Supplement: Improving Geriatrics Training: Training Internists in the Care of Older Adults |

General Internal Medicine and Geriatrics: Building a Foundation To Improve the Training of General Internists in the Care of Older Adults

C. Seth Landefeld, MD; Christopher M. Callahan, MD; and Nancy Woolard
[+] Article and Author Information

From the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California; Regenstrief Institute and Indiana University, Indianapolis, Indiana; and Wake Forest University School of Medicine, Winston-Salem, North Carolina.


Grant Support: In part by a grant to the Society of General Internal Medicine from the John A. Hartford Foundation, Inc., and by grants to the University of California, San Francisco, from the National Institute on Aging (K-07 AG00912) and the John A. Hartford Foundation, Inc. (2000-0455). Dr. Landefeld is a Senior Scholar in the Department of Veterans Affairs National Quality Scholars Program.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: C. Seth Landefeld, MD, Box 1265, University of California, San Francisco, San Francisco, CA 94143-1265; e-mail, sethl@medicine.ucsf.edu.

Current Author Addresses Dr. Landefeld: 4150 Clement Street, University of California at San Francisco, San Francisco, CA 94121.

Dr. Callahan: Center for Aging Research, Indiana University, 1050 Wishard Boulevard, RG6, Indianapolis, IN 46202.

Ms. Woolard: Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157.


Ann Intern Med. 2003;139(7):609-614. doi:10.7326/0003-4819-139-7-200310070-00034
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Over the next 30 years, the health care needs of older Americans will challenge physicians and other health professionals as the number of older persons explodes, their lifespans lengthen, and they are treated for more and more conditions. The number of Americans 65 years of age or older has doubled every 30 years since 1900 and will double again in the next 30 years, from 35 million (12.4% of the population) to 70 million (20.6% of the population) (1). Persons 65 years of age or older account for 25% of visits to physician offices, 36% of acute hospitalizations, and 50% of hospital expenditures (2). Medicare reimbursement accounts for 27% of physician income. Persons 85 years of age or older are the most rapidly growing part of the population, and they often have challenging combinations of conditions. Yet in an era that aspires to evidence-based medicine, we have little knowledge about how best to care for the very old, and most physicians are not taught the principles and perspectives that come into play in caring for the aged.

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The internal medicine training cycle.

Thin black arrows indicate the evolution of roles: Medical students become resident physicians, residents become practicing physicians or fellows, and fellows usually become practicing or faculty physicians. Thick black arrows indicate the contribution of fellows and faculty to knowledge about caring for patients. White arrows indicate the direct and indirect effects of faculty on the education of medical students, residents, and fellows. The dashed arrow indicates the flow of knowledge to practicing physicians and the reciprocal contributions of practicing physicians to knowledge about how to care for patients.

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