By: Benjamin A. Bensadon, EdM, PhD, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center
Geriatrics is a tough sell. As our article in the November issue illustrates, the multiple factors contributing to its ongoing unpopularity are psychological, economic, cultural, and pervasive. Though daunting, especially as our nation’s population continues to live longer, I believe there are many ways academic medicine can (and must) help.
The clearest cause for optimism may be the upcoming expansion of the MCAT in 2015, the importance of which cannot be overstated. Incorporating psychological and behavioral science content may result in more diverse medical school applicants, and hopefully lead institutions to follow suit with their curricula. Training in related areas such as communication, psychosocial aspects of medical illness, and the team-based biopsychosocial model, are particularly vital to elder care. Our attempts to infuse these concepts into our curriculum included several notable examples that struck a personal chord with our 4th-year medical students.
One method for acquainting students with geriatric care is exposure to “cool elders,” a program where we invite older community members to share their personal aging experiences (medical and other). By carefully selecting speakers students could identify with, and facilitating informal, honest, and non-threatening dialogue, we created a learning atmosphere where students observe “evidence” that dispels stereotypes related to both aging and psychosocial aspects of illness. For example, after one presentation by a husband and wife team of 90 year olds, I asked the couple “OK, so you have all these future physicians sitting here, they’ll be practicing in a few months, what makes a doctor a good doctor?” The couple replied in unison, “TLC [tender loving care].” A few students smiled, others seemed surprised, all were engaged. The couple went on to add, “Oh you’ll get the diagnosis stuff, sure, that’s important, but we really need to know you care.”
In another example, a couple joked about their challenges with failing eyesight, reduced driving capability, and COPD self-management. The students were particularly moved when the man, diagnosed with emphysema 13 years earlier, said he had taught himself the harmonica in an attempt to improve his lung capacity. They also seemed disappointed when he reported most of his physicians were pessimistic about his prognosis. When he later adjusted his nasal cannula, pulled a harmonica out of his pocket, and played the students a song, their mouths dropped open in disbelief.
Opportunities to follow patients longitudinally, visit them in their homes, and experience intergenerational day care, all provided learners unique exposure to older patients’ challenges and capacity for resilience, a reality often distorted by aging-related bias and stigma. Perhaps nowhere was this more evident than in students’ reflection essays after attending community-based dementia support groups for patients and their family caregivers. Students frequently admitted personal misconceptions that the exposure corrected.
I was surprised that I, myself, had never considered caregiver health when now it seems like an obvious part of the care. To be honest, before attending, I wasn’t sure how the experience would help me in practice, but I left feeling that these women’s stories and struggles greatly impacted the way I view dementia.
They also differentiated between traditional learning from textbooks and experiential learning via the group, highlighting the latter’s unique capacity to affect students on both cognitive and affective levels.
Attending this group was absolutely eye-opening. In most of medical school, we focus on brain tissue change with dementia, but I didn’t realize my education was incomplete until I met these individuals and realized there are many aspects of patient care that go beyond just the patient.
Most students also reported being surprised and inspired and many ranked it their best learning experience in medical school.
Regardless of specialty, US demographics suggest that, for most graduating medical students, contact with older patients is inevitable. Fortunately, a care approach informed by negative, stereotypical views of aging is not, if we are willing to think outside the box and implement novel, evocative curricula to help shape students’ perceptions. In the US, geriatrics consistently ranks low in reimbursement but high in physician satisfaction, underscoring that geriatricians find their work gratifying and meaningful for different, often personal reasons. To be effective, then, our educational efforts must take a similarly personal approach to reaching our increasingly diverse students.