Watching two first-year med students hobble down the hallway at UC San Diego School of Medicine last week, Dr. Roopali Gupta yelled a little friendly advice.
“Don’t turn away a patient if they’re five minutes late. Now you can feel what they’re going through getting to an appointment,” Gupta quipped.
The limps came from sticks strapped to healthy knees, simulating the stiffness of aging joints, and from corn kernels stuck in shoes to mimic a foot problem like bunions or nerve numbness.
The students were participating in the school’s aging simulation exercise, developed to deepen their understanding of aging beyond what they can learn by reading a textbook or sitting through a lecture. This was the fourth class to try the program and the first time the public got to observe.
In one exercise, students pulled on thick garden gloves and special glasses that blurred, reduced or skewed their vision, and were asked to sort colored M&M’s into medicine bottles.
“The point of this class is to put yourself in your patient’s shoes,” said Elli Novatcheva, a student from Sophia, Bulgaria. “You need to understand what an older person is going through.”
That understanding becomes more important for doctors as America ages. According to the U.S. Census Bureau, the nation’s population aged 65 and older will double by 2050 due to the aging of the Baby Boom Generation and gains in overall life expectancy.
This shift has pushed medical schools to increase their emphasis on geriatrics, introducing the basic concepts of aging earlier and moving toward hands-on simulation as they have in many other areas from patient examination to emergency care.
“We’re recognizing, with the exponential growth in this population, that these are skills they are going to be needed in many areas of medicine,” Gupta said.
It’s a story that goes beyond UCSD. Dr. Zaldy Tan, a gerontologist and assistant dean of the David Geffen School of Medicine at UCLA, said a growing number of programs are embracing simulation as a way of helping students understand older patients on a deeper level.
Medical schools are also using actors, trained to mimic real symptoms, to test students’ diagnosis abilities. Many schools, Tan said, instruct the “standardized patients” to exhibit hearing problems or signs of cognitive problems to provide a more realistic experience.
“We have to make sure that our students are prepared to take care of the kind of patients that are more and more common, patients with long medical histories and long medication lists,” Tan said.
Of course, garden gloves and funny glasses are only a crude approximation of the physical changes that come with getting older, and simulating physical changes is a little one-sided. Putting them on does not convey, for example, the decades of wisdom that accrue as the decades pile up.
But that’s not the point. The main thing, Gupta explained, is to instill an awareness in young doctors of what their older patients are going through so they’ll go beyond the basic diagnosis-and-prescription dance when they are out in the real world, working in busy offices that often provide too little time for much more than the basic facts.
It’s a message that seemed to resonate with Eric Arnold of Lake Forest, another student who said stumbling through the hallways trying to keep up with a classmate reinforced the notion that he will need to do more than the basics with senior patients. A leg problem, he noted, should mean more than a prescription for painkillers or physical therapy. It means asking about their living situation, finding out if they’re at risk of falling.
“It’s not just about saying ‘here’s what to do and check back with me in three months’” he said. “I need to stop and understand how a problem that they’re having is affecting their life.”
Another significant portion of the exercise was examining poll results from Americans of different ages to better understand how seniors see themselves, compared to what younger people might think.
Novatcheva, the student from Bulgaria, said she was most surprised that seniors were very concerned with maintaining their ability to drive. That just hadn’t occurred to her, but now that she knows, she said she’ll be looking out for that when she pulls on a white coat some day.
“This exercise, I think it makes you aware of the little clues in a patient’s life that you might be missing if you’re not paying attention,” she said.
Published at Tue, 31 Jan 2017 16:25:00 +0000