Job File: Geriatrician

As we approach the end of life, health problems multiply, and medical support becomes indispensable rather than necessary. The vast majority of our aînés then need dedicated and regular support from several health professionals. This is where the métier de gériatre comes into its own. He oversees all the care and treatment the patient needs. In this intimate and fragile period, during which the person is gradually losing capacity and autonomy, his or her role goes beyond pure medicine. It was therefore time to pay tribute to this professional through one of our métiers sheets.

What is a gériatre?

Geacute;riatrics is the medical specialty dedicated to the treatment and support of people with Alzheimer's disease. In this context, the médecin gériatre takes on the dual role of physician and carer, as he follows his patients throughout their end-of-life, developing a much more important relationship with them than that of the general practitioner with his patients. He adopts a transversal, multidisciplinary approach, in which he strives not only to heal, but above all to preserve the autonomy and quality of life of the patients in his care. In fact, he is the doctor of life, caring for all those who deserve to end theirs with dignity.

The gériatre's main missions

&Evaluate the overall state of health of the patient

The principal rôle of the gériatre is of course médical. From the very first consultation, this specialist must carry out a comprehensive assessment to better identify the patient's specific needs. This is crucial for making an overall diagnosis and anticipating possible changes. It must also: 

• Run a standard medical check-up
  
• &Evaluate cognitive functions
  
• Examining motor and sensory abilities
  
• Identify signs of dénutrition or hydration disorders
  
• Measure degree of autonomy
  
• Analyze psychological, emotional and social aspects

Implement personalized, multidisciplinary follow-up

On the basis of the assessment, the psychiatrist draws up an individualized care plan, mobilizing different professionals according to the problems identified. Depending on needs:

• Propose appropriate therapeutic protocols for the patient
  
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• Coordinating the intervention of a multidisciplinary team
  
• Implement regular monitoring to adjust treatments
  
• S’ensure proper compliance with treatments
  
• Adapting the patient's living environment with the support of an occupational therapist
  
• Organize pain management and, where appropriate, integrate palliative care
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Preventing loss of autonomy and coordinating care

Prevention is a fundamental focus in geriatrics. It's not just a question of treating illnesses, but of preventing the deterioration of the general state of health. The psychiatrist can therefore: 

• Prevent the risk of falls (assessment of balance, prescription of muscle strengthening exercises)
  
• Provide nutritional monitoring
  
• Detect cognitive or pressive disorders early
  
• Coordinating care between different levels of intervention
  
• Work with homecare services and social welfare institutions
  
• Guiding families through the démarches d’orientation

Training to access the specialty of geriatrics

Études générales de médecine

Before entering higher education, the aspiring gériatremust obtain a scientific baccalaureate. Once this has been completed, students wishing to pursue health studies can choose between two options:

• Le Parcours Accès Santé Spécifique (PASS)

• Introduced in 2020 to replace the former Premiée Année Commune aux Études de Santé (PACES), the PASS is a year of study combining a health major; é a minor from another discipline. This structure makes it possible to diversify skills and offer avenues for reorientation.
• Students are assessed on the basis of continuous assessment and final exams.
• Those who succeed can enter the health sector.
• Those who fail can reorient themselves towards their minor's field of study before, if they wish, trying their luck again.
• The PASS approach relieves the pressure associated with the former PACES competitive entrance exam, while diversifying the student's skills.

• La Licence avec Accès Santé (L.AS)

• Introduced in 2020 in order to diversify the training offer in health studies, the L.AS is a program combining any major (law, humanities, economics, etc.) with a specific health minor (biology, physiology, etc.).
• At the end of the first, second or third year, and if they have passed the minimum requirements, students can apply for health studies. They then sit specific examinations. Depending on their performance, they may be rejected or admitted to the second year of medical school.
• The L.AS enables students to follow a diversified pathway, promoting skills and orientations.
  

After the PASS or L.AS (see above), general medical studies are divided into two diploma sections: 

• Le Diplôme de Formation Générale en Sciences Médicales (DFGSM) : three-year curriculum (the PASS and L.AS count as the first) consisting of theoretical courses in medical sciences and clinical internships in hospitals.
• Le Diplôme de Formation Approfondie en Sciences Médicales (DFASM) : A direct continuation of the DFGSM, this is a three-year course of study that includes specialized courses and advanced internships in various hospital departments.

Éend-of-clerkship proofs 

During the final year of the second cycle, students must pass a battery of tests which, depending on their results and rankings, will enable them to formulate vœux de spécialit; mais également de ville. Here's the list: 

• Épreuves dématérialisées nationales (EDN): these take place in October and count for 60% of the final grade. In order to pass, students must obtain a mark of 14/20 or higher in the thematic knowledge required by all doctors, regardless of their specialty.
• Examens cliniques objectifs et structurés (ECOS): these are organized in May and count for 30% of the final grade. They test students' ability to develop clinical reasoning and problem-solving skills. The minimum mark must be 10/20.
• Academic progress grade: this continuous assessment takes into account the student's commitment, curriculum, mobility and level of English, and accounts for 10% of the final grade.

Spécialisation en gériatrie

Once the études générales de médecine completed, students specializing in geriatrics enter a five-year internship. This course is divided into theoretical and practical training:

• Training théoric : interns follow théoric courses covering the various aspects of gériatry. They take part in seminars and conferences to keep abreast of the latest advances and research in the field.
• Training practical : gériatry interns participate à l’activité de divers services de santé.

In addition, the gériatrie intern must write and defend a thesis in order to earn a doctorate. Upon completion of this specialization, the intern obtains the Diplôme d'Etudes Spécialis;es en Gériatrie (DES).

Further training

After obtaining the DES in gériatrie and registering with the Ordre des médecins, a gériatre can continue training to become more specialized in specific areas of gériatrie. These specializations enable you to deepen your skills and gain access to even more rewarding professional opportunities, while offering high-quality care to specific populations. This also enables the gynaecologist to stand out on the job market by promoting his or her know-how and expertise, and therefore better gynaecologist job offers.

The skills required to become a gériatre

Medical expertise in age-related pathologies

The gériatre must maîtrise the whole range of chronic affections fréquentes in seniors : cardiovascular disease, cognitive disorders (particularly Alzheimer's disease), osteoporosis, diabetes, cancers, neurodegenerative diseases, as well as heart, respiratory and respiratory insufficiencies. He is also trained in the management of specific geriatric syndromes: polymodality, falls, incontinence, weight loss, masked pressure, and loss of functional autonomy.

This expertise requires a solid ability to assess clinical complexity, identify drug interactions, prioritize interventions and adapt treatments to the patient's frailty. In addition, knowledge of standardized geriatric assessment (EGS), pharmacology adapted to the individual, palliative care and the ethics of care are valuable assets for these specialists.

Capacity for listening, patience and communication

Working with patients requires great human qualities. Courtesy, patience and the ability to establish a climate of trust are essential to understand patients' often implicit needs, explain pathologies in an accessible way and reassure in the face of uncertainty or loss of autonomy.

The geriatrician must also know how to manage relations with families, who are sometimes worried, disappointed or in disagreement with medical choices. Intelligence, pedagogy, moderation and conflict management are therefore essential human qualities for success. You also need to know how to spot signs of psychological suffering or social isolation, which are sometimes expressed in a disconcerting way by people who are being cared for.

Teamwork with other health professionals;

Geacute medicine is based on a comprehensive, multidisciplinary approach. On a daily basis, the medical specialist collaborates with a variety of professionals: nurses, care assistants, physiotherapists, occupational therapists, psychologists, speech therapists, dieticians, social workers and medical specialists.

He coordinates care, organizes team meetings, participates in the development of personalized care projects and the planning of health care pathways, whether in the city, the hospital or EHPAD. This collaborative work requires skills in inter-professional communication, complex case management and organization. It therefore requires the ability to fédér, to déléguer intelligently and to maintain a patient-centered vision.

The gériatre's conditions of practice

Practice settings: hôpital, EHPAD, libéral

The geriatrician can work in a wide variety of settings, each involving different missions and rhythms. This variety reflects the cross-disciplinary nature of geriatrics and the need to ensure continuity of care between the home, medical-social structures and hospital establishments.

• À l’hôpital, the gériatre is involved in several types of services:
  
  
• Unit of acute medicine (MAG)
  
• Geatric short stay units
  
• Service de soins de suite et de réadaptation (SSR)
  
• Cognitive-behavioral units (CBUs)
  
  
• In EHPAD, its role focuses on medical coordination, long-term follow-up, prevention of complications and support in end-of-life situations. He/she may be a coordinating physician or provide ad hoc support to care teams.
  
  
• En libéral, the gériatre follows patients in consultation, at home or in an institution. He or she may practice alone, in a group practice or within a multi-professional home or health center, which encourages exchanges with other practitioners.

Schedules, working hours and on-call time

The conditions under which a gériatre practices vary significantly depending on the setting chosen:

• À l’hôpital, the pace is generally sustained. Gynecologists take part in on-call duty, which requires them to be present outside normal working hours, including nights, weekends and public holidays. Care organization is often based on protocols, multidisciplinary team meetings and emergency response.
  
  
• In libéral, the organization of time is more flexible, but the workload remains heavy, notably due to:
  
  
• Home or institutional visits
  
• Administrative management
  
• The availability required for prolonged, individualized patient follow-up
  
  
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• In EHPAD, the rhythm is more regular, but the doctor can intervene in emergencies or adjust care frequently according to the resident's clinical condition. Daily presence is often required to ensure care coordination and liaison with the teams.

Relations with families and caregivers

The gériatre never intervenes alone: it works in a complex human and motional écosystème, where close caregivers play a fundamental role. The relationship with families is a central aspect of geriatric practice. It involves several dimensions:

• Inform: explaining the pathology, its evolution, the treatments envisaged and their effects. This requires an adapted and often repeated approach, particularly in the case of cognitive disorders in the patient.
  
  
• Support: recognize the moral or physical exhaustion of caregivers, offer support (home help, day care, temporary accommodation) and refer them to support services.
  
  
• Involve: involve caregivers in the care project, gather their opinions, value their role, while helping them to step back when necessary.
  
  
• Accompanying: in situations of loss of autonomy or end of life, the gériatre must be able to adopt a posture of eacute;coute, médiation and humanité.

In résumé, the métier de gériatre is perhaps the medical specialty that most intimately combines care and humanité. It is therefore a career that is as complex as it is rich, and one that demands total dedication on the part of the doctor to the care of those in need. As Western society ages, this speciality takes on considerable importance for our health professionals.

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