Inequities in the care of older adults: Identifying gaps in the education of geriatric medicine fellows

Background: The events of 2020 amplified inequities in the care of older adults In Geriatric Medicine our patients are dying at exponentially higher rates, particularly those that are Black and Latinx and those in congregate care settings Milestones focused on social determinants of health (SDOH) and health inequity are lacking within Geriatric Medicine fellowship training A virtual learning collaborative GERIAtrics Fellows Learning Online And Together (GERI-A-FLOAT) was developed by program directors from across the country to support trainees during the COVID-19 pandemic To address gaps in Geriatric education around SDOH, a fellow-lead educational thread was added Methods: To inform our SDOH educational thread, we developed a voluntary, anonymous needs assessment of fellows and program directors through GERI-A-FLOAT We sought to understand prior curricula trainees had been exposed to focused on the impact of specific SDOH on older adults Trainees then prioritized topic areas for building the curricular thread Results: A total of 52 participants completed the survey More than 50% of participants indicated no older adult specific training on sexism, homelessness, immigration, racism or LGBTQ+ health, with more than 70% having no training in the care of formerly incarcerated older adults The most commonly taught concepts were ableism, ageism and poverty, yet still more than 40% of participants had no formal teaching in these areas Trainees chose the following 6 priority topics: racism, ageism, ableism, LGBTQ+ health, post-incarceration and poverty/ homelessness Conclusions: Geriatric Medicine fellowships lack consistent SDOH curricula This needs assessment will guide our curricular thread and our unique online collaborative will allow for wide dissemination We are planning a monthly six-session series led by fellows paired with content experts We will evaluate longitudinally to assess for knowledge change We are hopeful this will also inform larger curricular milestones around SDOH for fellowship programs The time is now to improve the way in which we prepare the next generation of Geriatricians to serve as system leaders and agents of change