Dr Jenny Lonnen, ST5
One-line ‘definition’ of specialty

Geriatric medicine is one of the largest specialties in the UK. It offers a stimulating intellectual challenge: illness may present in unusual ways in older people, they frequently have multiple pathologies that interact, and they are particularly prone to adverse drug reactions. It allows you to maintain a generalist approach while also developing a sub-specialty interest. This can range from stroke to Parkinson's disease, falls and fracture prevention, diabetes or cardiovascular disease, to name but a few. It also offers the chance to work both in community and hospital settings. Research is at last generating an ever-expanding evidence base for the management of many conditions in old age and the National Service Framework for Older People has laid out some challenging targets for healthcare provision.

There are presently around 800 Consultants in the specialty but numbers are expanding, so career prospects are excellent. The most effective geriatrician is an excellent general physician with good communication skills, who is able to work well in a team with other disciplines and can empathise with older people. Most people are attracted by the holistic way that the specialty takes on acute investigation and management together with subsequent rehabilitation and discharge planning, all tailored to each individual's needs.

Brief run-down of training programme content and duration

A five-year programme (dual certification with General Internal Medicine [GIM]).

Year one: GIM.

Years two and three: Geriatric medicine (including palliative care, stroke, old age psychiatry, movement disorders, falls and orthogeriatrics attachments).

Years four and five: Half and half GIM and geriatric medicine (including Intensive Treatment Unit [ITU] and Coronary Care Unit [CCU] attachments).

Exam requirements

Specialty Certificate Examination in Geriatric Medicine.

Other requirements
  • Four-week attachments in each of: palliative care, old age psychiatry, ITU and CCU
  • Research methodology course
  • Teaching skills course
  • Logbook and record of clinics for GIM
Opportunities/expectations for out of programme/research

Research is not essential, but there are opportunities for this (usually by taking a higher degree i.e. MD or PhD).

You can apply to do a stroke year to obtain a GIM/Stroke/Geriatric Medicine combined Certificate of Completion of Training (CCT).

Other opportunities:  Clinical Teaching Fellow

A day in the life of a Registrar

Days are varied. They often, but not invariably, begin with a ward round. Then activities are a mixture of outpatient clinics, medical day hospital, long-term care wards, liaison work (e.g. orthogeriatrics, surgical), multi-disciplinary team (MDT)meetings and meeting with patient relatives. From the GIM/acute point of view, you also take part in the acute medical-take rota, and do post-take ward rounds with Consultant supervision.

Pros and Cons of working in this specialty

Pros  

  • Varied and interesting work
  • Usually involves working in a team with different disciplines
  • Rehabilitating patients to their potential is rewarding
  • There is a lot of general medicine involved
  • We see interesting patients with interacting co-morbidities and often complex social situations. We need to assess patients holistically in conjunction with a multi-disciplinary team (MDT)
  • Can sub-specialise if you wish (stroke, movement disorders, falls etc)

Cons

  • Lack of ‘craft’ (e.g. endoscopy) occasionally makes it hard to protect training time
How this specialty differs to others and what made me choose it

Teamwork is fundamental in geriatric medicine, and it could be argued that patients are assessed more holistically than in ‘single organ’ specialties. The work is very varied and patient conditions are often complex, which leads to continuing challenges and keeps the work interesting.

Tips for success in applying for this specialty
  • Speak to Consultants in this specialty to express your interest
  • Get involved in audits and projects in your local department
  • Join the British Geriatrics Society and go to conferences
  • Try to get involved in the work of the department out of the ward environment (e.g .day hospital, clinics etc)

For more information

Joint Royal Colleges of Physicians of Edinburgh (JRCPTB) website, specialties pages – has links to curriculum, annual review of competence progression [ARCP] decision aids etc.

British Geriatrics Society website (there is a trainees’ section)