Europe-Wide Survey of Teaching in Geriatric Medicine

EDUCATION AND TRAINING

Europe-Wide Survey of Teaching in Geriatric Medicine

Jean-Pierre Michel, MD,�w Philippe Huber, MD,� Alfonso J. Cruz-Jentoft, MD, PhDwz anda representative of each surveyed country1

By 2050, the European population of 720 million will in-clude 187 million (one quarter) octogenarians. Althoughliving longer is a true privilege, care for the grayingpopulation suffering from chronic and disabling diseaseswill raise enormous challenges to healthcare systems andgeriatric education. Are European countries ready to copewith these challenges? An extensive 2006 survey of geriatriceducation in thirty-one of 33 European countries testifiesthat geriatrics is a recognized medical specialty in 16 coun-tries and a subspecialty in nine of them. Six Europeancountries have an established chair of geriatric medicine ineach of their medical schools. Undergraduate teaching ac-tivities are organized in 25 of the surveyed countries andpostgraduate teaching in 22 countries under the leadershipof geriatricians (n 5 16) or general internists (n 5 6). Acomparison with data collected in the 1990s shows impor-tant progresses: the number of established chairs increasedby 45%, the undergraduate and postgraduate teachingactivities increased respectively by 23% and 19%.However, these changes are very heterogeneously orga-nized from country to country and within each country. Inmost European countries, there remains a huge need forreinforcing and harmonizing geriatric teaching activities toprepare the next generation of medical doctors to addressthe projected increase in chronic and disabled older pa-tients. Several different innovative strategies are proposed.J Am Geriatr Soc 56:1536–1542, 2008.

Key words: geriatrics; medical education; pregraduateteaching; life-long training

The Council of Europe, the continent’s oldest politicalorganization, groups 47 different countries (all Euro-

pean countries except Belarus), of which 27 are now statemembers of the European Union (Figure 1).1 The totalEuropean population of 720 million is likely to remainstable until 2050. Today, 20% of the European populationis aged 60 and older (144 million) and 15% aged 80 andolder (108 million). By 2050, the proportion of the popu-lation aged 80 and older will reach 26% (187 million).1 Atpresent, in the United States, patients aged 65 and olderaccount for 39% of ambulatory visits to general internalmedicine physicians.2 This fast growth in the oldest, sickest,and frailest patients, many with multiple comorbidities andin need of specific community or institutional care,3

presents tremendous challenges.Some years ago, a thorough reform of higher education

in Europe was started, known as the ‘‘Bologna process,’’aimed at establishing the European Higher Education Areaby 2010 to uphold and harmonize academic degree stan-dards.4,5 However, this process has not been fully appliedto medical studies,6 which are generally not yet fitted tomeet to the challenge of our aging populations. Specifically,medical graduates need to acquire adequate knowledge,skills, and attitudes to manage people with chronic anddisabling diseases.7

A small group of professors of medical gerontologyperformed a first European geriatric education survey in1991 and published it in 1994.8 It developed three mainstrategic goals to anticipate the impending needs of societyand to promote geriatric medicine throughout Europe:establish the basis of a consensus on the content of anundergraduate core curriculum in geriatrics, promote thecreation of a chair of geriatric medicine in each Europeanmedical school, and provide continuing education and life-long training in academic geriatric medicine for all thosewith responsibilities for older patients.8

Fifteen years later (2006/07), an updated survey isneeded to evaluate whether the previous goals were

Address correspondence to Jean-Pierre Michel, MD, Geneva Medical Schooland University HospitalsFRehabilitation and Geriatrics, Chemin PontBochet, 3 Thonex-Geneva 1226, Switzerland. E-mail: [email protected]

DOI: 10.1111/j.1532-5415.2008.01788.x

1List of surveyed countries and country respondents:Austria: K Pils, Belgium: JP Bayens, Bulgaria: I Petrov, Cyprus: C Agatha-ngelou, Czek Republic: E Topinkova, Denmark: F R�nholt Hansen, Estonia:K Saks, Finland: T Strandberg, France: A Benetos, Germany: D Luttje,Greece: G Sparatharakhis, Hungary : B Szekacs, Iceland: P. Johnson, Italy: ACherubini, Ireland: S. O’Keefe, Lithuania: J Macijauskiene, Luxemburg: JCLeners, Macedonia: M Adzic, Malta: A Fiorini, The Netherlands: L Boelaarts,Norway: M Mowe, Poland: A Skalska, Serbia: M Davidovic, Slovakia: ZMikes, Slovenia: PS Marija, Spain: P Abizanda, Sweden: A Rundgren, Swit-zerland: Ph Huber, Turkey: U Ateskan, Ukraine: V Bezrukov, United King-dom: P. Crome, A Mair and G Mulley.

From the �Department of Rehabilitation and Geriatrics, Geneva MedicalSchool and University Hospitals, Geneva, Switzerland; wEuropean UnionGeriatric Medicine Society, London; and zServicio de Geriatrıa. HospitalUniversitario Ramon y Cajal, Madrid, Spain.

JAGS 56:1536–1542, 2008r 2008, Copyright the AuthorsJournal compilation r 2008, The American Geriatrics Society 0002-8614/08/$15.00

achieved, to ascertain the actual situation, and to forecastthe education and training needs of medical practitionersto address the increasing demands of elderly and agingEuropean citizens.

METHODOLOGY

Three European organizations (European Union GeriatricMedicine Society (EUGMS),9 the European Region of theInternational Association of Gerontology and Geriatrics(ER-IAGG),10 and the European Union of Medical Special-istsFGeriatric Section (UEMS-GS))11 with similar andcomplementary goals in the field of aging and geriatricmedicine combined their resources to perform this surveyon training in geriatrics throughout Europe.

Each national geriatrics society from the differentEuropean countries was asked to designate a respondentwho would agree to complete the questionnaire preparedby the authors of the current report. If no geriatrics societyexisted in a particular country, the network members of theabove-mentioned European organizations sought a relevantcorrespondent. All identified respondents were asked togather accurate and current information from all medicalschools of their own countries to respond to a semistruc-tured questionnaire presented in five parts:

(1) General information: official recognition of geriatricmedicine as a medical specialty or a subspecialty, num-ber of medical schools, and number of establishedchairs in geriatrics in their country.

(2) Undergraduate teaching in geriatrics: number of medicalschools organizing training in geriatrics, academic rec-ognition of this teaching, qualification of the teachersinvolved in the program, existence of a core curriculum

in geriatrics, and mechanisms to expose medicalstudents to geriatric patients.

(3) Postgraduate training in geriatrics: the same set of ques-tions as for undergraduate teaching, and opportunitiesavailable to follow a residency program in geriatrics.

(4) Continuing medical education (CME) in geriatrics:main accountability of such programs, format, andvalidation.

(5) Additional information, comments, and suggestions.

Countries Studied

The EUGMS, ER-IAGG, and UEMS-GS questionnairewas sent to the identified representatives of 33 of the 47European countries in the Council of Europe (Figure 1). Inspite of tremendous efforts, it was not possible to identify areporting representative for geriatric medicine in 14countries, mainly because of the absence of a functionalgeriatrics society in these countries.

RESULTS

Table 1 summarizes the data from 31 of the 33 countriessurveyed (94% response rate) in 2006. Data from Portugaland Romania are missing. Among the 31 responding coun-tries, geriatrics is recognized as an independent specialty in16 and as a medical subspecialty of general or internalmedicine in nine others. Six countries do not recognizegeriatric medicine. Geriatric nurses are recognized in 13 ofthe 16 European countries where geriatric medicine is con-sidered a medical specialty.

An established chair of geriatrics exists in all medicalschools (100%) of six European countries (Belgium,Finland, France, Iceland, Norway, and Sweden) (Table 1).

Figure 1. State members of the Council of Europe for each country: medical schools (first number) and chairs of geriatrics (secondnumber).

EUROPE-WIDE SURVEY OF TEACHING IN GERIATRIC MEDICINE 1537JAGS AUGUST 2008–VOL. 56, NO. 8

There is an established chair of geriatrics in 71% of theItalian medical schools, 60% of the Swiss, 50% ofthe Dutch, 39% of the English, 36% of the Spanish, 33%of the Danish, and 16% of the German (Table 1). No chairof geriatric medicine exists in eight countries (Austria,

Greece, Estonia, Macedonia, Moldavia, Slovenia, Luxem-bourg, and Malta). There are no medical schools inLuxembourg, but in Macedonia, where there is no chairof geriatrics, the discipline is recognized as an officialindependent specialty.

Table 1. Educational Data from the 31 European Countries Included in the Survey

Country

Recognition

of Geriatrics

Medical Schools

n

Medical Schools

with a Chair of

Geriatrics

n

Undergraduate Teaching in

Geriatrics Postgraduate

Teaching in

Geriatrics;

If So,

Leaders

Continuing

Medical

Education

Mandatory?�1991 2006 1991 2006 Available

Mean

Number

of Hours

Clerkships

in Geriatrics

Available

Countries surveyed in 1991 and 2006 (n 5 21)

Austria No 3 3 0 0 Yes 40 No No Yes�

Belgium Specialty 11 7 2 7 Yes Varying Yes Geriatricians Yes�

Bulgaria Specialty 5 6 0 2 No F No No No

Denmark Specialty 3 3 1 1 Yes 25 Yes� No No

Finland Specialty 5 5 3 5 Yes� 40 No Geriatricians Yes�

France Specialty 37 32 0 32 Yes� 30 Yes Geriatricians Yes

Germany Specialty 36 43 3 7 Yes 25 ? Internistsand geriatricians

Yes

Greece No 6 7 0 0 No F No No No

Hungary Specialty 4 4 0 4 Yes 24 No Geriatricians Yes�

Iceland Subspecialty 1 1 1 1 Yes� 40 Yes� Internistsand geriatricians

No

Ireland Subspecialty 2 5 1 1 Yes 9 Yes� Geriatricians Yes

Italy Specialty 22 31 22 22 Yes� 45 Yes� Geriatricians Yes�

Luxembourg No 0 0 0 0 Yes 6 No No Yes

Malta Specialty 1 1 0 0 Yes 13 Yes Geriatricians Yes

Netherlands Specialty 8 8 2 4 Yes Varying Yes Geriatricians Yes�

Norway Subspecialty 4 4 3 4 Yes� 100 No Geriatricians No

Poland Subspecialty 10 12 7 10 Yes 30 No Geriatricians Yes�

Spain Specialty 23 28 0 10 Yes� 44 Yes� Geriatricians No

Sweden Specialty 6 6 6 6 Yes� 60 Yes� Geriatricians No

Switzerland Subspecialty 5 5 2 3 Yes Varying Yes Internistsand geriatricians

Yes�

United Kingdom Specialty 26 33 21 13 Yes Varying ? Geriatricians Yes

Countries surveyed only in 2006 (n 5 10)

Czech Republic Specialty F 7 F 3 Yes 10 Yes� Geriatricians Yes�

Estonia No F 1 1 0 No F No No No

Lithuania Specialty F 2 F 1 Yes� 12 No Geriatricians Yes

Macedonia Specialty F 1 F 0 No F No No No

Moldavia No F 2 F 0 No F ? No No

Serbia andMontenegro

Subspecialty F 2 F 1 Yes 60 Yes� Internistsand geriatricians

No

Slovak Republic Subspecialty F 3 F 2 Yes� 48 Yes� Geriatricians Yes�

Slovenia No F 1 F 0 No F No No No

Turkey Subspecialty F 11 F 6 Yes 9 Yes� Internistsand geriatricians

No

Ukraine Subspecialty F 14 F 3 Yes Varying Yes� Internistsand geriatricians

Yes

Note: The 1991 study (published in 19945) included countries whose borders have since been modified (e.g., Czechoslovakia, Soviet Union, and Yugoslavia).

West and East Germany were integrated after the 1991 survey but were combined for the purposes of that report. http://www.gfmer.ch/medical_search/countries/

Europe.htm� Indicates that programs are mandatory.

1538 MICHEL ET AL. AUGUST 2008–VOL. 56, NO. 8 JAGS

The 6-year undergraduate medical education, whichoccurs after 12 to 13 years of primary education, is orga-nized in most European countries, although big differencescan be found between countries in organization and contentof the curricula. Typically, medical students will start with a3-year preclinical curriculum in which the emphasis is onthe acquisition of basic sciences, followed by a 3-year clin-ical curriculum more oriented toward the acquisition ofclinical disciplines. Undergraduate teaching in geriatrics isimplemented in 25 of the 31 surveyed European countries(81%) but to widely differing extents. Undergraduateteaching in geriatrics in all medical schools of a countryoccurs in only seven countries (Table 1). Such undergrad-uate teaching is mandatory in nine countries but does notexist in six other countries. The content of the teaching ingeriatrics is based on the European Union core curriculumrecommendations in only two countries. In most countries,each medical school determines the undergraduate curric-ulum independently.

The mean number of undergraduate teaching hoursdevoted to geriatrics varies considerably, with a maximum of100 hours of teaching in Norway to less than 10 hours inIreland, Luxembourg, and Turkey (Table 1). In most cases,teaching in geriatrics takes place during the clinical years(fourth to sixth year) of the undergraduate medical curricu-lum. The teaching methodology is ‘‘problem-based learning’’in nearly 50% of the cases. Clinical rotations in geriatrics(clerkships) are organized in 16 countries (60%). These clerk-ships are mandatory in 11 countries and elective in five.

Geriatricians specifically organize postgraduate train-ing in geriatrics in 16 of 31 countries and in collaborationwith internal medicine in six other countries (Germany,Iceland, Serbia, Switzerland, Turkey, and Ukraine). In ninecountries providing postgraduate training in geriatrics,physicians must fulfill specific qualifications to be admitted.The content of the postgraduate curriculum is defined in 16countries. A final mandatory examination is taken atthe end of postgraduate training in 13 countries, and amandatory curriculum for maintaining certification isimplemented in eight countries.

CME in geriatrics is organized in 18 European coun-tries but is mandatory for maintaining certification in ge-riatrics in only 10 of them (Table 1). CME and continuingprofessional development are not harmonized in differentEuropean countries. Recently, the European AccreditationCouncil for Continuing Medical Education (EACCME)was created to facilitate the transfer of CME creditsobtained by individual specialists in CME activities thatmeet common quality requirements in European countries,in different specialties, in the European credit system, and incomparable systems outside Europe. The EACCME and theAmerican Medical Association have been recognizing eachother’s CME credits since 2000. The EACCME depends onthe UEMS, and each section (including the GeriatricSection) assesses geriatric content of activities.12

The questionnaire includes space for additional informa-tion and comments. Three frequently encountered responsesto this part of the questionnaire are important to report:

� The need for better training in geriatric medicine forfamily physicians was stressed, because in Europe, as inother parts of the world, general practitioners care for

the great majority of community-dwelling frail andolder patients.

� A desirable objective, expressed by respondents frommany countries, was that practitioners of internal andorgan specialized medicine should recognize geriatricmedicine as a specialty.

� The European Academy for Medicine of Ageing, which‘‘teaches the future teachers in geriatrics,’’ is a highlyvalued organization, according to 30 of 31 respondents.

DISCUSSION

The response rate for this extensive survey on geriatric ed-ucation in European countries in which a reliable corre-spondent was found was good (31 of the 33 Europeancountries (94%)), even if the response rate decreases to66% when considering the 47 countries that are membersof The Council of Europe. This response rate is comparablewith those of recent surveys. In the United Kingdom, 23 of31 medical schools (74%) responded to a World HealthOrganization/Royal College of Physicians questionnaire;13

in the United States, a cross-sectional survey of geriatricmedicine fellowship programs had a response rate of 76%(96 of 126 program directors),14 and a survey of geriatrictraining in internal medicine residency programs approvedby the Accreditation Council for Graduate Medical Edu-cation had a response rate of 60% (235 of 389 internalmedicine residency directors);15 whereas in Canada, only a48% response rate (253 of 530 geriatricians and medicaltrainees) to the Geriatric Recruitment Issues Study wasachieved.16 The good response rate of the present study isprobably linked to the enormous support from the threemajor European geriatrics bodies (EUGMS, ER-IAGG, andUEMS-GS) and the involvement of the various national ge-riatrics societies. However, 16 European countries are notincluded in the present survey. Two countries did notanswer: Portugal, which has five medical schools, andRomania, which has 13 medical schools. Moreover, it wasnot possible to identify a correspondent in 14 Europeancountries (among them, the Russian Federation, which has33 medical schools).

Numerous European political changes resulting in thecreation of new countries complicate comparison of thepresent results with those from the survey performed 15years earlier,8 but it is clear that the three goals identified inthe previous survey are only partly achieved:

(i) The UEMS-GS suggested, completed, and endorseda unified European Geriatric Undergraduate Core Curric-ulum under the leadership of the European Community,17

but only two countries were found to explicitly base theirundergraduate teaching on this consensus core curriculum.However, it seems likely that the majority of teachers ingeriatrics who organize their undergraduate teaching coursesin their various medical schools use this core curriculum.

(ii) The goal of creating an established chair of geriatricmedicine in each European medical school is not yet real-ized, but considering only the countries represented in bothsurveys (n 5 21), it appears that the number of chairs ingeriatric medicine increased from 88 to 136 (54.5% in-crease), which is outstanding progress in only 15 years.Among the countries that clearly enhanced their geriatricinvolvement during this period of time, the achievement of


France is outstanding. Political educational input obligedthe 32 French medical schools to create a chair of geriatrics,following the assumption that only academic geriatricianscould teach geriatrics at the undergraduate level (manda-tory course). In contrast, the number of chairs in geriatricmedicine markedly decreased in the United Kingdomfollowing new imposed academic standards18,19 and there-attribution of chairs of geriatrics to academics notworking in geriatrics.

There are 152 established chairs of geriatric medicinein the 288 medical schools of the 31 European countriesincluded in this survey. However, as previously stressed,the present survey does not cover 65 medical schools of16 other European countries, which in practice have noteaching activity in geriatrics.

(iii) The third recommendation concerned the settingup of a higher-qualification postgraduate course to ‘‘teachthe future teachers in geriatric medicine’’ called the Euro-pean Academy for Medicine of Ageing. This qualification isnow mandatory to obtain a professorship in geriatrics in afew European countries, including France.20

The 1991 survey showed that 14 of 21 different countries(67%) had undergraduate teaching in geriatrics.8 Consider-ing the same 21 countries in 2006, there are now 19 (90%)delivering geriatric undergraduate teaching. Of the 10additional countries included in the 2006 survey, six (60%)have undergraduate teaching in geriatrics. This teaching ismandatory in Lithuania and the Slovak Republic.

Despite these positive findings, the promotion of geri-atric education still needs to be strongly pursued. Twenty-five of the 31 surveyed countries (81%) offer undergraduateteaching in geriatrics; in only nine of these 25 countries(36%) is this teaching mandatory. The recommended‘‘European Union core curriculum’’ is strictly applied infew places. Moreover, there is consistency neither in thevolume of this undergraduate teaching in geriatrics nor inthe geriatric and internal medicine background of theteachers. This raises the controversial question of whetherto integrate undergraduate teaching in geriatrics with otherareas of medicine or provide specific and specialized train-ing in geriatrics to meet the needs of older people.13 Itwould be advantageous for academic geriatricians who canprovide a more-holistic perspective to performed theseteaching activities, but because of the lack of geriatricians, afaculty development program for clinician educators isunlikely to be effective in the short and medium term.21

Too many European countries fail to give medicalstudents sufficient exposure to geriatric medicine, whichwas also the case for U.S. medical students 2 decades ago.22

In 2000, the Spanish Geriatric Society found that 43% ofSpanish medical schools did not include any geriatric teach-ing or training in their undergraduate curricula.23 In Leeds(UK) Medical School, which developed robust methods ofgeriatric assessment and incorporated geriatric sessions inthe final medical examination, only 30% to 50% of thestudents were exposed to geriatric patients during their5 years of studies.24,25 In the United States, a survey con-ducted in 2000 showed that 93% of the 125 accreditedmedical schools taught geriatrics with various teachingformats. In spite of this, 38.6% of the graduating medicalstudents felt that this amount of teaching in geriatrics wasinadequate.26 Also, experience in the management of

geriatric care in the community during medical students’training will allow greater understanding of the importanceof home care and of continuity of care between home andhospital. Interdisciplinary teamwork, including excellentcommunication links, will be appreciated as facilitatingfactors enhancing the quality of care for older patients.

Undergraduate teaching of geriatrics needs to beconsolidated in all European medical schools, and expo-sure of medical students to geriatric patients must be greatlyincreased.

In 1991, postgraduate education was organized to in-clude training in geriatric medicine in 12 of 21 countries(57%),8 whereas in 2006, this was the case in 16 countries(76%). Across the 31 countries included in the 2006 survey,postgraduate training in geriatrics was organized in 22countries (71%). Geriatricians are specifically in control ofpostgraduate education in 16 countries, whereas specialistsin internal medicine and geriatrics are involved in six coun-tries. In the future, the collaboration between geriatrics andinternal medicine in teaching needs to be considered, asdoes the importance of cross-specialty training.25 In theUnited Kingdom, of the curricula of all 27 adult medicalspecialties taught, 13 lacked any specific mention of olderpeople, including gastroenterology, nephrology, and respi-ratory diseases.25 The John A. Hartford Foundation, whichsupports initiatives to improve the availability of effectivecare for older people in the United States, has funded 12geriatric educational retreats in the last 6 years with the goalof integrating geriatric medicine into subspecialties of in-ternal medicine, and these retreats have had successful,positive outcomes.27 Such initiatives must be urgentlypromoted in Europe.

Of the 21 countries included in both surveys, CME ingeriatrics existed in 12 countries in 1991 (57%) and in 14countries in 2006 (67%). Considering the 31 countriesincluded in the 2006 survey, CME is organized in only 18of them (58%). The fact that CME is now mandatory in 10of the 18 countries involved in this type of activity, whichis excellent progress, compensates for this unchanged rateof countries involved in CME. Following the recommen-dations of U.S. colleagues,22 CME activities are regularlyorganized in Europe using problem-based learning in smallgroups. Use of tool kits is not frequently encountered but islikely to be promoted in the future following the excellentresults reported for such methods of teaching.28

The main goal of the European Academy for Medicineof Ageing CME course is to provide academic reinforce-ment in different European countries by enhancing andupdating geriatric scientific knowledge and facilitatingresearch networking.21

New innovative European initiatives must be devel-oped, particularly making greater use of e-learning. A sur-vey of 130 U.S. medical geriatric educational programsshowed that 79% of the respondents were users of existingprograms and that 56% are developing Internet-basedteaching materials.29 Given the shortage of professionalstrained to care for older people, overcrowded medicalcurricula, the transfer of teaching venues to communitysettings, and the switch to competency-based educationalmodels, it is time to increase the use of e-learning inEurope,30 but users need to be aware that e-learningmaterials have often not been subjected to a rigorous peer


review process.31 Telemedicine mentoring of students couldbe another innovative way to increase the availability ofeducational geriatric programs.32

This present survey has four limitations. The first islinked to the large number of countries constituting theCouncil of Europe (n 5 47). Moreover, European politicalevolution has altered national boundaries and even thenumber of countries. Therefore, a strict comparisonbetween the 1991 and 2006 surveys is not possible. Thesecond limitation is the number of responding countries: 31of the 47 (66%) countries of The Council of Europe. Datawere not available for 16 European countries, mainlybecause it was not possible to identify any correspondent tofill in the questionnaire in 14 countries. The response rate isstill satisfying, considering that 31 of the 33 countries(94%) with an identified correspondent returned thequestionnaire and that all the main European countriesare represented, except for the newly constituted RussianFederation. Because numerous small European countries,which did not answer the survey, do not have any medicalschool, it is important to stress that the present surveyincludes 288 of the 353 European medical schools (82%).The third limitation is related to terminology; differences inlanguages, healthcare systems, and university structuresmake some of the 2006 survey outcomes somewhat equiv-ocal. Respondents from a few countries had difficultiesin answering some questions because of these differences interminology. The fourth limitation is related to the ever-changing organization of the world of medical education;although this survey reflects the situation in 2006, aspects insome countries will have inevitably already changed sincethe survey was completed.

CONCLUSION

Comparison of this present European survey with the 1991survey testifies to major progress in geriatric education,which is more frequently recognized as a specialty withinmedical schools that have established chairs. Undergradu-ate and postgraduate teaching activities are increasing,improving geriatric knowledge and facilitating medical stu-dents’ exposure to the oldest and most disabled of patients.CME is becoming mandatory in many European countriesfor validating practice within the specialty, but efforts topromote a stronger profile for geriatrics have to be rapidlyincreased, as does cross-specialty training and the useof new educational technologies to meet the medical chal-lenges of a longer life.

ACKNOWLEDGMENTS

We are extremely grateful to the designated respondentsfrom all the countries of Europe for their full responses andcooperation with this survey.

We acknowledge Mrs. Margaret Piggott for her helpfuleditorial review of the manuscript.

Conflict of Interest: The editor in chief has reviewed theconflict of interest checklist provided by the authors and hasdetermined that the authors have no financial or any otherkind of personal conflicts with this manuscript.

Author Contributions:

Jean-Pierre Michel: study concept, preparation of thequestionnaire, sending the questionnaire to each countrycontact person, gathering the answers, analysis, and writingof the manuscript.

Philippe Huber and Alfonso Cruz Jentoft: preparationof the questionnaire, completing the list of contact persons,contributing to the data analysis, and contributing towriting the final version of the manuscript.

Sponsor’s Role: No sponsor.

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Europe-Wide Survey of Teaching in Geriatric Medicine