Education, Training Needed for Managing Geriatric Otolaryngology Patients

by David Eibling, MD, Steven Parnes, MD, Karen Kost, MD, Carl Shipp, MD, Kourosh Parham, MD, and Brian McKinnon, MD •

It is rare that students and residents are exposed to a dedicated geriatric educational experience. Unfortunately, most complete their training with little focused education addressing the unique problems of the older adult with otolaryngologic disorders.

This initiative was followed by the establishment of the Section for Enhancing Geriatric Understanding and Expertise among Surgical and Medical Specialists, a group dedicated to promoting geriatric concerns for all specialties through scholarship funding. The AGS Jahnigen Award and the Professional Development Plan for the National Institutes of Health’s Grants for Early Medical/Surgical Specialists’ Transition to Aging Research (GEMSTAR) are two of the established funding streams. The goal of these efforts, in which ASGO members Dr. Shipp, Michael Johns, MD, and Kourosh Parham, MD, PhD, are involved, is to develop and circulate educational materials and, ultimately, to incorporate these principles into residency programs. The AGS has been the driving force behind these initiatives, with financial support from the John A. Hartford Foundation.

Assessing Competencies

The following issues have crystalized over the past several years since the ASGO was established:

  1. Geriatric patients have specific otolaryngology issues. Just as children are not “little adults,” geriatric patients are not just “older middle-aged adults.”
  2. Knowledge gaps regarding these issues and appropriate care currently extend across the spectrum of medical care. These gaps exist among otolaryngologists, primary care practitioners, nurses and other healthcare workers, and the public.
  3. Educating the newest generation of otolaryngologists will best be assured via incentivization. The most effective incentive will be the establishment of specialty-specific competencies that are assessed through formal evaluation on the OTE and American Board of Otolaryngology (ABOto) examinations.
  4. Otolaryngologists have the responsibility to educate others in the specific issues of geriatric otolaryngology.
  5. The mission statement of ASGO establishes its goal of helping to educate otolaryngologists so that members of our specialty can educate each other, our trainees, referring providers, and the lay public.

Dr. Miller, the executive director of the ABOto, pointed out that there is insufficient emphasis on assessing competencies specific to the care of the geriatric patient. Deficiencies exist both at the specialty level manifested in the ABOto examination process and at the broader level of the Accreditation Council for Graduate Medical Education (ACGME). The conclusion is that a tremendous opportunity exists for the ASGO, the AAO-HNS, the Triological Society, and other otolaryngological societies to collaborate to fill this gap. Through cooperation, we can help the ABOto and the ACGME establish specific competencies, as well as develop and implement educational material and programs on the care of the geriatric otolaryngology patient to address these competencies.