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The students' voice can be instrumental in modifying the
curriculum and developing new courses. By serving as a catalyst, student
geriatrics groups may be effective in expanding their institution's geriatrics
curriculum.
The role and structure of curriculum review committees varies
greatly from school to school. If at all possible, a student from the
geriatrics group should seek appointment to the committee to represent
the student body as a whole, and give voice to the importance of incorporating
geriatrics into the curriculum. If the student position on the committee
is already filled or does not exist, a special audience with the committee
should be requested. The student members of the geriatrics group, along
with faculty advisors, can design a presentation to inform the committee
of the anticipated magnitude of the geriatric patient population. They
can also present some of the special geriatric health care issues that
are critical to a comprehensive medical education.
Approval for credit-hour courses can be an enormous challenge
in many medical schools. Additions to the core and elective curriculum
can be sought whenever possible, but a wealth of opportunity also exists
in non-credit courses. Non-credit courses can be designed by the group
to reflect their main interests. They don't generally require official
approval, and a successful course may be more readily accepted as part
of the elective curriculum.
Since the funding base for non-credit courses is either
absent or limited, it may be necessary to seek volunteers to teach the
class. Instructors are usually more willing to participate if a minimal
amount of time is required, so the group should plan on recruiting a number
of volunteers to assist with each course. The group can best recruit volunteers
by researching and discussing various candidates at a meeting with their
faculty advisor. One or two delegates of the group can then meet with
the proposed instructors to explain the group's overall objectives, course
outline, and the instructor's proposed topic.
In the planning of a non-credit course, group members can
be very creative. Students can pursue their individual and group interests,
and can explore a variety of institutional and community resources. Some
ideas for non-credit courses include:
Held once a week, or even once a month, the noon-hour conference
is one of the more successful educational endeavors. The burden of organization
can be significant, but the reward of a continuing series can be profound.
The series can focus on a variety of health care issues that concern aging
patients, including: foot care, psychological issues, special medical
problems, and areas of research. The faculty in the medical school can
also be encouraged to participate. The sessions are also an excellent
opportunity for house staff, residents and interns to present topics of
interest that relate to the older patients who utilize the hospital services.
There is a way of caring for older patients that is not
well taught in the basic core courses of most medical schools. Dedication
to detail and nuances coupled with a genuine compassion for the concerns
of the older patient are part of the "art of medicine" that
is often learned best from observation of a practiced physician. As electives
for first- and second-year students, area geriatricians could be paired
one-on-one with interested students. The student would be expected to
spend one afternoon each week as a shadow of the physician, seeing patients
in the office, nursing home, hospital or home. The opportunity to experience
the practice of geriatrics in the community could also be extended to
third- and fourth-year students as a clinical elective. As such, it would
probably be necessary to acquire approved credit-hour status. Most medical
schools do not allow sufficient free time for third- and fourth-year students
to pursue outside interests. If students can arrange to see patients in
a geriatric outpatient clinic, third- and fourth- year students might
be able to arrange preceptorship as part of their regular course work.
The education and socialization provided for students in
today's medical schools often ignores the important role that the humanities
can play in the development of the physician as a complete, caring person.
The curriculum is often inadequate in the subjects of medical ethics and
related humanities. Many of the issues facing elderly patients focus on
difficult social settings, painful decisions, or frustration with the
definitions of wellness as opposed to illness. It seems only logical that
humanities-based courses be offered to medial students, as they are likely
to be challenged with these issues during the course of their careers.
Funding for these classes is the ultimate challenge. Occasionally a professor
from the university associated with the medical school can be persuaded
to teach a course. Sometimes the dean's office of the medical school will
have a discretionary fund that can be tapped to fund such a course. Topics
that would fit into this format include:
- the phenomenon of aging as represented in literature;
- a film series exploring the impact of aging on the individual
and society including movies such as: On Golden Pond, Harold and Maude,
The Sunshine Boys, Dad, Cocoon, Driving Miss Daisy;
- ethical conflicts in decision making with aged
patients;
- ethical dilemmas concerning demented patients;
- the living will and its mandate for physicians and patients;
- understanding the long journey from horse drawn buggies
to the space shuttle: a discussion on the enormous resilience and adaptability
demonstrated by elderly persons;
- small group/problem-oriented discussions in which the
clinical problem format can be used to illustrate some of the medical
and social problems that directly influence the elderly patient. (A
case might focus on hip fracture secondary to osteoporosis to illustrate
the subset of the population that is especially at risk, the alternatives
in treatment, the associated risks imposed by treatment, and the basic
pathophysiology of the disease.) Course faculty could produce a CPC
type of case that could be distributed to the group for some preliminary
research and discussion. The faculty member would then be invited to
join in for a more in-depth discussion of the case and its outcome.
A few topics that might be appropriate include: iatrogenic over-prescribing
(drug interactions), laxative abuse, urinary retention or incontinence,
and sensory losses.
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