Meharry Medical College School of Medicine.

Abstract

Overview of the Geriatrics Curriculum The geriatrics curriculum at Meharry Medical College School of Medicine is designed to create a continuum of learning about the care and treatment of elderly persons. The integration of geriatrics into the undergraduate medical curriculum was designed to be vertical (extending through all four years) and horizontal (incorporated into all courses during a given year). Targeted learning experiences are offered each year. The preclinical experiences include lectures on geriatric medicine, the Freshman Aging Workshop, and the Sophomore Geriatrics Module and Symposium. These activities are part of the Introduction to Clinical Medicine (ICM) courses. The Department of Family and Community Medicine has enhanced its third-year clerkship to include targeted didactic instruction and clinical assignments at long-term care facilities. The Department of Internal Medicine has revamped a senior elective in geriatrics and also facilitated the organization of a student interest group in geriatrics. When the geriatrics curriculum was implemented, all departments were encouraged to update course content to highlight the normal aspects of aging and to integrate discussion of aging across disciplines. This is an ongoing activity. The geriatrics curriculum at Meharry Medical College also includes use of objective structured clinical examination (OSCE) cases to assess students’ ability to apply information and techniques relative to caring for elderly persons. Curriculum Management and Governance Structure The School of Medicine's Curriculum Committee is charged with monitoring the content and efficacy of the preclinical and clinical curricula. The committee oversees course continuity, implementation, and maintenance of the entire curriculum. The Curriculum Committee receives recommendations from the preclinical and clinical subunits and ensures that basic science course content is clinically relevant and the clinical courses contain references to basic sciences. The Curriculum Committee has final curricular authority for the School of Medicine and presents its findings to the dean for approval and implementation. The Geriatrics Curriculum Advisory Committee was responsible for developing the geriatrics curriculum. The advisory committee includes faculty members who are familiar with the course offerings and schedules for each academic year. Several of the members were also on the Curriculum Committee when this project was launched. The Geriatrics Curriculum Advisory Committee presented its plan to add modules to existing courses, increase opportunities for interaction with elderly patients through the internal medicine and family medicine clerkships, and revamp an existing senior elective clerkship to the Curriculum Committee in spring 2001. The Curriculum Committee approved the recommendations. The dean of the School of Medicine approved implementation of the plan upon receipt of the grant from the AAMC/Hartford Foundation. THE AAMC/HARTFORD GERIATRICS CURRICULUM PROGRAM Institutional Involvement in Curricular Change In February 2001, the School of Medicine held a strategic planning retreat to launch a revision of the curriculum. Department chairs, course coordinators, and administrative leaders who attended the retreat identified avenues for integrating content about “hot topics” into the curriculum. Geriatrics was one of the “hot topics” that were discussed. Acknowledgment of the need, as well as expressed support for incorporating more information about geriatrics into the curriculum, created a receptive environment and opportunity for developing and implementing the geriatrics curriculum. Theme for the Geriatrics Program If there is a theme for the geriatrics program at Meharry Medical College, it is that teaching and understanding about geriatrics have to be vertically and horizontally integrated into the curriculum and that teaching and learning must encompass students and faculty. Learning Outcomes for the Geriatrics Curriculum We believe many of our learning objectives are indeed learning outcomes. The belief is based on the implementation of the curriculum as planned, feedback from students, and empirical data obtained through student performance on course examinations and our attitudinal survey of students. Our learning objectives/outcomes include: Demonstration of knowledge of biochemical, physiological, anatomical, cellular, genetic, pathological, and pharmacological changes associated with normal aging and age-associated disease processes. Demonstration of knowledge of disease processes that disproportionately affect elderly members of the population, with an emphasis on those that disproportionately affect minorities. Differentiation between normal and abnormal physical changes related to aging. Identification of factors other than disease (i.e., environmental or cultural) that affect the health of older persons. Assessment of students’ own attitudes toward aging, disabilities, and death and how those attitudes may affect students’ ability to care for older persons. Demonstration of knowledge of common geriatric syndromes, conditions, and diseases with an understanding of associated risk factors, causes, signs, symptoms, differential diagnoses, and preventive strategies. Identification of signs and symptoms of psychosocial problems and issues common to elders. Development of proficiency in performing basic geriatric clinical assessments. Understanding of ethical issues in geriatric care, such as palliative care. Special Programs The program includes community partnerships, geriatric standardized patients, a faculty development program related to geriatrics, a student interest group, and a palliative care/end-of-life course. Community partnerships The preclinical and clinical curricular activities have been supported by academic partnerships with the Alvin C. York Veterans Administration Medical Center in Murfreesboro, Tennessee, and local long-term care facilities that provide clerkship opportunities. The Consortium Geriatrics Education Center (CGEC) at Meharry Medical College has worked with the Department of Medical Education to extend the college's initiative on geriatric education to the community. The CGEC's partnerships with local agencies and organizations that cater to the needs of the elderly have provided additional opportunities for students to learn and interact with older persons. Standardized patients The standardized patients (SPs) who facilitate our OSCEs on geriatric cases are over the age of 60. The use of older SPs strengthened the teaching aspects of the structured cases. Faculty development In addition to enhancing the curriculum for students, the AAMC/Hartford Foundation initiative included activities to enhance faculty members’ knowledge about contemporary issues in geriatrics. The faculty development component included seminars by visiting faculty who are experts on issues of aging, and presenting the Stanford Faculty Development Center's Geriatrics in Primary Care seminars on campus. Meharry faculty members, who were trained at the Stanford Faculty Development Center, led the seminars for attending faculty and residents. The Student Geriatrics Forum The Student Geriatrics Forum was organized under the auspices of the Department of Internal Medicine in 2001. All medical students as well as students in the Schools of Dentistry and Graduate Studies were invited to participate in the interest group. In September 2002, the American Geriatrics Society (AGS) recognized the Student Geriatrics Forum as an official student chapter of the national organization. The American Gerontological Convention also recognized the student group in 2002. Representatives of the students’ group have attended a geriatrics education program at Boston University School of Medicine, which is cosponsored by AGS and the National Institute on Aging. Participation in the students’ group has grown from five students in 2001 to approximately 80 regular participants as of March 2003. During monthly meetings, local and national speakers address students about relevant topics in geriatrics and gerontology. Members of the Student Geriatrics Forum have provided screenings for seniors during local health fairs. Palliative care The freshman small-group course on palliative care was enhanced as a result of the geriatrics curriculum initiative. Two faculty members in the Department of Medical Education strengthened their ability to teach preclinical students about palliative and end-of-life care by participating in the Harvard University Palliative Care Program in 2002 and 2003. These faculty members assumed responsibility for teaching the small groups in fall 2003 and significantly revamped the course content to include discussion of effective communication from a geriatrics perspective, breaking bad news, holistic care, and advanced directives. Resulting Pedagogical Changes A new element of self-directed learning was introduced through the sophomore geriatrics module and symposium. In conjunction with visits to the long-term care facility at the York Veterans’ Administration (VA) Medical Center, students are required to conduct research and prepare a poster or oral presentation on a condition or disease that primarily affects older adults. The posters are exhibited during Research Day (a campus-wide event) and during the Introduction to Clinical Medicine Geriatrics Symposium. The oral presentations are also presented during the symposium. Faculty members judge all presentations, and cash prizes are awarded to the groups of students who receive the top three ratings. The exercise was designed to enhance research and presentation skills among sophomore students. Application of Computer Technology The geriatrics program incorporates the use of computer technology by requiring student to conduct research that includes use of Web-based resources (e.g., online medical journals and other sites designed for medical professionals). Students’ Clinical Experiences in Geriatrics The ICM sophomore geriatrics module/symposium provides a clinical experience for sophomore students. Students conduct a history and physical examination of residents at the York VA Medical Center. The family medicine clerkship includes assignments at local nursing homes. Students routinely interact with elderly persons during the internal medicine junior clerkship. The senior elective in geriatrics is designed to provide students with a four-week experience of interacting with residents at a long-term care facility. The Program’s Assessment and Evaluation Instruments The Facts on Aging Quiz developed by Erdman Palmore (1998) was adapted for use as a pre- and posttest of students’ attitudes and knowledge about aging. The 20-item multiple-choice quiz has been administered to freshmen as a pre-test each year since January 2001. The quiz is administered to sophomores as a posttest following the preclinical geriatrics experiences. The 2003 version of the assessment tool has been revised to include statements or questions that require selecting the single best answer. These questions enhance our ability to assess students’ integration of information from the basic sciences, independent research, and clinical experiences of the geriatrics curriculum. Resources Required A core group of the Geriatrics Curriculum Advisory Committee met monthly to plan and monitor the implementation of the curriculum initiative. Several faculty in the Department of Medical Education as well as the freshman curriculum coordinator and director of the Consortium Geriatrics Education Center were involved in coordinating and facilitating the preclinical modules, visiting lecturers, and faculty development activities. Additional financial support was provided through existing grants and institutional support for the development of cases, training of standardized patients, and execution of the OSCE for sophomore and senior students. Requirements to Sustain the Program Most of the components of the geriatrics curriculum were added to existing courses as modules. The freshman aging workshop and sophomore module/symposium have become imbedded in the Introduction to Clinical Medicine courses. The nursing home assignments have become an integral part of the family medicine clerkship. Other funding sources support the school's ongoing OSCE program. Consequently, these activities will be sustained as part of the ongoing curriculum. New sources of financial support will be needed to continue awarding prizes for best poster and oral presentations during the ICM Geriatrics Symposium, providing meals for the Student Geriatrics Forum meetings, sponsoring visiting faculty, and providing workshops for faculty development. Unanticipated Outcomes The level of receptiveness by faculty and students has been greater than expected. The anticipated concerns about adding something new to the crowded academic calendars and course content were allayed by reallocating time within existing courses. Impact of External Funding The external funding provided impetus for implementing the geriatrics curriculum initiative sooner rather than later. The task of planning a curriculum worthy of external funding stimulated the creative juices among faculty and led to creative interdepartmental and interdisciplinary planning to enhance coverage of geriatrics. The funding facilitated the purchase of books and other instructional materials about geriatrics, palliative care, and caring for elderly patients for departments; enhanced students’ and faculty members’ exposure to experts in the field of geriatrics; provided incentives for students’ research projects; and offered a structured, short-term training program in geriatrics for attending faculty and residents. The initiative to enhance geriatrics has become a model for integrating other topics into the curriculum at Meharry Medical College. For additional information, contact Juanita F. Buford, EdD, at 〈[email protected]〉.