Impact of Participation in TimeSlips, a Creative Group-Based Storytelling Program, on Medical Student Attitudes Toward Persons With Dementia: A Qualitative Study

As the incidence of Alzheimer's disease and related dementias (ADRD) rises precipitously in industrialized nations as well as in low- and middle-income countries (Ferri, Prince, & Brayne 2005), geriatric care will become urgently demanded by modern health care systems, including the United States (Institute of Medicine, 2008). However, recent research has shown that medical students report not feeling appropriately engaged in geriatrics (Bagri & Tiberius, 2010). Recent systematic reviews have documented a variety of interventions that focus on improving student attitudes toward geriatric care, such as senior mentoring, didactic and experiential sessions, intergenerational programs, aging simulations, game-based and community contact programs, and Web-based curricula among others, suggesting that interventions that facilitate interactions between students and healthy older adults are more likely to improve student attitude than those with elderly patients in the clinical environment (Flaherty, Fabacher, Miller, Fox, & Boal, 2002; Tullo, Spencer, & Allan, 2010; Yuen et al., 2006). Taken together, these emerging data suggest that student attitudes toward older patients may be improved by nonclinical geriatric experiences. Despite other tried methodologies, there are no known interventions that integrate creative arts into medical student geriatric care education. Such interventions may foster positive attitudes by removing students from purely clinical interactions with aging persons and allowing less formal relationships to evolve around a cocreative activity. Such improved attitudes could ultimately contribute to students taking a more humanistic approach to the care of geriatric patients, including those with ADRD. This manner of care would address neuropsychological symptoms and brain pathology while also supporting the personhood of those affected by dementia, bringing the older person into focus rather than the disease, reducing the stigma associated with ADRD, and helping preserve meaningful interrelationships and social status for those so affected (Kitwood, 1997). Not only would such care benefit medical student education, it could also contribute more broadly to improvements in the training of paraprofessional caregivers, a disproportionate percentage of whom are ethnic minorities and/or persons from lower socioeconomic backgrounds who work in long-term care facilities and may hold culturally specific—and sometimes negative—views about people with dementia that are not necessarily informed by evidence-based practice (Ayalon, Arean, Bornfeld, & Beard, 2009; see also Brodaty, Draper, & Low, 2003). The purpose of this research was to evaluate the participation of fourth-year medical students in a nonclinical, group-based creative storytelling program called TimeSlips (TS), which was developed in the 1990s and is now practiced around the world (Basting, 2009). Unlike traditional reminiscence therapies that evoke biographical details to capture a sense of who a person with ADRD was in the past, TS elicits a performance of self in the present moment. The activity involves facilitators encouraging persons with ADRD to exercise their imaginations—even in the face of memory loss and disorientation—thereby underscoring the inherent dignity of persons with ADRD by creating a valued social role (Whitehouse & George, 2008). A small evidence base suggests that participation in TS benefits persons with ADRD as well as their professional caregivers. Researchers have found that individuals with ADRD who engaged in a 6-week session of TS experienced greater positive affect than those receiving a control intervention (Phillips, Reid-Arndt, & Pak, 2010). Facilities that have integrated TS into their care services over a 10-week period report that TS fostered more frequent staff–resident interactions and social engagement while also nurturing more positive staff views of residents than in control facilities (Fritsch et al., 2009). However, no existing studies have evaluated whether participation in TS can have an impact on the attitudes of medical students toward persons with ADRD. This pilot study used qualitative techniques to explore how medical students experienced their own attitudes and perceptions of persons with ADRD to have been affected by their coparticipation in TS sessions.