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Keeping Granny Safe on July 1: A Consensus on Minimum Geriatrics Competencies for Graduating Medical Students

Leipzig, Rosanne M. MD, PhD; Granville, Lisa MD; Simpson, Deborah PhD; Anderson, M Brownell; Sauvigné, Karen MA; Soriano, Rainier P. MD

Academic Medicine:
doi: 10.1097/ACM.0b013e31819fab70
Geriatrics Education

Competency-based education prepares trainees to perform tasks occurring within the context of practice. There are currently no geriatrics-specific, competency-based consensus performance standards for medical students.

The authors present the results of a systematic, multimethod process to identify and define the minimum geriatrics-specific competencies needed by a new intern to adequately care for older adults. An alpha draft was crafted by geriatricians, identifying measurable performance subtasks associated with accepted standards of evidence-based geriatric care, patient safety, and “do no harm” within the first-year resident's expected scope of practice. The competencies were then assessed for content validity by key stakeholders and informants. Of the 315 respondents, 26% were geriatricians, 21% family physicians, 24% general internists, 6% neurology program directors, 14% surgery program directors, and 9% other. Twenty-four were decanal appointees. Faculty from almost half (44%) of U.S. medical schools and representatives of several major medical education organizations were present at the working conference.

The final document consists of 26 competencies nested within eight content domains: Medication Management; Self-Care Capacity; Falls, Balance and Gait Disorders; Hospital Care for Elders; Cognitive and Behavioral Disorders; Atypical Presentation of Disease; Health Care Planning and Promotion; and Palliative Care.

Setting minimum geriatric competency standards establishes the performance benchmarks for medical school graduates who as first-year residents will care for geriatric patients. Only half-facetiously, they are referred to as the “Don't Kill Granny” competencies. Achievement of these minimum competencies by medical students, grounded in evidence-based principles of quality care for older adults, will assure that, each year, older patients are in safer hands on July 1.

Author Information

Dr. Leipzig is vice chair for education and Gerald and May Ellen Ritter Professor of Geriatrics, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York.

Dr. Granville is professor, associate chair of the department of geriatrics, and Year 1 Doctoring Course Director, Florida State University College of Medicine, Tallahassee, Florida.

Dr. Simpson is associate dean for educational support and evaluation, director of educational services, and professor of family and community medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

Ms. Anderson is senior director of educational affairs, Association of American Medical Colleges, Washington, DC.

Ms. Sauvigné is deputy director, Medical Education Division, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York.

Dr. Soriano is associate professor of medicine, medical education, and geriatrics and director of medical student education, Brookdale Department of Geriatrics and Adult Development, and Year 2 Clinical Skills Course Director, Mount Sinai School of Medicine, New York, New York.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. Leipzig, Mount Sinai School of Medicine, 1468 Madison Avenue, Box 1070, New York, NY 10029-6574; telephone: (212) 241-4274; fax: (212) 987-0793; e-mail: (

Editor&’s Note: A commentary on this article appears on page 542.

© 2009 Association of American Medical Colleges