Centers of Excellence in Geriatric Medicine and Training

Developing the Faculty to Teach Tomorrow’s Doctors about Older Persons’ Health Needs A Brief History of Geriatrics Why Are Centers of Excellence Needed? Preparing Tomorrow’s Leaders in Geriatric MedicineCenters of Excellence Focus on Research and Training Centers of Excellence: Support for Basic Science Research Centers of Excellence: Support for Clinical Research Centers of Excellence: Support for Health Services and Outcomes Research Centers of Excellence: Support for Clinician Education Centers of Excellence: Infusing Aging into Clinical Speciaties The Hartford Foundation’s Continued Commitment to Geriatric Medicine

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Preparing Tomorrow’s Leaders in Geriatric Medicine

JAHF Funds Centers of Excellence

The Foundation initially supported advanced fellowship training with the establishment of the Academic Geriatrics Recruitment Initiative, funding 10 centers of geriatrics beginning in 1988. In 1993, an Institute of Medicine Report, "Strengthening Training in Geriatrics for Physicians," emphasized that there were still inadequate numbers of faculty to meet the nation's training and research needs in geriatrics. The Hartford Foundation responded by transforming the initiative into the Hartford Centers of Excellence program.



Rainier Soriano, MD, Mount Sinai Medical Center, New York, NY, with second-year medical students. Dr. Soriano, considered the local geriatric-education “czar” focuses on ensuring that all medical school graduates have sufficient expertise to meet the needs of the largely geriatric population found in hospitals and other healthcare settings.

Since 1997, the Foundation has invested more than $25.5 million in Centers of Excellence. Currently, there are 24 active Centers of Excellence, 22 in geriatric medicine, and in 2004 the Foundation expanded the program to include two Centers of Excellence in geriatric psychiatry.

The Centers of Excellence initiative provides young scholars with the boost they need to establish their careers, develop programs of research, and prepare for leadership roles in the field of geriatrics. Centers provide support which protects their time from excessive demands of clinical practice, allowing them to nurture their budding academic careers and to prepare to apply for the grant that will sustain a career in academic medicine. Funding is used variously for direct salary support, pilot research, development of service venues for research, and hiring much needed research support personnel. Perhaps the most valuable component of Center of Excellence funding is a built-in flexibility that allows each program’s leaders to tailor the support provided for fellows and junior faculty, providing salary support where needed, or using grant monies to customize professional development plans for fellows through tuition support for research and other courses.

“You’re always vulnerable in the academic setting, but never more so than when you’re getting started. The Centers of Excellence funds enable us to shepherd people through that vulnerable period of time.”
Harvey Cohen, MD, Director, Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina

“The Hartford Centers of Excellence program does not provide a large amount of money,” says UCLA’s Dr. Reuben, “but the funds are very strategically targeted.” Each Center of Excellence has its own constellation of institutional resources to support fellowships, research, and faculty development. “The strength of the Hartford Center of Excellence program is that it strategically fills the gaps, directing resources where the needs are.”

In general, the Centers of Excellence use their grants to:
1) fund advanced geriatric fellowship training;
2) support junior faculty working to establish themselves in independent academic careers; and
3) draw other areas of medicine into aging-relevant research and training.

“Being able to take somebody who’s very promising as a fellow and provide the initial support until they’re competitive for their own career development award is key to the success of the program. To have the resources to support these people has been a wonderful tool for our Center,” says Dr. Reuben.

This formula has produced tangible results for the field of geriatrics. So far, 163 advanced geriatrics fellows have been trained in Hartford Centers of Excellence and 222 faculty members have been supported for geriatrics development. Evaluation studies have shown that the vast majority (82 percent) of faculty supported by a Center of Excellence pursue careers in academic geriatrics.

Directors of the Hartford Centers of Excellence also report less measurable but equally important benefits, reporting the Centers enhance the field of academic geriatrics and increase the prestige of geriatrics at an institutional and a national level. “Being a member of the Hartford-funded Center of Excellence ‘club’ is important,” says Boston University’s Dr. Silliman. “It has given us national visibility and allowed us to compete successfully for other sources of funding.” 

“The Hartford Center of Excellence gave us seed money to pilot new ways to apply the science of education and adult learning to reach future doctors about the needs of their older patients. In general there is not much money for education innovation in our system.”
Roseanne Leipzig, MD, PhD, Vice Chair for Education, Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York City

“Having 24 Hartford Centers of Excellence, and the number of people who’ve been supported through these centers, is really raising the visibility of geriatrics around the country. It’s both the direct knowledge that has been created from the people supported and the critical mass,” says Mary Tinetti, MD, Yale University, New Haven, Connecticut. “It’s been proven over and over that it takes numerous researchers and educators to make a difference,” says Roseanne Leipzig, MD, PhD, Vice Chair for Education, Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York City. “Our Center of Excellence provides this critical mass.”

“The resources from the Center of Excellence have helped us to encourage people to choose aging instead of another discipline at a critical time in their career.”
Mary Tinetti, MD, Director of the Claude D. Pepper Older Americans Independence Center, Yale University School of Medicine, New Haven, Connecticut

Measuring the Success of the Centers of Excellence Initiative

Success of the Hartford Centers of Excellence program is demonstrated by the program’s significant impact on the field of geriatrics. For example, since 1997:
  • 68% of all geriatrics fellows in the United States were trained at Hartford Centers of Excellence
  • 71% of all advanced fellows in the United States were trained at Hartford Centers of Excellence

  • 163 advanced geriatrics fellows have been trained
  • 222 faculty have received direct support for geriatric development in geriatric medicine
  • 82% of faculty, supported by a Center of Excellence, remain in academic geriatrics
  • Centers of Excellence directors report being able to obtain additional institutional resources to support the Centers of Excellence mission
  • Centers of Excellence have increased the prominence of geriatrics institutionally and nationally
  • New academic and clinical programs have been developed for teaching good geriatric practices to medical students, residents, and students learning interprofessional team skills.
  • Training material and geriatric curricular models have been developed for use at other institutions

Source: Hartford Foundation internal reports and Building Academic Geriatric Capacity: An Evaluation of the John A. Hartford Centers of Excellence Initiative. August 2004 Journal of the American Geriatrics Society.

“The Centers of Excellence initiative has formed a community of distinguished academic programs that are geared toward training the next generation of leaders in geriatrics,” says Dr. Reuben. “The vast majority of academic leaders in geriatrics are being trained at the Centers of Excellence, whether they be clinician educators or clinician scientists; the centers are the training ground for the people who will lead the discipline in the future.”