3. PROFESSIONAL TRAINING IN GERONTOLOGY

I. SUMMARY OF SEMINARS, UNIVERSITY OF MICHIGAN, JULY 1956

Preparing medical students and professional workers for dealing with the diseases and disabilities of old age was the subject of a seminar on geriatric medicine conducted by Dr. E. V. Cowdry, director of the Werle Cancer Clinic, Washington University Medical School, and a second seminar conducted by Clark Tibbitts, department of health, education, and welfare, at the Ann Arbor conference on aging.

Other professional occupations associated with gerontology include professors of social work and public health, educators, State officials, administrators of old-age homes, case workers, vocational rehabilitation workers, and counselors.

The seminar on geriatric medicine included senior faculty representatives of 170 medical schools as well as the Veterans' Administration and the Public Health Service. A spirited discussion quickly brought general agreement that departments of geriatrics would be unwelcome additions to medical schools. It was also agreed that the schools must focus increasing attention on the problems of the aged. Students need to develop a more wholesome attitude toward this group of complex patients. Research needs to be intensified.

Although it is recognized that the faculty of each medical school will make its own arrangements, a coordinator for aging is needed to act as a focal point for activities related to aging.

The coordinator could be in any medical school department although most often he would be in the department of internal medicine. He would head an interdepartmental committee concerned with incorporating appropriate material on aging into the curriculum content of each department. He would spark research and would serve as liaison officer with the general university. It is vital that he have full financial support and control of an adequate budget.

Graduate departments should be organized to train investigators and teachers in geriatric medicine, the seminar indicated. It was agreed that large numbers of geriatricians are not required for service programs since medical care of older people is the legitimate province of the internist and the general practitioner.

Although the second seminar was exploring a relatively uncharted field when it considered professional training for gerontology, it was able to reach several major conclusions.

For example, it was agreed that middle age and old age are identifiable periods of life, having characteristics that should be studied in all of the life-science and social-science courses given in secondary schools and in colleges and universities.

Equally general was the agreement that gerontology is a science in its own right and that all professional persons planning to work

with older persons should have specialized training throughout their preparation in didactic instruction and fieldwork.

This seminar identified three principal occupational categories calling for specializing in work with older persons: The professional occupations such as social work or adult education, related occupations having some involvement with older persons, and generalists in aging.

The generalist was defined as an individual who has a broad knowl edge of the characteristics, needs, and circumstances of aging and older people; understanding of aging as a social, cultural phenomenon; knowledge of community organization and resources; and skill in working with individuals and groups. His training should draw upon the bioligical, psychological, and social sciences at the graduate level.

Generalists are employed as community and State coordinators in aging, administrators of old-age homes, specialists in voluntary and governmental agencies, and executives of university programs. As awareness of the expanding field grows, the number of places open to generalists is expected to increase rapidly.

As to the administrative location of gerontology training in a university, the seminar leaned toward establishment of a new department or institute that would offer core courses in gerontology combined with elective courses in related departments.

CLARK TIBBITTS,

Chairman, Committee on Aging, Department of Health, Education, and Welfare.

II. PROFESSIONAL TRAINING IN BIOLOGICAL-MEDICAL GERONTOLOGY 1

This conference is in agreement as to the need and desirability of stressing a program in schools of medicine for teaching, research and service on aging and the aged.

Where in the curriculum, both graduate and undergraduate, such concepts can most profitably be introduced must remain the problem of the faculty in each school. It is thought that the teaching of gerontology can best be accomplished through promoting study of the concepts of growth, aging, and their significance through all faculty departments.

At the undergraduate level, it is suggested that the coordinator plan which has worked so well in cardiology and encology could well be duplicated in gerontology. Where this has worked out most successfully in encology and cardiology, the coordinator has had the proper faculty status and adequate budget; and such is recommended for gerontology.

In view of the relatively small number of teachers qualified in the field of gerontology, it seems wise to establish graduate departments in selected medical schools. The function of these departments would not be to turn out large numbers of graduates who could practice

1 Submitted to the Ninth Annual Conference on Aging, University of Michigan, July 1956.

geriatrics as a specialty, but to produce investigators and teachers in this field. Medical schools should be provided with the means for establishing the facilities for such a program.

III. DRAFT REPORT OF THE SEMINAR ON PROFESSIONAL TRAINING IN SOCIAL GERONTOLOGY2

Two parts of the conference program were 4-session seminars on training in gerontology. One seminar was concerned with training for physicians and hospital service. The other, covered by this report, was concerned with all other occupations.

The seminar was only roughly structured so that the participants were quite free to develop their thinking as their conceptions of the problem dictated. The membership of the group represented several Occupations, hence, several approaches and wide experience backgrounds. See list at the end.

The following report constitutes a trial run or first approximation to the development of a set of principles and a program for training in gerontology. The seminar group hopes that the report will stimulate other groups to give similarly serious consideration to this matter and to carrying the work forward.

Questions

During the course of the discussion, the participants raised a number of major questions. These were:

1. Should we think in terms of meeting immediate needs or direct our thinking toward an ideal program?

2. How many and what occupations require training in gerontology?

3. Is there a need for generalists in the field of gerontology? What and how many positions might require broad, general training in the field?

4. What kinds of knowledge and skills are required by those working with middle-aged and older people?

5. Are middle age and old age identifiable periods of life or merely continual of earlier periods? Do the characteristics and situations of people in the second half of life differ from those of people in the first half of life?

6. Does gerontology have a body of knowledge of its own or does it represent merely the application of other knowledges and skills to older people?

7. Whose responsibility is it to offer the education and training needed for work with the aging and aged? Is there need for new courses, curricula, departments, fieldwork experiences, degrees?

8. How and by whom should the next steps be taken in developing recommendations for training in the field?

These are major and far-reaching questions. The seminar did not reach detailed or final conclusions on all of them. Yet, the participants felt that they did make a good deal of progress toward finding some

2 This draft report was submitted to the Ninth Annual Conference on Aging, University of Michigan, July 1956, and will have some editorial revisions in the final draft.

of the answers. And they were unanimous in their conviction that the need to find all of them is urgent.

While the participants recognized that there is a critical present need for gerontological training in connection with many occupations, they elected to spend most of their time developing their ideas for comprehensive and long-range programs. They foresaw a rapidly growing demand for well-trained workers and believed that adequate training programs should be developed as soon as possible.

THE LATER YEARS AS AN IDENTIFIABLE PERIOD OF LIFE

The members of the seminar recognized that the middle and later years of life represent phases of a continuing life process and that, to a considerable extent, how one ages is a function of the manner in which one has developed and made adjustments during the earlier periods of the life cycle. Nevertheless, the participants found little difficulty in agreeing that middle age, later maturity, and old age are relatively distinct stages of development and as completely identifiable as the stages of childhood and adolescence. Changes in physiological and psychological traits are measurable, personality changes are observable, and changes in roles and circumstances are usually quite marked.

It was the position of the group that the characteristics and situations of aging and older people must become more clearly understood through research and that they must find opportunity to meet their needs through specially developed opportunities, facilities, and services. The group's conclusion pointed at once to the need for specially trained workers in many fields of activity.

IS GERONTOLOGY A FIELD OF SUBJECT MATTER OR SPECIAL SKILL IN APPLYING KNOWLEDGE FROM OTHER FIELDS?

The seminar participants were quite definite in taking the position that gerontology has a subject matter of its own. Approaches or treatment measures undertaken without specific knowledge of the peculiar characteristics of older people are almost certain to miss their mark, said the conferees. Concepts with reference to the aging individual borrow directly from the biological, psychological, and social sciences and, in considerable part, represent a synthesis of knowledge obtained when the research procedures of these fields are applied to study of older persons. Aging is also a cultural phenomenon described in terms of demography, social change, economics, and other fields.

OCCUPATIONS

Seminar participants listed several fields and occupations in which varying degrees of training in gerontology are required, the amount dependent upon the nature and intensity of specialization required by the position to be held.