National Geriatrics Interest Group (NGIG) is a student-driven initiative aimed at improving perceptions
and attitudes toward care of the elderly in Canada
By: Katrin Dolganova (Class of 2013, Queen’s School of Medicine)
The New York Times has just recently introduced a new online blog entitled “The New Old Age” to
explore societal challenges posed by adults aged 80 and older becoming the fastest growing segment of
the population in North America1. The subject matter of the blog reflects expanding recognition in
mainstream media of an emerging “aging” or “longevity” crisis1, and reflects general rising concerns
about inadequacies of current health care systems in caring for retiring baby boomers.
By 2031, seniors will make up 25% of the Canadian population2. Although most recent economic
reports indicate that the share of health care spending on the elderly has yet to increase2,3, utilization
rates of health care services are only starting to rise and will have a noticeable impact on the economy
and the medical profession within the next 10 years. The expanding aging population and the increasing
demand for quality geriatrics care calls for an action plan.
A ratio of 1.25 geriatricians per 10,000 individuals aged 65 and older is considered a reasonable target
for acceptable specialist patient care4. Canada currently lags behind most other developed countries
with a ratio of 0.57 per 10,0004. This lag may be attributable to low levels of student interest and/or
awareness resulting in low numbers of students choosing geriatrics as a specialty4,5. Not addressing the
low level of student awareness/interest may exacerbate the shortage of geriatricians (and physicians with
care-of-the-elderly training) as population demographics change.
The shortage of practicing geriatricians in Canada may be attributable to another important factor:
prevalent misperception of the specialty. In the USA and Canada, geriatrics is consistently rated by both
physicians and medical trainees to be the least-prestigious medical subspecialty5. This perception
persists despite the recent increase in inclusion of geriatrics-specific education modules in medical
school curriculums in both Canada and the USA6. While curriculum modules that focus on geriatric
disease and patient management increase awareness and interest in geriatrics6, increases in awareness
and interest do not necessarily accompany positive perceptions of geriatric medicine or positive attitudes
toward the elderly5,6,7.
In fact, many studentseven those who finished a geriatrics-specific clerkship,feel frustrated by geriatrics
care and harbor negative attitudes toward their patients6. The perceived chronicity, complexity, and
uncertain nature of geriatric disease management, combined with the focus on quality of life rather than
cure, seem to be sources of deep frustration for students4.
New approaches are therefore needed to address and reverse negative attitudes of students toward
elderly care. For example, courses that provide students with an opportunity to discuss and dispel
stereotypes, and that show the relevance of geriatric medicine to all areas of medicine, are most effective
in improving medical trainees' attitudes toward geriatric medicine7. Furthermore, physician mentorship
has been shown to be highly effective in instilling genuine and well-informed interest in pursuing a
career in caring for the elderly8. Similarly, pairing medical students with community-dwelling elderly,
who acted as mentors, resulted in significantly better student attitudes toward the elderly and improved
student interest in geriatrics as a specialty 8, 9.
Initiatives such as these have proven to be successful when they include more opportunities for informal
discussions that focus on the intersection of geriatric care with other specialties, address patient and
physician stereotypes in geriatrics medicine, and are fully integrated throughout the pre-clerkship
curriculum5. Much less successful are "stand-alone" geriatric curriculum units5. These findings suggest
that a “bottoms-up” student-focused strategy can be devised to address the scarcity of geriatricians in
Canada.
The National Geriatrics Interest Group (NGIG) is a nation-wide student-run initiative aimed at
producing positive changes in perceptions and attitudes towards geriatrics among Canadian medical
trainees. NGIG is a student branch of the Canadian Geriatrics Society (CGS), which seeks to improve
the medical care of senior Canadians through the promotion of geriatric education in Canadian medical
schools.
NGIG provides financial and mentorship resources to Canadian medical students interested in the care
of the elderly. NGIG’s mandate is to facilitate the collaboration of minds and the sharing of resources to
develop new strategies and initiatives to improve geriatrics medical training and care of the elderly in
Canada.
NGIG currently seeks representatives from each medical school in Canada to fulfill its mission. Even
for schools that already have a well-developed Geriatrics Interest Group, benefits can be derived from
joining NGIG. Each member school will have access to funding from the CGS and valuable
opportunities for networking and attending conferences.
The rationale for NGIG’s mandate is that medical students can and should be leaders of positive change.
Trainees can and should attempt to improve perceptions and attitudes towards care of the elderly by
establishing local Geriatrics Interest Groups (GIGs), organizing and attending geriatrics care events, and
by advocating for geriatrics as individuals.
For more information and to become involved in this new initiative, please contact Katrin Dolganova at
edolganova@qmed.ca.
References:
1
Gross J. The next public health crisis: longevity. New York Times [Internet]. 2010 Oct 21 [cited 2010
Nov
9];
Caring
and
Coping
[about
2
p.].
Available
from:
http://newoldage.blogs.nytimes.com/2010/10/21/the-next-public-health-crisislongevity/?scp=1&sq=geriatrics&st=cse
Blackwell T. Maybe the aging population isn’t driving health costs, after all. The National Post
[Internet]. 2010 Oct 29 [cited 2010 Nov 5]; Posted [about 1 p.] Available from:
http://news.nationalpost.com/2010/10/29/maybe-the-aging-population-isnt-driving-health-costs-after-all/
2
Ubelacker S. Canada’s health spending to reach $192B: report. The Toronto Star [Internet]. 2010 Oct
28 [cited 2010 Nov 10]. Available from: http://www.thestar.com/news/canada/article/882737--canada-shealth-spending-to-reach-192b-report
3
4
Diachun LL, Hillier LM, Stolee P. Interest in geriatric medicine in Canada: how can we secure a next
generation of geriatricians? J Am Geriatr Soc 2006 Mar; 54(3):512-519.
5
Bagri AS, Tiberius R. Medical student perspectives on geriatrics and geriatric education. J Am Geriatr
Soc 2010; 58(10):1994-1999.
6
Eskildsen MA, Flacker J. A multimodal aging and dying course for first-year medical students
improves knowledge and attitudes. J Am Geriatr Soc 2009; 57(8):1492-1497.
7
Golden AG, van Zuilen MH, Mintzer MJ, Issenberg SB, Silverman MA, Roos BA. A fourth-year
medical school clerkship that addressed negative attitudes toward geriatric medicine. J Am Geriatr Soc
2010; 58(4):746-750.
8
White HK, Buhr GT, Pinheiro SO. Mentoring: a key strategy to prepare the next generation of
physcians to care for an aging America. J Am Geriatr Soc 2009; 57(7):1270-1277.
Lu W-H, Hoffman KG, Hosokawa MC, Gray MP, Zweig SC. First year medical students’ knowledge
attitudes and interest in geriatric medicine. Educational Gerontology 2010; 36(8):687-701.
9