Implementation of geriatric education into the first and second years of a baccalaureate-MD degree program

As the population ages with an increasing standard of good health, medical students must redefine their views on aging and their approaches to aging and medicine. Consequently, the UM-KC School of Medicine has introduced an innovative approach to geriatric education. The approach seeks to help students view aging as a multidimensional process, challenge stereotypes about aging, learn about factors in healthy aging, and explore medical conditions of older patients.

To fulfill these objectives, each first- and second-year medical student (n = 200) in a six-year BA-MD degree program is paired with a mentor on aging. The mentor is an older adult living independently and experiencing normal psychosocial issues of aging without major medical problems. Over two years, students converse with their mentors about aging, keep journals reflecting on their conversations, complete projects with their mentors, and write scholarly papers. Thus, students can experience aging through their mentor relationships, gain an appreciation of their mentors' lives, and sharpen communication skills. In small groups, students and a physician-facilitator discuss problem-solving exercises keyed to American Geriatrics Society competencies and participate in an empathic aging exercise. Students also attend lectures on the care of older women and primary prevention.

Assessment of students' performances is ongoing. Mentors have rated their students positively for being interested in them, being good listeners, and being eager to learn. Facilitators have rated most students highly for small-group participation. Instructors have reviewed and commented on student journals that suggest students have changed their stereotypes about older adults and appreciated the uniqueness of their mentors' lives. A performance-based assessment of the students' abilities to elicit life histories from senior volunteers will be administered halfway into the second year, and the scholarly papers will be critiqued at the end of the second year. Program evaluation is also under way. A pre-test of knowledge and attitudes showed students had little knowledge of the aging process, held negative stereotypes of older people, and preferred to care for younger patients. After-measures will be administered at the close of the second year. Evaluating their experience, mentors have said their interactions with students were enjoyable and beneficial to both parties. Students, while initially hostile because the program shifted their focus from sickly to healthy older adults, have found the evolving bonds between them and their mentors to be a benefit of the program. They believe that the most important lessons learned involved seeing the vitality and courage of older adults and improving their communication skills. Nevertheless, students feel they need more training in leading conversations and conducting interviews. Structured communication training will be added as the program continues to be a required part of the curriculum. Students have also thought the problem-solving cases should be more medically focused. While cases in the second year will emphasize medical aspects of aging, the cases in the first year will continue to explore psychosocial issues. Finally, to highlight psychosocial issues of aging, a session will be added utilizing a panel of older adults to provide examples and insights and to answer questions.