Scholarly 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: [email protected] 
Phone: 401-444-5248

Iva Neupane, MD
Co-director Geriatrics Trauma Program
Division of Geriatrics and Palliative Medicine, Department of Medicine 
Warren Alpert Medical School of Brown University 
Email: [email protected]

Overview

The Scholarly Concentration (SC) in Aging addresses the broad areas of aging, encompassing the basic sciences, social sciences, public 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 scholarly 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 creative student-initiated ideas for the SC-Aging.

Learning Objectives

Students will be able to demonstrate:

  • knowledge of geriatrics topics;
  • extensive knowledge related to their project 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;
  • 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.

 

Curriculum

Students will use the SC Aging 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-Aging directors, identify a project and mentor; arrange an in-depth aging-relevant summer experience/project; make application to the SC program and outline plan of study with proposed end product; review the draft application with one or both SC-Aging directors prior to submission; and consider application for external funding (e.g. MSTAR - see below).
  • February -June: prepare IRB, prepare data collection tools. 
  • Summer: Launch SC-Aging project; begin to meet monthly with an assigned elder guide during medical school; spend ½ day monthly shadowing a geriatrician; attend evening 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 POB 438.

Year 2

  • In early fall, make a presentation of the work completed during the summer to the SC-Aging 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;
  • Meet regularly with mentor;
  • 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 the Brown Research Day event;
  • Attend Concentrators’ field trips in Semesters 1 and 2;
  • Attend mandatory evening SC-Aging small group discussion meetings in Semesters 1 and 2;
  • Shadow a geriatrician monthly; and
  • Continue monthly elder guide relationship with older person when possible.

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, finalize literature review, write up abstract &/or manuscript); depending on the project, it may be possible to continue/complete the work during a clerkship or a research elective month;
  • Choose 1 or 2 electives related to the concentration;
  • Meet regularly with mentor
  • 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

  • Complete scholarly project report or manuscript and submit to mentor and SC-A directors by end of SEMESTER 1;
  • 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 and semesters 1 and 2;
  • Shadow a geriatrician when possible;
  • Continue elder guide relationship with older person when possible;
  • 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 graduation ceremony in spring of fourth year.

Field trips: Three to 4 field trips are held in year 2, to acquaint concentrators with services and facilities for the older person in RI. Examples include, Alzheimer’s adult day care center, inpatient hospice, model of nursing home “culture change” movement; outpatient physical therapy unit; driving assessment site. Concentrators’ suggestions for field trip sites are welcome.  


SC-Aging evening small group discussion meetings: Each year, Scholarly Concentrators in Aging of all years will meet 3-4 times 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; older adults’ views on what makes a satisfactory encounter with a doctor; cross-cultural aspects of aging; older adults who are LGBTQ; a local author who discussed her book on Cambodia based on her life experience as a CIA agent. Concentrators’ suggestions for evening discussion topics are welcome.

Concentration Related Electives

Clinical: 

Psy-570 - Psychiatry of Late Life

IM-3180 - Hospice & Palliative Medicine

Neuro-3790 - Aging and Dementia

Evaluation

 For the above learning objectives, students will be evaluated by their mentor; and their curricular advisor(s) in the case of a curriculum development project.  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, Richard W. Besdine, MD; Renée Shield, PhD; Paul Greenberg, MD; Sevdenur Cizginer, MD; Nadia Mujahid, MD; Iva Neupane, MD; Stefan Gravenstein, MD, MPH; James Rudolph, MD.

Project Examples

  • Picking a choosing wisely campaign initiative and assessing whether providers are following the guidelines via chart review, e.g. preoperative evaluation for cataract surgery.
  • Qualitative survey of the impact of dementia on patients and caregivers resulting in a paper.
  • Basic science project with one of our biology of aging faculty (Drs. Helfand, Kreiling, Sedivy or Tatar).
  • Extensive systematic literature review of a topic of choice suitable for publication.
  • Impact of Nursing Home Compare quality ratings for outcomes of patients discharged to skilled nursing facilities (e.g. for sepsi survivors or hip fracture patients).
  • Develop a new geriatrics curriculum product for a targeted area or course.
  • Become involved in ongoing quality improvement (QI) projects with Healthcentric Advisors of Rhode Island (the Quality Improvement Organization holding the Medicare contract for QI in RI).

 Accepted Students & Scholarly Concentration Projects:

Student

Project Title

Mentor

Samanthalee Obiorah

Hospice for Assisted Living Residents: Can We Do Better?

Dr. Lynn McNicoll and Dr. Renee Shield

Brittany Ricci

Effectiveness of Cardia Monitoring for Secondary Stroke Prevention in Patients with Cryptogenic Stroke

Dr. Shadi Yaghi

Patricia Giglio

Impact of Nursing Home Quality Rating on Outcomes in Survivors of Hip Fracture

Drs. Nadia Mujahid and Lynn McNicoll

Sarah Kler

Health Needs and Outcomes of Older Adults Living in Subsidized Housing

Drs. Rebecca Brown and Kali Thomas

Connie Liou

Systemic Metabolic Disease and its Role in Alzheimer’s Disease

Dr. Suzanne M. de la Monte

Kevin Tang

Accuracy of Biometric Formulae for Intraocular Lens Power Calculation

Dr. Greenberg

Elaine Tran

Prevalence of Preoperative Medical Testing in Cataract Surgery Patients

Paul B. Greenberg, MD, MPH

Marie Anderson

Impact of Patient and Geographic Characteristics on Successful Community Discharge from Skilled Nursing Facilities in Older Adults Following Traumatic Brain Injury

Kali Thomas, PhD

Maximum Number of Students

The Concentration can accommodate up to 5 students annually.

Faculty Resources and their fields of interest (partial list) from the Division of Geriatrics or the Center for Gerontology and Health Policy:

Rosa Baier, MA – Long-term care quality and innovation

Emmanuelle Belanger, PhD – palliative care policy

Richard W. Besdine, MD, FACP – geriatrics, public policy, education

Lesley Bostom-Robinson, MD - dermatology mentor

Sevdenur Cizginer, MD - geriatrics, colorectal surgery co-management

Alicia Curtin, PhD, GNP-BC - Family Medicine at Memorial

Julio Defillo-Draiby, MD - geriatrics, joint replacement surgery

Kim Dodd, MD - geriatrics, VA

David Dosa, MD - VA, nursing homes, disaster medicine

Mary Fennell, PhD - health care organizations, rural medicine, long term care 

Emily Gadbois, PhD - NH hospitals

Omar Galarraga, PhD - health care economist, incentives in healthcare

Pedro Gozalo, PhD - health care economist

Stefan Gravenstein, MD - Division Director for Geriatrics, public policy, infections (flu)

Paul Greenberg, MD - VA ophthalmology mentor

Daithi “David” Heffernan, MD – geriatric surgery mentor

Eric Jutkowitz, PhD - non-pharmacological interventions in dementia care

Sylvia Kuo, PhD - public health, health care economist

Bart Laws, PhD - communications, HIV

Ed Martin, MD - palliative care and hospice

Ellen McCreedy, PhD - music and memory in dementia in NHs

Lynn McNicoll, MD - geriatrics, quality improvement

Whitney Mills, PhD - VA

Betsy Moody, MD - NH Care, green house project

Vincent Mor, PhD - public health

Nadia Mujahid, MD - geriatrics, orthopedics co-management

John Murphy, MD - geriatrics, Administration

Aman Nanda, MD - geriatrics

Ive Neupane, MD - geriatrics, trauma surgery co-management

Sakeena Raza, MD - geriatrics, urology surgery co-management

Linda J. Resnik, PhD - public health, VA, veterans, physical rehabilitation

Shantu Rahman, PhD - health care economics

Maricruz Rivera-Hernandez, PhD - insurance reform, minority aging

James Rudolph, MD - geriatrics VA, delirium

Renee R. Shielf, PhD - anthropology, transitions, culture change NHs, hospice

Theresa Shireman, PhD - pharmaco-epidemiologist, research in multiple sclerosis

Kali Thomas, PhD - public health epidemiologist

Amal Trivedi, MD - public health epidemiologist, Medicaid

Ana Tuya-Fulton, MD - Butler, consultative geriatrics

Terrie Wetle, PhD - public health epidemiologist

Lindia Vognar, MD - geriatrics, VA, elder neglect, transitions, Hospital at Home

Ira Wilson, PhD - public health, physician-patient communications

Ting Ting Zhang, MD - epidemiologist, research in MS

Andrew Zullo, PharmD PhD - pharmacoepidemiology

Funding Opportunities (alternatives to Summer Assistantships)

Scholars in Aging are encouraged to apply for the Medical Student Training in Aging Research (MSTAR) Program  for summer funding.