Using simulation to explore medical students’ understanding of integrated care within geriatrics

Abstract

Background Given the increasing evidence and expansion of integrated care (IC) in healthcare, new IC curricula introduced early in undergraduate medical education (UME) are needed. Building on a pilot IC simulation called “Getting to Know Patients’ System of Care” (GPS-Care), we aimed to explore students’ understanding of patients’ complex physical and mental health needs, and to increase our understanding of how students learned in this simulation. Methods 177 of 259 first-year medical students participated in GPS-Care at the University of Toronto. Students role-played an elderly patient or caregiver within 5 simulated healthcare professional appointments. Students completed written reflections and 7 students participated in one-on-one interviews. A thematic analysis of the reflections and transcripts was conducted and descriptive data was generated for questionnaires. Results Data saturation was reached at 43 reflections and 7 transcripts and the following themes emerged: a) students reflected on patients’ complex care experiences, b) students reflected on of the healthcare system needs care, c) students increased understanding of IC, and d) students desire to improve the care of IC patients within the healthcare system. Conclusions In addition to confirming previous pilot study themes, the results from this study identified the role of productive struggle to provide students with a deeper understanding of patients’ IC care needs. Moreover, GPS-Care resulted in a transformative learning experience resulting in new insights into the importance of IC early in UME training. Electronic supplementary material The online version of this article (10.1186/s12909-019-1758-9) contains supplementary material, which is available to authorized users.

Components and Outcomes in Under- and Postgraduate Medical Education to Prepare for the Delivery of Integrated Care for the Elderly: A Scoping Review

“…setting, and duration of the educational programmes. Thirteen papers originated from North America [34,[37][38][39][40][41][42][43][44][45][46][47][48], two from Europe [49,50], one from South America [51], and one from Oceania [52]. The majority (n = 13) was published after 2008 [37-39, 41-44, 46, 48, 50-52].…”

“…classroom-based, workplacebased, or a mix of both (Table 1). Six programmes had a classroom-based setting [34,37,39,40,47,48]. These programmes varied from interactive seminars based on a clinical case [34,40], a workshop based on a clinical case [37], an application of a web-based tool to manage care on a population level [47], a quality improvement project [39], and a scenario play [48].…”

“…One programme had an intraprofessional learning setting [50], and in one programme, participants received supervision from different medical specialists [42]. Another paper described an interactive session with other healthcare professionals [41], and the last programme described a simulation of a patient who visits multiple health and social care workers [48]. Three programmes featured social care without interaction with a social care worker [34,37,48], and five programmes did not mention social care [41,42,44,45,50].…”

“…One paper described the concept of situated learning, in which learning requires interaction and collaboration [52]. The second paper described a productive struggle to ensure students' understanding of the complexity of care experienced by patients [48]. The third paper mentioned the pedagogical guideline of problem-solving, in which the students were encouraged to reflect on their actions concerning the actions of other professionals [51].…”

Clinical simulation in health education: a systematic review

“… 54 This tool is becoming important in the area of health, for communication between professionals and patients. Also, in two studies, 34 , 47 the simulation consisted in students experiencing the point of view of the patient and the complexity of the procedures they are subjected to, to stimulate empathy with people who are sick.…”