Geriatrics for juniors: tomorrow's geriatricians or another lost tribe?

BACKGROUND: To meet the needs of the ageing population, more geriatric medicine doctors are required. We aimed to determine: (i) career preferences of junior doctors with an interest in geriatric medicine, (ii) factors influencing the likelihood of junior doctors undertaking a career in geriatric medicine and (iii) whether a geriatric medicine conference for junior doctors influenced their views on the specialty and their likelihood of choosing it as a career option. METHODS: All delegates who registered to attend the 'Geriatrics for Juniors' conference (G4J) were invited to complete both a pre- and post-conference survey online. Delegates' free-text responses were subjected to thematic analysis. Differences between paired ordinal data from pre- and post-conference surveys were determined using the Wilcoxon signed rank test. RESULTS: A total of 108 delegates attended G4J. Pre- and post-conference survey response rates were 67% and 51% respectively. Commonly reported deterrents to a career in geriatric medicine included 'being the medical registrar' (27.1% of respondents) and 'second-class specialty' (20.6%). There was a statistically significant difference between pre- and post-conference responses, with a tendency towards less agreement with the statement 'the prospect of being the medical registrar puts me off applying for higher specialty training in geriatric medicine' (Z=-2.512; p=0.012). CONCLUSIONS: The perceived unattractive nature of the medical registrar role may deter some junior doctors from a career in geriatric medicine. A lack of clarity regarding the nature of the specialty still exists. Targeted educational interventions, such as G4J, may positively influence junior doctors' perceptions of the specialty and the role of the medical registrar.

Effects of a single dose of cortisol on the neural correlates of episodic memory and error processing in healthy volunteers.

RATIONALE: Neuropsychological impairments seen in depression may be secondary to hypercortisolaemia. Repeated cortisol administration impairs episodic memory with an alteration in event-related potentials (ERPs) recorded during information retrieval. It is unclear whether such ERP effects are specific to episodic memory, or whether repeated cortisol administration is required. OBJECTIVE: To investigate the effect of a single dose of hydrocortisone on the neural correlates of episodic memory and error detection. METHODS: Twenty healthy subjects were treated with hydrocortisone (100 mg) or placebo orally, in a double-blind, two-way crossover study. ERPs were recorded during an episodic memory and a Stroop task, 1-3 h following the medication. RESULTS: Cortisol increased error rates during the Stroop task but had no effect on episodic memory. The magnitude of ERPs associated with incorrect response in the Stroop task between -250 ms and +500 ms post-response was increased by cortisol, with no effect on correct-response ERPs. There was no effect of cortisol on episodic memory-retrieval-dependent ERPs. CONCLUSIONS: Cortisol can impair not only episodic memory but also processes involved in error detection. In contrast to repeated cortisol administration, a single dose of cortisol does not alter the behavioural performance or the electrophysiological correlates of episodic memory. However, it increases error rates in a choice response task with associated quantitative changes in incorrect-response ERPs. This probably reflects an alteration in anterior cingulate cortex activity. Such changes may contribute to the neuropsychological impairment seen in depression. This study also demonstrates the utility of ERPs for investigating the effect of neuroendocrine manipulations on the neural correlates of neuropsychological function.