Early exposure to geriatric care: developing an undergraduate internship in ethics and geriatric practice

According to the United States Census Bureau, there was a 15.1% increase in the sixty-five and older population between 2000 and 20101 and is expected to climb to 16.3% by 2020.2 In addition, older adults have shown a greater need for health care resource utilization in America; while only 12.8% of the U.S. population in 2008, older adults accounted for 26% of office visits, 35% of hospital stays, and 38% of emergency medical services.3 The increase in care necessary for the aging population paired with the ebb of resident interest in geriatrics4 has prompted many to call for a more focused effort toward expanding awareness of and recruitment to geriatrics.5-8 Toward these ends, Saint Louis University (SLU) developed a university-level undergraduate course in ethics and geriatric care designed to expose students to the field prior to beginning formal post-baccalaureate medical education. In addition to regular classroom discussion of issues in geriatric care, students spend significant time learning through direct exposure to geriatrics by spending one hour shadowing clinicians and two hours visiting an elder at the nursing home. Students are assessed on classroom participation, completion of required hours, regular reflection papers integrating nursing-home experiences with classroom discussion, and completion of a quality improvement (QI) project. This course is unique for three reasons. First, it is one of the only university-level undergraduate courses engaging students in direct experiences with long term care residents. Second, it was designed in collaboration with undergraduate pre-professional students, who were surveyed to incorporate their needs into the course curriculum (predevelopment needs analysis). Finally, it integrates reflection on and discussion of ethical issues related to geriatric longterm care with the students’ time at the nursing home, thereby grounding the practical experiences in theory and animating theory with real-world examples.