Concentration in Aging

Concentration Co-Directors

Lynn McNicoll, MD
Associate Professor of Medicine, Director of Education
Division of Geriatrics and Palliative Medicine, Department of Medicine 
Warren Alpert Medical School of Brown University 
c/o Rhode Island Hospital 
593 Eddy St., POB 438, Providence, RI 02903 
Email: lmcnicoll@lifespan.org 
Phone: 401-444-5248

Renée Shield, PhD 
Professor in Health Services, Policy and Practice (Clinical)
Center for Gerontology and Healthcare Research 
Email: Renee_shield@brown.edu  
Phone: 401-863-9958 
Box G-121 (6), Brown University, Providence, RI 02912

Overview

The Scholarly Concentration (SC) in Aging addresses the broad areas of aging, encompassing the basic sciences, social sciences, community health, psychology, ethics, and medical education that are central to an understanding of healthcare and society in the context of aging. Under the guidance of a mentor expert, students choosing the SC-Aging will design a project that will be the centerpiece of the Concentration. In the SC-Aging, students will explore a particular clinical issue or health/public health area related to older adults that results in a major product, such as a publishable paper, new curricular content, innovative pedagogical approach (see examples of possible projects below) or a community intervention. The SC leadership is committed to flexibility regarding student-initiated ideas for the SC-Aging.

Curriculum

All students selecting the SC in Aging will be expected to access, appropriate to the student level, a defined body of clinical information and clinically relevant basic science information on aging beyond that in the core medical school curriculum. In addition, students will utilize the SC to bridge disciplines in the pursuit of a targeted project. During the years of the SC, students will be expected to 1) undertake self-directed learning to acquire knowledge related specifically to their final product/project; 2) choose and work closely with a faculty mentor for guidance in the pursuit of the concentration; 3) attend the summer lecture series on geriatric medicine and psychiatry if in Providence for the summer following Year I; 4) participate in an aging-related summer experience (e.g., Summer Assistantship [SA]); 5) shadow a geriatrician; 6) attend Concentrators’ Small Group evening discussion meetings and field trips; 7) establish and maintain an “elder guide” relationship with an older person living in the community; and 8) meet in individual progress meetings with the Directors of the Scholarly Concentration in Aging at least once each semester.

Timeline of Activities

Year 1

  • August-December: Attend orientation, learn about SCs, and identify an interest in aging;
  • December-February: After consultation with the SC-A directors, identify a project and mentor; arrange an in-depth aging-relevant summer experience; make application to the SC program and outline plan of study with proposed end product; consider application for external funding (e.g. MSTAR or MSTREAM - see below).
  • Summer: Participate in summer project on aging that launches the project; begin to meet with an assigned elder guide during medical school; spend ½ day monthly shadowing a geriatrician; attend evening and small group discussion meeting; and attend Concentrators’ first field trip. If at Brown, attend weekly Fundamentals of Geriatrics lecture series held at Rhode Island Hospital.

Year 2

  • In early fall, make a presentation of the work completed during the summer to the Oversight Committee;
  • Allocate, on average, half of the day protected for self-directed learning each week to the concentration (e.g., project work - collect data, do experiments, work in the community, do literature review);
  • Engage regularly in self-directed learning about aging in greater depth than offered in the standard curriculum;
  • Attend the geriatrics-related offerings at Rhode Island Hospital (weekly Fundamentals, brown bag seminars) and Division of Geriatrics (RI, TM, Memorial, VA, Butler Hospitals) when possible;
  • Submit poster on summer work for December’s Summer Showcase event;
  • Attend Concentrators’ field trips held twice in Semester 1, once in semester 2;
  • Attend evening SC-Aging small group discussion meetings held twice in Semester 1, once in semester 2;
  • Shadow a geriatrician monthly; and
  • Continue monthly elder guide relationship with older person.

Year 3

  • If not already done, complete the project’s data collection early in the year as clerkship demands permit (e.g., continue to collect data, do experiments, work in the community, do literature review, write up abstract &/or manuscript); depending on the project, it may be possible to continue/complete the work during the Community Health clerkship;
  • Choose 1 or 2 electives related to the concentration;
  • Attend mandatory evening SC-Aging small group discussion meetings held once in summer, twice in semester 1, and once in semester 2;
  • Attend weekly Fundamentals, brown bag seminars, grand rounds related to geriatrics when possible;
  • Shadow a geriatrician when possible;
  • Continue elder guide relationship with older person when possible.

Year 4

  • Prepare first draft of the SC project report or manuscript by November 1 for submission to mentor for review and suggestions;
  • Do 1 or 2 electives based on concentration; Attend weekly Fundamentals, brown bag seminars, grand rounds related to geriatrics when possible;
  • Attend mandatory evening SC-Aging small group discussion meetings held once in summer, twice in semester 1, and once in semester 2;
  • Shadow a geriatrician when possible;
  • Continue elder guide relationship with older person when possible;
  • Complete scholarly project report or manuscript and submit by end of SEMESTER 1;
  • Write a 2-page reflective statement that reviews the SC-A project, describes its meaning to the student and identifies ways the SC-A  project impacted his/her medical school career; and
  • Present scholarly project and reflective statement at Scholarly Concentration in Aging Oversight Committee’s “Concentrator Day” in spring of fourth year.

Field trips: The first field trip will be held in the summer after 1st year; two field trips will be held in semester 1 and one in semester 2, year 2, to acquaint concentrators with services and facilities for the older person in RI; e.g., Alzheimer’s adult day care center, inpatient hospice, model of nursing home “culture change” movement. 
SC-Aging evening small group discussion meetings: Each year, Scholarly Concentrators in Aging of all years will meet once in the summer, twice in semester 1, and once in semester 2 with SC-Aging directors and mentors to discuss important issues related to aging and complex cases encountered on rotations and to share progress on projects.  Recent examples include an expert on narcotics use in elderly emergency room patients or a visit from a local author who wrote a book on Cambodia based on her life experience as a CIA agent.

Concentration Related Electives

Clinical: 
Geriatrics and Rehabilitation 
Hospice and Palliative Medicine 
Psychiatry of Late Life

Learning Objectives and Evaluation

Students will be able to demonstrate:

  • knowledge of geriatrics materials developed for the new integrated curriculum;
  • extensive knowledge of a particular aspect of aging, of a disease important in older patients, or of a geriatrics syndrome, and understand the social, clinical, epidemiological and psychological consequences of the chosen topic;
  • extensive clinical experience in working with older patients in a variety of settings, including nursing home, assisted living facility, hospital, hospice, outpatient clinic or office; and
  • an appreciation of the experience of healthy aging as well as a deeper understanding of the experience of living with chronic and multiple medical conditions often associated with aging.

For the above learning objectives, students will be evaluated by 1) their mentor; 2) the shadowing geriatrician; 3) curricular advisor(s) in the case of a curriculum development project; and 4) the SC-Aging Oversight Committee.  Students will also be expected to discuss ongoing progress and/or interim results of their work in Concentrators’ evening small group discussion meetings.

An Oversight Committee consisting of interdisciplinary faculty (medical and other faculty) will provide review of students’ work culminating in the final project. Committee members include Lynn McNicoll, MD, Alicia Curtin, PhD, GNP-BC; Richard W. Besdine, MD; Renée Shield, PhD; Paul Greenberg, MD; Nadia Mujahid, MD.

Project Examples

  • A student interested in neurological disorders in older adults might become proficient in the etiology, treatment and consequences of Alzheimer’s disease, and conduct a set of interviews with affected persons and selected family members to better understand the broader implications of the disease. The resulting project could be a publishable paper or poster on the topic.
  • A student could conduct a basic science project with one of our biology of aging faculty (Drs. Helfand, Reenan, Sedivy or Tatar).
  • A student could become proficient in a topical area or course domain and perform an extensive systematic literature review suitable for publication.
  • A student could focus on exploring the literature on how to teach the non-cognitive aspects of geriatrics (shaping attitudes, values, skills), and then work with advisors to devise educational strategies that could then be implemented.
  • A student could lead the development of a new geriatrics curriculum product for a targeted area or course.
  • In addition to traditional research projects, community-based work and scholarly reviews, there will be the opportunity for students to undertake quality improvement (QI) projects in the multiple settings applicable to care of older adults. The settings include nursing home, home health, hospital, and ambulatory care. This work will be conducted in collaboration with Healthcentric Advisors of Rhode Island (the Quality Improvement Organization holding the Medicare contract for QI in RI).

Other project ideas could include 1) producing a series of thematically related research papers, 2) developing and documenting a legislative campaign related to an issue important in aging, and 3) creating a visual or oral history project related to the pursuit of a topical area in aging.

2014 Accepted Students & Scholarly Concentration Projects:

Student Project Title Mentor
Alison Chen Sudden visual loss and mortality in African Americans Dr. Paul Greenberg
Maggie Chung Lower gastrointestinal bleeding: Indicators to increase diagnostic yield of catheter angiography following scintigraphic screening Dr. Sun Ho Ahn
Adam Henderson Prescription opioid use and misuse in older emergency department patients Dr. Francesca Beaudoin
Connie Wu Cataract surgery quality of care: An evaluation of US and Canadian cataract surgery clinical practice guidelines Dr. Paul Greenberg

 

Maximum Number of Students

The Concentration can accommodate up to 5 students annually.

Faculty Resources and their fields of interest

Susan Allen, PhD - public health, community care, VA nursing homes
Richard W. Besdine, MD, FACP - geriatrics
Lesley Bostom-Robinson, MD - dermatology mentor
Melissa Clark, PhD - public health, survey methods
Sevdenur Cizginer, MD - geriatrics, colorectal surgery
Alicia Curtin, PhD, GNP-BC - Family Medicine at Memorial
Julio Defillo-Draiby, MD - geriatrics, joint replacement surgery
Clarisse Dexter, GNP - geriatric nursing home
Kim Dodd, MD - geriatrics, VA
David Dosa, MD - VA, nursing homes, disaster medicine
Mary Fennell, PhD - health care organizations, rural medicine, long term care
Pedro Gozalo, PhD - health care economist
Paul Greenberg, MD - VA ophthalmology mentor
Daithi Heffernan, MD - surgery mentor
Marianne Hurley, GNP - geriatrics nursing home
Sylvia Kuo, PhD - public health, health care economist
Linda Laliberte, JD, MS - legal aspects of aging
Ed Martin, MD - palliative care and hospice
Lynn McNicoll, MD - geriatrics, quality improvement
Edward Miller PhD - federal and state policies affecting elderly
Susan C. Miller, PhD, MBA - public health, hospice care, culture change NHs
Vincent Mor, PhD - public health
Nadia Mujahid, MD - geriatrics, orthopedics
John Murphy, MD - geriatrics
Aman Nanda, MD - geriatrics
Paul Pirraglia, MD - pulmonary mentor
William Rakowski, PhD - public health
Linda J. Resnik, PhD - public health, VA, veterans, physical rehabilitation
Rachel Roach, GNP - geriatrics
Renée R. Shield, PhD - anthropology, transitions, culture change NHs, hospice
Joan M. Teno, MD, MS - geriatrics, palliative care and hospice, transitions, epidemiology
Amal Trivedi, MD  - public health epidemiologist
Ana Tuya-Fulton, MD - Butler, consultative geriatrics
Mary-Beth Welesko, GNP - geriatrics
Terrie Wetle, PhD - public health epidemiologist
Lidia Vognar, MD - geriatrics, VA, elder neglect
Ira Wilson, PhD - public health, phsyician-patient communication

Funding Opportunities (alternatives to Summer Assistantships)

Scholars in Aging are encouraged to apply for the Medical Student Training in Aging Research (MSTAR) Program  (due 1/31/12) and/or the M-STREAM program (due ~3/12) for summer funding.