For physicians, it’s not just about caring for a person’s physical wellness, but also the person as a whole.
But if the patient doesn’t remember what day it is, where he or she lives or isn’t even able to recognize family members and loved ones, it can make care much more difficult and draining for the patient, family and the physician involved.
This is why the division of geriatrics and the department of family and community medicine decided to ramp up medical student training to sooner prepare future physicians to deal with patients who have more on their plate than standard ailments.
July marked the launch of a new four-week longitudinal teaching module as part of the required third-year family medicine clerkship on the evaluation and management of the older adult patient and caregiver with a focus on Alzheimer’s disease.
Gregg Warshaw, MD, chair of the division, Rocky Ellis, MD, and Barbara Tobias, MD, are spearheading the module, which started for the third time ever at UC on Friday, Sept. 2.
"Using standardized patients and support from the Alzheimer’s Association, the goals of this curriculum are for medical students to begin to develop an understanding of the components of a comprehensive geriatric assessment and an appreciation for the importance of family and community resources in the care and management of older adults during the progression of this disease,” Tobias explains.
The module was developed in collaboration with faculty from the division of geriatrics, the department of family and community medicine, the James L. Winkle College of Pharmacy and the Alzheimer’s Association through a grant from the Reynolds Foundation.
Tobias says large group sessions and individualized time are integrated into this module.
"The introductory session during the first week of the clerkship consists of a half-day workshop which includes a presentation of basic concepts around the diagnosis and outpatient treatment of Alzheimer’s disease, focusing on key issues of caregiver support, safety, driving, medications, quality of life and team based interprofessional clinical care,” she says.
"There is also an interview and discussion paralleling the initial diagnosis and management of Alzheimer’s disease with a standardized patient and caregiver. Students learn about patient, family and community collaboration in chronic care management.”
Tobias says that during the second and third weeks of the clerkship, students receive emailed questions from the caregiver of the patient who was interviewed on the first week.
"These questions reflect a progression of the disease over time—12 months by the second week and 18 months by the third week—and are prepared with the help of the Alzheimer’s Association and College of Pharmacy faculty to reflect commonly asked real life questions by the families of patients with Alzheimer’s,” she says.
"Students are given a community resource list and bibliography to prepare their responses to these ‘families,’ and responses are submitted electronically to simulate email access to patients and their families.”
In the final session of this module, faculty members facilitate a discussion with the students based on their responses and follow-up management of the patient and caregiver. Students are tested on this material as part of their final clerkship exam.
"This truly puts the face of Alzheimer’s in front of students and allows them to see how important it is to have the knowledge to care for patients with this condition and to support their caregivers as well,” says Tobias. "The earlier we can introduce students to this population and the resources available, the more prepared they will when they see these patients during clinic in their fourth year rotation, in their residencies and for the rest of their career.”
Students Say Experience Was Enlightening and Necessary
Nicholas Jabre, a third-year medical student who was one of the first students to complete the module in July, says that it struck a personal chord in him.
"My grandmother was diagnosed with Alzheimer disease,” he explains. "I watched her decline mentally and physically over a 10-year period until she passed away several years ago. By that time, she could not remember me or any other loved ones, and she was unable to walk, eat or dress without help. It was a terrible illness because it took away her dignity and left behind a person that I could hardly recognize.
"The worst part of the disease is knowing that its progression is unstoppable. Medication only delays the inevitable. Telling our patient he had Alzheimer’s disease felt like giving a terminal diagnosis, and it was a really painful, but necessary, exercise.”
Although the exercise was tough, Jabre says he learned valuable lessons from his experience.
"I learned to face dignity-robbing diseases like Alzheimer’s with courage and to utilize outside resources for guidance when the road forward is unclear,” he says. "This was an excellent learning opportunity that should be experienced by all medical students at UC. By treating this simulated scenario as a real encounter, I feel that we will all become more compassionate and more knowledgeable physicians.”
Third-year student Kathryn Engelhardt completed the module during the same clerkship rotation as Jabre and agrees that this experience is "100 percent necessary,” adding that she thinks the curriculum should include even more interaction with geriatric populations.
"The major goal of geriatric medicine as I see it is to focus on every aspect of the patient's life: financial, psychosocial, family or other support, and spirituality, among others,” she says. "I think the most valuable part of this experience for me was the simulated email conversations because these were directly toward a family member and not the patient. While we don't have extensive experience with patients at this level of our training, we have virtually zero experience in addressing a family caregiver's concerns.
"The issues and concerns that define geriatrics for me are applicable to every field of medicine: We focus so much of our time learning about the disease process that it's easy to forget about the person living with the disease. Geriatrics is such an important field for many reasons and this helped me to further see its significance.”