Baylor College of Medicine

Geriatrics and Medicine’s Next Generation




[Intro Melody]

Juan: And welcome to the Baylor College of Medicine Resonance Podcast. My name is Juan Carlos Ramirez, I'm one of your hosts. 

Aaron: My name is Aaron Nguyen, and I'm also one of your hosts and the lead writer for this episode.

Shubh: My name is Shubh, and I am the sound engineer for this episode. 

Juan: Awesome. Well, welcome guys. And today, we are going to be interviewing Dr. Angela Catic. So, could you tell me a little bit more about? 

Aaron: Yes, so Dr. Catic is a geriatrician here at Baylor College of Medicine. I can tell you a little bit about her biography. She earned her MD from the University of Missouri, Columbia School of Medicine in 2003, and she completed her residency in Internal Medicine at Beth Israel Deaconess Medical Center in 2006 as well as a fellowship in geriatrics at Harvard's combined geriatrics fellowship program in 2007. In addition, she's earned a master's in education from the University of Houston in 2019. And we'll talk about that later in the episode as well. And then, she has also previously served as the director for the geriatrics fellowship, as well as the geriatrics physician assistant program here at Baylor. She currently serves as associate professor at the Huffington Center on Aging here at Baylor and is the associate chief of staff for education at the Michael DeBakey VA Medical Center. She's also the co-PI for the Southeast Texas Geriatric Workforce Enhancement Program. It's a five-year program focused on geriatric interprofessional education in primary care in Houston and the greater Southeast Texas region. And so, today’s episode is focused primarily on medical education and geriatrics, and particularly how medical education serves as an intervention to solve some of the challenges or opportunities in geriatric medicine, including physician shortages and a rapidly growing population of older Americans. 

Juan: Yes, and as we know, this is going to become more of a challenge, as the population ages in the coming years, and it really comes down to us to really do our best for this population, medically and in our communities as well. I mean, it seems like as you know like many other faculty that we interview on this podcast that Dr. Catic wears many hats. So, is there anything that particularly stood out to you that you were like, “yes, we have to interview her for the podcast.”

Aaron: Of course. So, I've actually worked with Dr. Catic for a couple years now, and I'm always impressed with how many hats she wears. I think that it's really special because, as a geriatrician, I think that you have to wear a lot of these hats in order to effectively care for your patients because there isn't a lot of infrastructure in place to care for older patients. And so, just for some context, geriatrics, I think that it’s something that's very intuitive for people. thinking about caring for older patients, but the reality what it looks like can be very different. And so I think, when we think of like the “cutting edge of medicine,” we think of something out of Sci-Fi, something like genetics or like robot surgery.

Juan: Implanting electrodes into people’s brains.

Aaron: Of course, of course. But geriatrics, I think in my opinion, is very much on the “cutting edge of medicine” because, at no other time in human history, have people been able to live this long. And so, we've kind of created these opportunities for people to live in these advanced stages of life, but we haven't really written a script for how that can play out and how we can support these people. 

Juan: And not just help them live longer, but help them have a good quality of life as they age into the later years. And so, all of this sounds very exciting, and I think I'd love to as well as our audience, we'd love to hear more about Dr. Catic. We can scoot on over to the episode. 

[Interlude Melody]

Juan: And welcome back. We are here with Dr. Catic.

Aaron: Hi Dr. Catic, how are you doing today? 

Dr. Catic: I'm doing well. Thank you so much for having me. 

Aaron: It’s a joy to have you. Maybe let's start with a little bit about your background. Can you tell me a little bit about your journey to medicine?

Dr. Catic: Happy to do that! So, I've always had an interest in medicine. Growing up, I was very close to my grandparents. I'm an only child, so I spent a lot of time kind of hanging out, enjoying their company. And I had an interest, I thought in caring for older adults. I explored that a bit more in high school by volunteering in a nursing home, and by the end of high school, I was quite committed to a career in medicine and particularly having an interest in geriatrics. 

Aaron: That's really great. I think, in my experience talking to some geriatricians. it's especially a big source of inspiration, is the loved ones that we have. And it's really good to hear that you have loved ones as well who you have cared for and who inspired you to come to geriatrics. Is there a particular moment where you think that you thought, “hey, geriatrics is the way, particularly being a doctor, is the way that I can care for older adults the best?.”

Dr. Catic:  I think it was a couple of factors. Number one, just enjoying the company of older adults, enjoying hearing their stories and learning from them, and just the wealth of wisdom that they bring to the table. But then, once I got to medical school, it became much more real, much more tangible. And I have to say, I enjoyed all of my rotations. I didn’t have the problem of not enjoying. In fact, I was a little worried how to narrow down, because I liked everything. But, I just kept coming back to that patient population and also realized I enjoy the academic challenge. Oftentimes with older adults, it's not black and white. They don't follow our evidence-based guidelines, and I really found that something that was intellectually stimulating, And something that I thought I would enjoy doing for many, many years. It wouldn't get old. 

Aaron: Yes, that sounds great. I mean geriatrics is so, so interesting. I don't think that many people really truly understand what a geriatrician does. You kind of have to be a little bit of everything for your patients in order to advocate for them. Can you give us a little bit of background? What is, in your opinion, what is geriatrics, and what does being a geriatrician kind of look like? 

Dr. Catic: I think that's a great question. And if we were talking a decade ago, we probably would have been talking about an age. Typically, taking care of older adults, 65 years of age or older, and that really has changed over time. I think of my dad who's in his mid-70s who really doesn't need a geriatrician. Thankfully, he's quite healthy. And so, we moved away from that number, and we think much more about complexity. As I'm sure you're aware and many of our listeners, people are living longer life spans, and they're living with larger numbers of chronic illnesses. So in geriatrics, we’re really thinking about providing care for the most complex individuals, and unfortunately, that could be somebody in their 50s who has a multitude of chronic illnesses, who perhaps has some functional or cognitive impairment. And, we have many people in their 80s and even in their 90's who are working part time, they're very physically functional. And while it would be great for them to see a geriatrician, given the shortage, they don't really need to because they’re thriving and can be well served by a primary care provider. 

Aaron: Yes, that's very important, and I think that people might think of geriatrics is very intuitive that it's based on age, but it's actually very complex about the way that we're able to care for older people, and older might be different for different people. The advanced stages of life are still kind of being defined a lot, and I think that that's something that is going to be really a big challenge in our generation, in caring for older patients in the future. And so, it's really great to hear that from you. So ,what are some of the most pressing issues in geriatrics? You've mentioned that there's the complexity and the shortage of geriatricians, and I think that that's something that we're definitely going to need to address in the coming years. But, is there anything in particular that you think is going to be coming over the horizon for caring for our older adults in our society? 

Dr. Catic: I really like to think of it as a time of opportunity. For the first time in history, we’re moving from a pyramid, so if you think of the base of the pyramid, always we've had more younger individuals and the tip of the pyramid has been our older adults. And so, for the first time in history, we will actually be a pillar. We’ll have as many older adults as younger adults, which, of course, brings lots of opportunities, but also some challenges. So, I think the things that were really considering in geriatrics, as we mentioned, there will never be enough board-certified geriatricians to care for all older adults. And really, that's okay. So, I think one way we can think about this, and Dr. Rosanne M Leipzig and colleagues have written about this, is “Big G versus little g.” So, with a “big G,” we can think of a board-certified geriatrician, and these are the people who perhaps are seeing the most complex older adults, or they’re leading policy change around caring for older adults or leading educational and research efforts. And then really, we want everyone in medicine to be “little g” geriatricians. So, while they may not have a formal fellowship or advanced training in geriatrics, making sure that they have a strong base of knowledge and have those core fundamentals to provide appropriate care for older adults. 

Aaron: That's really great. I love that pivot that you did with talking about opportunity rather than challenges, and I think that that's something looking to the future, how we should really see this topic, is that there are a lot of opportunities that we’re able to empower people and support people in the future, and so I thought that that's really great. In particular, I think that you're talking about training the next generation, and I think that one really great thing that Dr. Catic has worked with a lot, is in medical education and really investing in training that next generation of both “big G” and “little g” geriatricians. And so, one thing about Dr. Catic is that she went back to school to get her master's in education at the University of Houston. And so, I was just wondering how that experience was for you? I think that we talk about medicine being… To be a physician, you have to be a lifelong learner, and you really put that into effect in going back to school. So, how is that experience, going back to school a little bit later and using those skills?

Dr. Catic: It was really wonderful. I've always enjoyed being a student. I didn't know that it was something I would return to almost two decades after medical school. But, I really believe that we have to keep learning, and to be the best medical educator I could be, I wanted to pursue more formal training. I come from a family of educators. I recognize that, to teach, we need to be trained to do that. In medicine, we have often had this theory of “see one, do one, teach one,” but unfortunately that does not bring to bear standards of curriculum design or thinking about how you evaluate your learners. And, I really wanted to have a deeper understanding of that, and I have to say I enjoyed the program very much. I found it very valuable. And I graduated in December 2019, so shortly before COVID, and there was a large focus in the program on using technology in teaching and I never dreamed how important that would become only a few months later when everything went virtual. So I felt very very blessed to have that experience before pivoting to virtual education. 

Aaron: That's good to hear. I mean, we're all kind of adjusting, of course. This is one of the challenges of the pandemic is that now we're transitioning to more kind of a distanced, virtual, asynchronous kind of teaching. And so maybe, can you tell us a little bit about how you utilize those technological skills in translating in your work is as the geriatrics fellowship director earlier and then now transitioning to your new role at the VA as a chief of staff there? 

Dr. Catic: Absolutely. I think COVID is hard to find a silver lining, but for me if there one, it probably is our increased use of technology in education. And in hindsight, we could have been doing this all along, but I think it just didn't occur to us. So I'll take geriatrics as an example to start with. Geriatrics is a relatively small community. Really across the country, most of us know each other, and yet it had never occurred to me that I could ask my colleague who lived across the US and was an expert in a particular area to teach my fellows via Zoom or a similar platform. It just never occurred to me before the pandemic. And so, I think one of the best things that has come out of that is this wealth of experts that we are able to tap into, who teach our fellows, who teach our residents, and are able to do that virtually. So, they can do it inexpensively; it doesn't require them to fly across the country. And it also allows us to bring different groups of learners together to hear these experts in the field, which is really special. In geriatrics in particular, some individuals formed something called “Geri-A-Float” where they actually have geriatric fellows from across the United States come together for education on a regular basis. And again, an opportunity we probably would not have thought about or pursued at least for several years unless we were kind of pushed to do so for COVID. And then in my role at the VA, I'm an associate chief of staff for education. We're continuing to implement a lot of this technology, even as we try to get our feet under us and find whatever this new normal is going to be. I don't think we're going to get rid of the virtual education entirely. We're seeing a lot of hybrid, which is great, because for trainees, if we want to think about them who happened to be at the VA that day, yes, they can come down to the auditorium and that speaker may be there in front of them. But if we have trainees at out at our community-based outpatient clinics or trainees at the other pavilions, who just have an interest in that topic, they're able to call in via Zoom. So I think it really has just added to the opportunity that we all have for education, and I know it's something that I found very valuable and I think my trainees have as well. 

Aaron: Yes, that’s wonderful to hear. I mean, I've actually worked with Dr. Catic on that Geri-A-Float project with our colleagues at Yale. And what a great opportunity because, going back to earlier when you were talking about everybody having a general education in geriatrics, especially making things more accessible in terms of technology, making sure that if you are, for example, a surgeon or an internist that you're able to still get those kinds of resources in caring for your older patients. I think that that's something that I'm glad to hear about your work in that and be able to help you with that as well. So, kind of circling back to medical education as well, what do you think the role of education plays in addressing some of the particular challenges in geriatrics? We've talked about physician shortages, geriatrics shortages, but maybe let's talk about a little bit about your work with the geriatric PA program. I think that that's something very interesting and kind of a novel solution that a lot of specialties that might have some shortages might implement in the future as well. 

Dr. Catic: Yeah, happy too. We are really lucky to have an amazing PA program here at Baylor. They have just amazing, trainees go through, and they have been very supportive of geriatrics for many years. So having a core geriatric rotation is not required nationally for PA schools, but it's something that Baylor has had for decades, and we are lucky enough to have all of the PA’s spend 4 weeks doing geriatrics with us at the VA. So right there, a shout out to them and really making sure that they have this exposure to geriatrics. We have taken that a step further at the Michael DeBakey by having the first geriatric PA residency program in the United States. So as I'm sure many of our listeners know, PA’s do not necessarily need to pursue a residency, like you would once you finish medical school, but it is becoming more common. So these are individuals who would have graduated from PA school but then would spend a year with us doing a residency focused on that complexity that we talked about earlier. So not only seeing older adults in the geriatric clinic, but seeing them in our community living centers, on the floors in the hospital, doing a variety of different electives including geriatric mental health, hospice and palliative medicine, so really a deep dive into that complexity. And, you know, I think this has a couple of roles. Number one, it just makes them more facile, more comfortable in caring for complex older adults, and I can tell you our graduates go into these fields that are high in complexity: spinal cord injury, caring for individuals with HIV and AIDS. So not necessarily geriatrics, but very complex. But secondly, there's a lot of them who do choose to go into geriatrics, and we recognize that training people like PA colleagues in geriatrics could be very helpful in helping to negate that workforce shortage and just spread that geriatric knowledge in a variety of care settings. 

Aaron: Yeah, that's really great. I mean, we really need allies everywhere, right? And so, it's really great to see that concrete work in investing in the education and the training of allies. And the PA’s, I’ve worked with the PA’s that you've trained and their exceptional people as well. They've obviously very caring and very passionate about geriatric advocacy. And so, it's going to take a lot of a lot of people in order to capitalize on these opportunities in geriatric advocacy. And so, it's great to see that kind of work coming through. Maybe, can we talk a little bit more about, so you previously have served as the geriatrics Fellowship director and then the geriatric residency for the PA program. And now, you’ve kind of transition to a new role as associate chief of staff at the Michael DeBakey VA Medical Center. What kind of initiatives do you think you're going to try to integrate and initiate in that new role? And how does geriatrics fit into that that role? 

Dr. Catic: So the associate chief of staff for education at our VA oversees both trainee as well as staff education. So it's a big umbrella, and I'm lucky to have some wonderful mentors as I get my feet on the ground. And I think, where I really want to increase visibility of our education service line that this falls under, is highlighting all the good educational work being done at the VA. Baylor does an amazing job highlighting the academic work of both their trainees and their faculty, and we have some equally amazing work at the VA and we want to make sure that that is recognized. So one example is in March of this year, we are going to be hosting a first annual education day. We are going to be having a poster session and giving out some prizes in various categories, including undergraduate medical education, GME, as well as for our associated health trainees. We're going to be bringing in some great speakers on education and QI topics. And I'm really looking forward to making that a robust annual occurrence to highlight that good work being done. In terms of geriatrics, as much as I would love to bring geriatrics to everything, my role here is really thinking about education across the board. I think where geriatrics does come to bear is in Age-Friendly Health Systems, which we know is a national Initiative for the VA. So Age-Friendly Health Systems were developed in concept in 2019, by a group of organizations, including the Institute for Healthcare Improvement and the John A Hartford Foundation. And really, this goes back to what we were discussing earlier the recognition that our population is aging, and we are never going to have enough formally trained geriatricians. So they said, “we want to make sure that every older adult, no matter who is seeing them in, and no matter what setting of care they are in, is receiving an excellent geriatric base to their healthcare.” And so, age-friendly systems of care are centered around what we call the 4Ms. Not candy, but the 4M’s of what matters, mentation, medication, and mobility. And we know that if those areas are covered in the care of older adults, we are covering a good portion of what's really important for them. And most importantly and what I would really like to highlight is that “what matters.” So it's by talking with the older adults and their caregivers, understanding what matters to them, and then aligning their health care to support that we can really improve the outcomes that matter to that individual in front of us. And so, this is something, it’s growing within the VA, it's an initiative within the VA, and I look forward to supporting that in my new role, as much as possible, as it really rolls out from geriatrics to our other specialties. 

Aaron: Yeah, that’s really great to hear. I mean, especially the implementation of age-friendly, I think that that's something that, across the nation and around the world, I think is something that is going to continue to progress and to develop. And so, could you talk a little bit more about your ideas about “what matters” and how you hope to help clinicians, hope to help just anybody who's around older patients to address that part of caring for older adults? 

Dr. Catic: Absolutely, so I like to tell trainees, if I have a room of trainees, I tell them, if I look at all of you and if you're in your mid-20s or your early 30s, you probably have very similar goals for your healthcare. You want to live long, healthy lives. But if I have a room of 85- or 90-year-olds, we could have as many different responses for what's important to them and what they want to get out of their healthcare, as there are individuals in the room. So, this is really turning how we think about medicine a bit on its head. We've all been trained to think problem-centric, think of an assessment and plan in a note: hypertension, dementia, diabetes. We really want to change that line of thought because, with our older adults, especially as they're living with more and more complex and chronic illness, we have to understand what's important to them. And we use a framework called Patient Priorities Care to do that that was developed by several geriatricians including Dr. Aanand Naik who was previously at Baylor College of Medicine, he's now just across the street at UT. But this framework walks us through, as we meet with an older adult, how to elicit their values. We know that each of us as human beings have core values that make us who we are. So we actually talked to them about values and from those, we work with them to craft a specific reasonable and actionable goal. I'll give you an example, so this isn't quite as intellectual here. So I may find out that the patient in front of me really values their relationship with their wife and remaining as independent as possible. And as we talked about that, that individual may say to me, “I would really like to be able to take a 20-minute walk with my wife, every day in the morning. It's time for us to be together. It's equally great because I get some exercise, which helps me remain independent, but I really want that time with her.” And then, I'm going to talk with that individual about what in their healthcare right now do they find helpful, what do they find burdensome, and I'm going to really be thinking about what changes do we need to make to help support that goal of taking that daily walk with their wife. So this person may say to me, “I find it burdensome to take a lot of medications. I find my rollator helpful because it gives me stability. And if I get tired when I'm out walking, it has a seat and so I can sit down and rest.” And it may be that this individual in the past has said, “I don't really want to do physical therapy. I don't know how that's going to help me. I already take walks.” But I think maybe they could benefit from some lower extremity strengthening and gate training. So with Patient Priorities Care, I think, “okay, I'm going to try to align their care with this goal of walking with their wife on a daily basis. And I'm going to use that in my communication with the patient.” So I could say, “Mr. Smith. I understand you want to take a daily walk with your wife, and I'm so happy that your rollator is helpful to you. But, you're still having some lower extremity weakness, and maybe some pain. I know you want to minimize your medications, but could we talk about trying some scheduled Tylenol, some scheduled acetaminophen, to see if that helps your pain, and would you be willing to do some physical therapy, which I know in the past you've been reluctant to do? But could we try that just to see if that helps you feel a bit stronger, with the specific goal of you being able to walk more easily with your wife.” And then when we see that individual back in the office, or we follow up on the telephone, we're not really following up to say, “how's the osteoarthritis in your knees, or how is your gate doing?” We're following up to say, “have you been able to take that walk with your wife every day? How's that going? Has it gotten easier for you with these changes we made to your medication regimen?” So that's really how you can think about and implement what matters for an individual and align their medical care, not around their diseases, but around what's most important to them.

Aaron:  Yeah, that's wonderful. I mean, what matters I think is a concept that is very attractive as well because it can really allow everybody to be part of that medical decision process. Sometimes it's hard to know exactly what dementia is doing in your life or how hypertension might be affecting your life. But putting in very human terms about going on walks, being with your wife, being with your family, I think that that's something that everybody can have access to. And, I kind of suspect that many of our listeners might have some loved ones who are older adults in their own lives, and so, do you have any suggestions on how our audience might be able to implement these ideas in their own lives and really support that kind of age-friendly care for their loved ones? 

Dr. Catic: Absolutely. So, I mean, it can really start out just as a conversation. This is really a human conversation before we get to the aligning, the medical part. This is just a human being saying to another human being, “I want to know you as a person. I want to know what's important to you” and having that conversation. If the listeners would like something to guide that a bit more formally, they do have a website through Patient Priorities Care called “” And older adults and their loved ones can go there, and it actually will walk you through the process of thinking about “what are your values? What goals do you have related to these?” And this is information that, of course, you can have for your own use, but what we would really encourage you to do is bring that and share that with your medical providers, so they can take it that next step and align care based on what's important to you. 

Aaron: Yes, I think that's great because, as a caregiver, as a somebody who has somebody who is older in your life, you are really a big role in their life as well. And so, it's a team effort, especially in geriatrics, when things are a little bit more complicated. Everybody needs to be able to have hands-on so that you can really support older adults, the best way possible, and so, it's good hear. 

Dr. Catic: Yeah, and surprisingly, Aaron, some caregivers have had real revelations as we've had these conversations with older adults, you know, we think I'll speak for myself. I think I know my parents. I think I know what’s important to them, but when you actually stop and ask, you can be surprised, you can find out something that maybe you didn't realize was such a priority to them. And I think that's helpful, obviously for caregivers. I think it also makes sure that all the medical providers are aligned and on the same page, especially in this day and age where people have a primary care provider, but they can have a whole list of different specialty providers. And of course, with our older complex adults, we like to say they weren't included in most of the studies, and so having that to go back to that foundation of what's important can really help bring together colleagues across the discipline to know what we're focusing on with that particular patient. 

Aaron: Yes, that's very good too because I think that maybe some of our listeners might have older patients, older adults in their lives, who have gone through healthcare or some sort of challenges with that. And so, it's very frustrating when you're entering these healthcare settings that you have a cardiologist telling you one thing and you have pulmonologists telling you another thing. And, really having this grounded work that is very accessible about what matters most of the patient to streamline medical decision making can be very powerful and very important to the overall well-being of an older patient. It's something that I think that will be very important going forward and caring for older patients, so it's really great to hear your work at that and your perspective on that. So, I think that we're transitioning more towards your work as a Co-PI in something called the Southeast Texas Geriatric Workforce Enhancement Program. It's SETxGWEP; it's a mouthful, but that's some work that really addresses a lot of what Dr. Catic has been talking about the Patient Priorities Care, and then also a lot of different aspects of geriatric advocacy. So could you share a little bit about your work with them and how that came to be? And then, maybe a little about your goals with your work with that?

Dr. Catic: So, the Geriatric Workhorse Enhancement Programs are founded by HRSA and supported through that funding mechanism, and we are lucky in Texas to have two “GWEP’s” as we call them. Most states only have one, but these are scattered across the nation. They are five-year educational grants and the focus for this grant cycle was really building and spreading geriatrics in primary care. And one of the main means that we're doing that is by helping our primary care partners implement Age-Friendly Health Systems, like we have been talking about. But, this is a collaboration. This brings together academic partners throughout Houston, a variety of primary care sites, as well as really critical community partners, including Care Partners and the Montrose Center. I'm not going to name everybody because I would end up leaving people off the list, but it has been a wonderful collaboration, and as you mentioned, has several different initiatives in addition to Age-Friendly Health Systems, which is based on Patient Priorities Care for our what matters. We're also working with our dental colleagues to teach about and think about oral health. We have a huge focus on dementia, both Alzheimer's and other dementing illnesses. There's a geriatric mental health initiative. There's one looking at falls, transitions of care, and elder abuse. So it's a very broad reaching project, but I think the thing that brings us the most joy, where we're making the biggest difference, is touching trainees from a variety of specialties, practicing providers from a variety of specialties in all being able to learn from one another. So for example, my geriatric fellows, they learn from some of our dental colleagues over at UT, and in turn, I go over to UT and teach the dental students about geriatric concepts that are important for oral health. So that partnership, that back and forth has been really incredible. And we've been lucky to build these relationships, and I can see them continuing for many, many years to come. 

Aaron: Yes, of course. I mean, I think we talked about medicine as a growing team sport, but I think geriatrics is even further a team sport, and you really need everybody. SETxGWEP has really, I've worked with SETxGWEP myself, and there are a lot of people that come from across the community, case managers, social workers, everybody's kind of hands-on in order to ensure that you can provide the best resources for your patients. And so, let's say maybe some people in the audience, might be professionals, healthcare professionals might be engaged in the community and some sort of geriatric-adjacent way, how could they get involved in this kind of work and kind of advocate for geriatric patients themselves?

Dr. Catic: Probably the best place to start would be our website, I would encourage you to go there. We have a lot of resources, both for healthcare providers as well as older adults and their informal caregivers. So you can find information on Age-Friendly Health Systems, on opioid use an older adults, in oral health and older adults. The list goes on and on, so go check out those resources. And it also provides a link where you can contact us, and of course, if people would like to get involved, we would love to hear from them. As I mentioned, this is really a community and a growing community, and we are always happy to help build these new relationships. 

Aaron: Is there anything on the horizon coming for you? Anything that you'd like to share with the audience? Anything that is particularly interesting for you right now?

Dr. Catic: I think one thing that is interesting and that we're working on one of our colleagues Dr. Ali Asghar Ali is a real expert in cultural humility, and we are in the midst of looking at all our materials that we develop for the SETxGWEP and even going to our mission statement, to think we want to make sure that we have cultural humility built into that, that we are inclusive and what we are doing ,and that we're reaching the most high-risk populations of older adults in Houston and Southeast Texas. So, I see that as our next steps and something that we are starting a journey and we’ll be actively engaged, especially with our Community Partners who are much further along in this area, in many instances than we are in academics. So, we look forward to both learning from them and working with them as we enhance our diversity and inclusiveness within the GWEP.

Aaron: That's really great to hear because thinking about what matters most, I think that that encapsulates everything about what you are and who you are. And so having that cultural humility aspect, especially in healthcare is, especially important because you have to have an appreciation for that in order to make those decisions and understand that completely. 

Juan: No, we're great. And I think this kind of wraps up the whole, “we want to be able to take a very humanistic approach to geriatric healthcare across the system.” I think that part of the human approaches that understanding all things human, our daily needs, our values and then our background. So but with that being said, I think we're in good hands as we age. And just as a parting words or advice, is there anything that you think, is there anything that you think as medical students that we could do to facilitate the accomplishment of your mission? 

Dr. Catic: I think this generation of trainees, including medical students, but I'll be broader. I think you all are poised to practice medicine in a different way. You are poised to learn it thinking about that patient-centered care, thinking about “what matters” as the foundation, which is very different than those of us who trained a decade or two decades ago and learned and thought about patients from a very disease-based perspective. And so, this is what is going to move healthcare. This is what is going to change the care that we provide, not just for older adults, but hopefully, as we move a few years into this, and we become more comfortable providing this for older adults, for all of us, no matter our age. Wouldn’t it be wonderful when we go into a medical encounter, to have the provider talk to us about what's really important to us? How are things going at home? Are there things that we could do with our medical care that would support us in our roles as a mom, a wife, a doctor? I'm using myself as an example, and I think this generation of trainees is the one who is going to really build this and carry it forward. 

Juan: And we can already start to see some of those changes being implemented. You know, I think as part of the Baylor curriculum, we’re spending more time in the clinics. This is just through my experience. I tell the incoming class, the hidden curriculum that where you go and spend all this time and learn about the patients and learn about it in a story way, that is the critical part for you to learn to interact and talk in a very human way with patients, and that is what the really goes further than trying to memorize everything that you can and score the best score on an exam. It's the human side, right, that's really the driver of the best possible care I think. 

Dr. Catic: And I think this is a swing back. I think before my time, long before my time, it was a much more focused on the human interaction, on listening ,on the laying on of hands. And we didn't have the technology. And then we got the technology, and I think we went through a period where we were very technology-focused and spending more time looking at the scans and looking at the numbers on the computer perhaps than spending it with the patient. And now we're coming back. And of course, that technology is important. It has allowed us to progress, but we have to find a happy medium where we realize that that human interaction, that understanding of the human and front of us, is what is going to allow for exceptional medical care, supported by the technology, but using that technology thoughtfully and in alignment with what that patient actually wants. 

Juan: Absolutely. Well, with that being said, thank you very much for providing us this wonderful, human interaction, and thank you for your time. We look forward to hearing more about your accomplishments and what you do in the future. 

Dr. Catic: Thank you so much. It's my pleasure. 

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