Charles E. Schmidt College of Medicine
Florida Atlantic University
777 Glades Road
Boca Raton, FL 33431
There is no question that Americans are living longer; but the challenge is to ensure that they live better longer. According to US Census data, adults 65 years and older account for nearly 25% percent of the population in Palm Beach County, Florida, where the Florida Atlantic University Schmidt College of Medicine is located. Moreover, this segment of the population is expected to grow substantially in the coming 10 years. This population trend creates a unique learning opportunity for our medical students, one that fully aligns with one of the four major research focus areas in our college’s strategic plan: healthy aging.
Students in aging sensitivity training learn the challenges older people face by wearing gloves and vision-altering glasses while performing daily activities such as buttoning a coat.
Early in its development as a new community-based medical school, Florida Atlantic University hired internationally recognized geriatrician, Joseph Ouslander, M.D. to develop and direct the geriatrics programs at their new college of medicine. A former president for the American Geriatrics Society and past director of Geriatric Medicine and Gerontology at Emory University, Ouslander joined the Schmidt College of Medicine with a vision that geriatric education must be incorporated within the four-year curriculum rather than limited to a few lectures. His vision has been realized with the successful creation of a Geriatrics and Healthy Aging longitudinal curriculum thread. This thread ensures that FAU medical students are trained throughout their four-year program to be equipped to treat the unique health needs of older adults.
“Education in geriatrics is important everywhere,” said Ouslander, senior associate dean of Geriatrics Programs, and chair of the Integrated Medical Sciences department at the Schmidt College of Medicine. “The number of people who are going to live into extreme old age is increasing exponentially. What I say to students is that unless they are going to focus their careers on pediatrics, they need to understand principles of geriatric medicine because they will see a lot of older patients, including middle age people caring for older parents, and children who are cared for by their grandparents.”
Now directing the Geriatrics and Healthy Aging thread is Mandi Sehgal, M.D., associate professor of Geriatric Medicine and associate director for the year three Geriatrics and Palliative Care Clerkship. Sehgal also serves as the chair of the Teachers Section for the American Geriatrics Society. Although other medical schools may include geriatrics in their curriculum, she says FAU might be unique in providing geriatric-focused content in all courses throughout the four years of medical school.
All graduating medical students at the Schmidt College of Medicine must show competencies in the specific geriatric areas of medication management, cognitive and behavioral disorders, self-care capacity, falls, balance, and gait disorders, health care planning and promotion, atypical presentation of disease, palliative care, and hospital care for older adults.
“It is imperative to empower our medical work force to care for older adults. All physicians, regardless of specialty, need to know how to best take care of the older patient,” Sehgal said: “Our curriculum focuses on the total patient, not just the disease processes they may have. We have a person-centered approach,” she explained.
The framework for the Geriatrics and Healthy Aging thread is based on the AAMC Minimum Competencies in Geriatrics for Graduating Medical Students and the “Big 10” Basic Principles in Geriatrics, a modified version of the principles created by Ouslander and his team at Emory University. Sehgal also stresses the importance of these principles, especially number one - “aging is not a disease.”
“Although everyone ages, each person is unique, and aging alone does not cause symptoms,” Sehgal emphasized. The curriculum thread includes experiential and active learning as well as didactic, small group, and standardized patient activities.
Included in the curriculum in year one is aging sensitivity training which provides students with hands-on knowledge of what older adults may experience as they age. This training is done in small groups. Students are directed to put on gloves that simulate arthritis, cotton in their ears to simulate hearing impairment, and glasses on to simulate cataracts or other visual impairments and then asked to perform tasks like opening a water bottle, button their white coat, and read content on a white board. “We want them to see firsthand how different abilities can be challenges for older adults,” Sehgal said. Additionally, students participate in panel discussions comprised of independently living older adults who provide tips for successful aging - advice that the future doctors can share with their older patients.
Second-year medical students work in teams to demonstrate the medical knowledge and clinical skills needed when helping patients who have fallen.
Active learning is integral in the Geriatrics and Healthy Aging thread. During the second year, students are taught about falls. The session uses the flipped classroom approach and consists of a round robin exercise that requires medical students to work in teams to demonstrate both medical knowledge and clinical skills related to patients who have fallen, and a standardized patient exercise where students must evaluate a patient who has fallen and develop a treatment plan.
The thread also incorporates Interprofessional Practice and Education (IPE), as this is another key component of Geriatric Medicine. In their first-year, medical students team up with their peers from nursing, social work, and pharmacy and visit an older adult in their home, three times over the year, and conduct a history, including geriatric screening and assessment, perform a home safety evaluation, and medication reconciliation. This longitudinal experience helps students to recognize the complex needs of older adults and that it is critical to respect the roles of the interprofessional team to best serve those needs. Additionally, in their second year, medical students collaborate with pharmacy students in a session focused on polypharmacy, a ubiquitous problem in the older population, and a dangerous one. Students learn to perform a medication reconciliation with a standardized patient who is taking too many medications, including medication from other people, not their own prescriptions. Medication side effects and errors such as those portrayed in this teaching session are a leading cause of preventable hospitalizations in the geriatric population.
“Several of our students have recounted that they have felt incredibly prepared to take care of older adults in residency because of our curriculum and that they are teaching others these skills” says Sehgal.
Recently, Sehgal was invited to discuss the importance of geriatric medicine on the NPR segment “Up to Date.”
During the interview, Sehgal explained that her interest in geriatrics began with her close relationship with her grandparents. “The health care they were receiving was fragmented,” she said. With only 7,200 geriatricians in the U.S. and approximately 74 million baby boomers, she explained that all physicians and health care professionals must be well versed in caring for older patients.
To Sehgal and her fellow geriatric educators, Ouslander and Bernardo Reyes, M.D., associate director of the FAU Internal Medicine Residency Program, and director of the resident rotation in Geriatric and Palliative Care, educating tomorrow’s doctors on the needs of the growing aging population is more than a job – it is a mission.
“Geriatrics as a specialty allows me to take care of the most vulnerable individuals with respect and compassion,” said Reyes. “Also, it allows me to develop a research-driven career and clinical programs that are unique to this patient population,” he said. “The opportunities to work and improve geriatric care are endless.”
Geriatric care embodies the Schmidt College of Medicine’s culture. “As a community-based medical school, we are dedicated to the health care needs of our local South Florida community,” said Philip Boiselle, M.D., dean of the FAU Schmidt College of Medicine. “I congratulate Drs. Ouslander, Sehgal, Reyes, and other faculty members for ensuring that all of our medical students receive innovative and integrated geriatric education throughout their four years of education, so they can meet the future health care needs of the aging population here in Palm Beach County and beyond.”