Early exposure to geriatric care: developing an undergraduate internship in ethics and geriatric practice.

According to the United States Census Bureau, there was a 15.1% increase in the sixty-five and older population between 2000 and 20101 and is expected to climb to 16.3% by 2020.2 In addition, older adults have shown a greater need for health care resource utilization in America; while only 12.8% of the U.S. population in 2008, older adults accounted for 26% of office visits, 35% of hospital stays, and 38% of emergency medical services.3The increase in care necessary for the aging population paired with the ebb of resident interest in geriatrics4 has prompted many to call for a more focused effort toward expanding awareness of and recruitment to geriatrics.5-8 Toward these ends, Saint Louis University (SLU) developed a university-level undergraduate course in ethics and geriatric care designed to expose students to the field prior to beginning formal post-baccalaureate medical education. In addition to regular classroom discussion of issues in geriatric care, students spend significant time learning through direct exposure to geriatrics by spending one hour shadowing clinicians and two hours visiting an elder at the nursing home. Students are assessed on classroom participation, completion of required hours, regular reflection papers integrating nursing-home experiences with classroom discussion, and completion of a quality improvement (QI) project.This course is unique for three reasons. First, it is one of the only university-level undergraduate courses engaging students in direct experiences with long term care residents. Second, it was designed in collaboration with undergraduate pre-professional students, who were surveyed to incorporate their needs into the course curriculum (pre-development needs analysis). Finally, it integrates reflection on and discussion of ethical issues related to geriatric long-term care with the students’ time at the nursing home, thereby grounding the practical experiences in theory and animating theory with real-world examples. Course design The course was designed to meet several stakeholders’ interest simultaneously. First, the Division of Geriatric Medicine at SLU School of Medicine expressed a desire to increase awareness of common geriatric care issues and to pursue more volunteers to spend meaningful time with nursing home residents. Second, the pre-professional students at SLU completed a needs-based assessment to delineate student-driven course objects. The survey answers were qualitatively analyzed for common themes: 1) gaining experience with patients, 2) improving medical school applications, 3) increasing shadowing opportunities, 4) understanding the geriatric population, and 5) exposure to medical-ethical discussion. Finally, the University’s Center for Health Care Ethics was seeking opportunities for students to engage in real-world health care experiences while receiving course credit toward a minor degree in Health Care Ethics.The interests of these three stakeholders were combined to develop an internship-based service-learning course with resident companion contact hours, shadowing hours, classroom discussion, and ethics education. Students gain relevant knowledge and skills through real-world learning contexts and insight through volunteer and community service experiences. Upon completion of the course, students should be able to identify: (1) medical and professional challenges to geriatric care, (2) related ethical issues inherent in geriatric and end-of-life care, (3) effective communication and patient-centered skills with elder patients, and (4) principles of ethical care-giving.