Best Practices

The VA Geriatric Scholars Program

This national longitudinal educational program shares state-of-the-art geriatric practices in primary care PACTs through continuous professional development.

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In 1973 the VA addressed the “age wave,” recognizing the need to advance geriatrics and gerontology in the U.S. by creating the Geriatric Research Education Clinical Centers (GRECCs) with its mission to improve health care for all older veterans. Twenty GRECCs were authorized, and as advances have moved from bench to bedside, the role of education has become increasingly important.

The Institute of Medicine observed the need to focus on training for the existing U.S. health care workforce, which lacks sufficient expertise in geriatrics. The VHA Office of Geriatrics and Extended Care (GEC) also noted that lack of training in the care of older adults is a serious problem in the VHA, because more than half the veterans who seek health care annually are aged > 65 years. The VHA also has fewer geriatricians per patient (1:11,515 patients) than the overall U.S. average (1:6,028 patients) (Kenneth Shay, DDS, MS, written communication, April 13, 2015).

About 2.4 million older veterans receive health care in primary care Patient Aligned Care Teams (PACTs), whereas only 87,000 older veterans receive specialty care in geriatrics. The lack of specialty care in geriatrics is even more problematic in rural areas, where there are fewer specialists and the patient population is older than in urban areas. Typically, rural-dwelling veterans are older, in poorer health, and have a higher incidence of mortality than do their urban counterparts.

Related: Infusing Gerontologic Practice Into PACT

To address this need, 10 of the 20 GRECC associate directors for education/evaluation have joined with the GEC and the VA Employee Education System (EES) to collaborate in a national longitudinal educational program to integrate state-of-the-art geriatric practices in primary care PACTs throughout the VA. The program targets primary care providers as well as associated health professionals who support the PACTs (pharmacists, psychologists, and social workers).

The VA Geriatric Scholars Program (GSP) is a longitudinal multimodal educational program designed on the principles of adult learning and continuous professional development, including a demonstration of skills. The VA Office of Rural Health and Primary Care Services fund the program. All learners are nominated by their respective VISNs and commit to implementing systematic changes in personal and clinic practices to improve the quality of care for older veterans.

Core Elements

The GSP consists of core elements and a broad variety of electives to meet learners’ individual goals for the development of new skills and competencies. There are 3 core elements: (1) a ≥ 35-hour CME/CEU intensive didactic course in geriatric medicine sponsored by leading universities; (2) an 8-hour CME/CEU course sponsored by the EES; and (3) a demonstration of how new knowledge is being applied through a quality improvement (QI) project in the PACT or clinic.

The GSP with the EES also developed specialized didactic courses for social workers and for psychologists when none previously existed. The optional learning components include clinical practicum experiences, online learning, audio conferences, and refresher courses. With evaluations of learners several times a year, new programs and educational materials are developed to meet the self-identified needs of VA clinicians. The program recently added advanced tracks in clinical leadership and management and in palliative care.

Since its inception as a pilot program in 2008, the GSP has continued to expand, adding components such as on-site team training at rural community-based outpatient clinics (CBOCs) and building infrastructure through online learning. The program has also spun off initiatives to provide high-quality geriatric education to rural CBOCs through its GRECC-CBOC Connection program, which offers case presentations and consultations through clinical video teleconferencing in 8 VISNs and a new virtual learning community at http//www.gerischolars.org.

Each of the 10 GRECCs has a unique and well-defined role in the collaboration. For example, the Nashville-based Tennessee Valley GRECC contributes its expertise in QI and is responsible for the curriculum design, training, approvals for QI projects (rather than research projects), and individualized coaching. The Bronx GRECC in New York pioneered the Rural Interdisciplinary Team Training (RITT) program, which provides education in geriatrics and clinical teamwork, combined with group activities to improve team function over the course of a year. The Palo Alto GRECC in California responded to requests from the field to develop a specialized course to enhance skills in geriatrics and gerontology for VHA psychologists. The Little Rock GRECC in Arkansas has taken a lead role in developing audio conferences to meet learner-defined educational needs, and the San Antonio GRECC in Texas is developing interactive online training modules.

Related: Home-Based Video Telehealth for Veterans With Dementia

The GRECCs offer unique, clinical practicum experiences for both groups and for individual scholars. These include late life issues in mental health and palliative care at the Boston, Massachusetts-based New England and Madison, Wisconsin GRECCs, dementia care at the Puget Sound GRECC in Washington, physical function and fitness at the Durham GRECC in North Carolina, and in alternating years, comprehensive functional assessment and integrative medicine at the Greater Los Angeles GRECC. The hub site for the program is at the Greater Los Angeles GRECC in California, which handles the administrative component and develops new components for social worker education, integrative health, and an online infrastructure to maintain and expand the didactic activities.

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