In 1999, the University of Rochester School of Medicine and Dentistry committed to major restructuring of its undergraduate medical school curriculum. A distinguishing feature of this reform was the planned emphasis on and integration of several core topics or themes throughout the 4 years of the curriculum. One of these curricular themes was aging. The faculty in geriatrics was presented with an unparalleled opportunity to develop a geriatrics curriculum of major proportions through the development of an aging theme. Through a user's guide approach based on the authors' experience to date, this article identifies the 10 steps necessary to “win the geriatric game” successfully integrating an aging theme into an undergraduate medical school curriculum. Since the initiation of the aging theme, several new courses, cases, and conferences have been added or enhanced, affecting all 4 years of the curriculum. Key operational challenges included successful engagement of course directors, tracking the actual experience of the aging theme, and evaluation of students' attainment of learning objectives and eventual career choices. The authors' experience suggests that an aging theme can successfully enhance the geriatrics curricular content of undergraduate education and strongly affect students across all 4 years. This 10‐step approach may serve as a model for other universities committed to integrating geriatrics across the full undergraduate medical curriculum.
Clinical instruction for medical students traditionally occurs in hospitals and offices, whereas patients and families face many health issues in their homes. This is particularly true for frail older adults, those with chronic illness, and patients at the end of life. The authors sought to incorporate geriatrics, primary care, and palliative care into house calls for medical students by integrating a home visit experience into their ambulatory clerkship. Using a guide jointly developed by geriatrics, primary care, and palliative care faculty, students conduct three home visits with a patient from their community preceptor's practice. The first visit focused on medical diagnoses and symptoms, the second on functional assessment/geriatric syndromes, and the third on social/cultural and end-of-life values. Students completed a 2,000-word write-up, including a narrative using the "voice" of the patient. Students presented the cases in small groups facilitated by geriatric and palliative care faculty. Eighty-three percent of students reported positive feedback about the experience. Based on write-ups and program evaluation, students voiced improved knowledge of functional assessment, geriatric syndromes, and progression of chronic illness. Students also poignantly expressed advantages of home visits in exploring psychosocial aspects of medicine, including affirming the humanity of medicine, understanding family systems, providing patient-centered care, and understanding patient beliefs. Several students expressed pursuing a house calls career. A longitudinal home visit experience for medical students can successfully enhance the geriatric, ambulatory care, and palliative care curricular content of undergraduate education and positively affect student's attitudes toward the chronically ill and homebound.
This article describes the experience of fourth‐year medical students participating in a geriatric education program integrated into a 4‐week emergency medicine student clerkship. Between July 2002 and April 2003, all students in this required clerkship participated in a geriatric educational program consisting of a small group discussion of medical and psychosocial issues of older adult emergency department (ED) patients. Students used learned skills to evaluate older adult ED patients for medical and psychosocial issues and later followed up with these patients by telephoning them at their homes or visiting them in the hospital. Students tracked their evaluations of the medical problems, functional abilities, and social supports of patients in the ED. Students also noted when their assessments resulted in the acquisition of new skills or knowledge and when their evaluation of geriatric syndromes resulted in a change of the patient care plan. Seventy‐seven students evaluated 217 patients in the ED, of whom 167 (77%) received a follow‐up visit or phone call. Students documented learning new skills while caring for 80 (48%) of the older adult patients. Qualitative survey responses from students indicated that students had increased understanding of the importance of assessing functional status and social supports and providing interdisciplinary care. Integrating geriatric education modules into existing emergency medicine clerkships is an effective method to expand the geriatric curriculum in medical schools and to emphasize the importance of geriatric assessment and syndromes in emergency care.
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