January 23, 2019

Freshmen medical students learn challenges of aging through unique P4 serving learning course assignment

The Wayne State University School of Medicine's 300 freshmen medical students spent the night at an extended care facility in their first few months of medical school, interviewing residents and staff caregivers to study how to prevent falls.

The program, woven within the medical school's Patient, Physician, Population and Professionalism Course designed for the Class of 2022 as part of the Year One curriculum revision, provides physicians in training a unique opportunity to learn about the challenges of aging and experience the special qualities exhibited by older persons, as part of Service Learning in the community.

Students provided the older adults with education on strength and balance exercises, properly managing medications, the need for regular vision checks and how to make their living environments safer.

"The older adult I was assigned to often complained of having weak knees and requiring the use of her hands and arms to push herself out of a chair to stand up. Due to the issues with her knees, she has fallen twice in the past year," said Class of 2022 medical student Rhett Carpenter-Thompson.

Every student stayed one night with fellow classmates at locations run by Presbyterian Villages of Michigan. The students surveyed residents and staff on falls using the U.S. Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths and Injuries) Fall Prevention Survey.

Carpenter-Thompson stayed at The Village of East Harbor in Chesterfield Township, Mich. He had just completed the musculoskeletal system unit when he spoke with his older adult.

"While further testing would need to be completed to fully assess the reason for my older adult's weakness in her knees, her problem could be related to the muscles around her knees. After taking the musculoskeletal unit, I understand that rising from a seated position requires more than the muscles around the knees," he said.

He recalled that the quadriceps, the spine and various smaller muscles in the feet are involved in the process of rising from a seated to standing position. The knees also contain multiple ligaments.

"As a result, in the case of my older adult, the weakness in her knees can be attributed to any number of causes, which makes her problem one that requires patience and lots of testing and understanding of human anatomy to fully assess the cause," he said.

They also interviewed residents during dinner, asking them about childhood nicknames, siblings, fond memories, educational background, hobbies, lessons they hope to impart to their families, their definition of happiness, secrets to healthy aging, who they talk to when feeling sad or lonely, and more. The completed biography is given to the resident as a keepsake. The biographies were reviewed by a Wayne State University writing class.

"For physicians in training, there is a lack of emphasis placed on teaching medical students about the unique challenges experienced in the aging process. The students in their first few weeks experience compassion and understand the value of engaging with staff from all levels of care, and it is a tremendous opportunity," said LaTonya Riddle-Jones, M.D., co-director of the Service Learning program.

Quality health care depends on a physician's ability to internalize, reflect upon and respond to the stories and emotions of their patients. The CDC's STEADI report lists several topics to reflect on the reason for falls, including Vitamin D deficiencies causing proximal muscle weakness, joint abnormalities, impaired cardiac function that can lead to shortness of breath, bladder dysfunction that can cause rushing to the bathroom, impaired position sensation, vertigo, brain atrophy due to dementia, medications that can cause confusion or dehydration, post-stroke weakness and diabetic neuropathy.

The Year One project also integrates arts and humanities into medical education related to patient safety, an initiative of both WSU and the Association of American Medical Colleges. The latter is designing a portal to showcase curricula like the WSU course to benefit the AAMC's community of educators, said Lisa Howley, AAMC's senior director of Strategic Initiatives and Partnerships in Medical Education.

The program is partially supported by an award from the Blue Cross Blue Shield of Michigan Foundation.

"Everyone at the Wayne State University School of Medicine, including our administrators, faculty and staff, are so appreciative of the time and attention the older adults and Presbyterian Villages of Michigan staff and administrators gave our students. Their partnership advances medical education," added Vice Dean of Medical Education Richard Baker, M.D.

The first student from each group visited their respective participating older adult at his/her extended care facility residence and asked questions about his/her past. Several weeks later, the second student from each group visited and asked questions about his/her present life. Finally, the third student from each group visited and read back to the older adult the short biographical snapshot the students had written based on conversations during the first two visits. Each group wrote a brief reflection on the experience.

"At some point in their careers, they will probably need to care for older patients. For the Class of 2022 to be able to experience what it is like to live in a nursing home and see for themselves the risk for falls while connecting it to their musculoskeletal course will help to connect the dot," said Jennifer Mendez, Ph.D., associate professor and director of Community Engagement at the School of Medicine.

Dr. Mendez and second-year students designed this hands-on application of the Year One course work.

The practice also gives students early experience in storytelling and history-taking, widely used in medical practice, while connecting it to the foundation courses.

"Most people seem to enjoy and are willing sharing their experiences and stories, and even problems, with those who are pleasant and engaging toward them. Therefore, I learned that being respectful and having a warm personality, especially when interacting with patients, may help facilitate my patient's inclination toward opening up to me," Carpenter-Thompson said.

His classmate, Kafa Alshohatee, visited The Park at Trowbridge in Southfield, Mich., on Sept. 21, 2018.

Alshohatee was so positively affected by the 90-year-old resident she met and interviewed, she returned on her own time to throw him a birthday party.
"When I had my first meeting, I never knew how much that me being there would contribute to the older adult's life. I underestimated going there. I just decided to visit again," she said. "That's all they needed was for someone to be there and to listen. It was an interesting experience and an eye-opener for me."

Fellow freshman Nicole Murray visited the same location a week later and had a similar experience, connecting with her resident so much she had plans to visit again to help her work through some legal issues. "I really connected with her and she reminded me of my mother. I thought, 'I can't leave her like this. I have to help her somehow.' Being there and listening to her was very stress relieving for her," Murray said.

For more information about the program, contact Dr. Mendez at jmendez@med.wayne.edu

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