Medical students’ experiences of the Senior Citizen Partnership Program: Evaluation of a five-year longitudinal program

Abstract

Purpose

This article reports on an evaluation which explored students’ experiences with a Senior Citizen Partnership Program (SCPP). This was implemented in 2017 as part of Curtin Medical School’s curriculum to support students’ learning about healthy ageing.

Methods

This mixed methods study reports a cross-section of attitudes and content analyses of (i) open-ended responses from 258 students and (ii) transcriptions from seven focus group discussions which allowed 33 students from first, fourth and fifth years to articulate their experiences of the SCPP and its impact on their training.

Results

Three main themes were identified: (i) challenges to prior perceptions of older adults (with ten subthemes), (ii) positive impacts on their medical education (with eight subthemes) and (iii) on their personal development (with five subthemes). Overall, students viewed the SCPP as a valuable contribution to their learning. Its intentional creation of a designated space and time coincided with students’ transition into adulthood and formation as a doctor. Clinical-year students attributed the SCPP to improved interpersonal communication and care of older patients.

Conclusion

A longitudinal program which partners students with residential-based older adults may support the emerging identity of a doctor who provides quality care for older persons.

Keywords:

• Experiential learning
• identity formation
• longitudinal program
• medical students
• older adults

Introduction

The United Nations has projected that the global population of older persons will rise from 10% of the total population in 2022 to 16% by 2050. It recommends countries with ageing populations to actively undertake public programmes in response to the growing numbers of older persons (United Nations Department of Economic and Social Affairs Population Division 2022). As health care of older people encompasses many medical specialties, an understanding of older patients and healthy ageing is core learning for future doctors.

Practice points

• An embedded longitudinal program partnering medical students with older adults to strengthen students’ learning about healthy ageing.

• Non-prescriptive and authentic dialogues facilitate students’ genuine interest in perceiving their older partner as a friend and/or mentor, rather than as a future patient.

• Medical students reported that the program challenged their previously held stereotypes of older adults.

• Holistic authentic learning experience facilitated an increased awareness of their older partner’s lives and life experiences.

• This study’s results suggest that students’ emerging professional identity fosters an empathetic and considerate approach in their care of future older patients.

Intervention-based research has examined this important learning. As medical students’ attitudes have been considered predictors of the quality of older patient care (De Biasio et al. 2016), interventions to improve attitudes have been developed. However, a systematic review of 30 studies found that whilst knowledge-focused interventions increased knowledge, there was no significant change in attitude scores after attitude-focused interventions (Tullo et al. 2010). A subsequent systematic review of 27 studies highlighted that interventions that include an empathy-building component (such as contact with a healthy older adult) were associated with a positive change in medical students’ attitudes toward older adults (Samra et al. 2013). It is therefore suggested that integrating an empathy-building intervention into the medical curriculum may improve students’ attitudes and perceptions (De Biasio et al. 2016).

Furthermore, other studies suggest that early engagement (Wilkinson et al. 2002) with older people living independently during medical training (Ross et al. 2018) positively shapes students’ attitudes towards the older population. The Senior Mentor Program (SMP) model is an example of such longitudinal education (Stewart and Alford 2006) and aims to positively influence the attitudes of future doctors toward older patients (Ross et al. 2018). This model involves the cultivation of interpersonal relationships between older adult volunteers and medical students. Older adults are given the opportunity to offer their personal context in which to help shape and develop students’ knowledge, clinical skills and positive attitudes (Corwin et al. 2006).

Using the SMP model, Curtin Medical School developed the Senior Citizen Partnership Program (SCPP). It involves engaging paired medical students with the same older person or couple in a partnership for the duration of the Bachelor of Medicine, Bachelor of Surgery (MBBS) five-year degree. Whilst the SCPP shares the laudable characteristics of SMP initiatives as cited above, it seeks to encourage personal in-depth connections rather than clinically focused interactions. To the best of our knowledge, the gap that the SCPP addresses is a deliberate creation of a holistic and relationship-building accompaniment where students are dissuaded to view their older partner as a patient. The SCPP’s empathy-building component is reinforced by using the Experiential Learning Cycle of experiencing, reflecting, thinking and engaging (Kolb and Kolb 2018). In this way, the SCPP aims to create a sustained, dynamic, and personalised learning journey based on authentic dialogues and written reflections.

This article reports on a mixed method study that set out to address two research questions during phase one and phase two of data collection:

1. What are students’ understanding of the SCPP’s purpose and how does it impact on their perceptions of older people; and

2. How have students’ SCPP experiences contributed to their learning and medical training?

This article discusses how the SCPP is an example of ‘slow medical education’ (Wear et al. 2015) which may contribute to students’ professional identity formation as doctors-in-training.

Materials and methods

The SCPP

The SCPP is a 5-year longitudinal fieldwork program. Pairs of medical students are partnered with a healthy and active older partner residing independently in one of six retirement facilities. The older partners volunteer for a minimum of 14 visits with the same student pair during the 5-year MBBS degree. All participants formally consent and understand written instructions that students do not provide medical advice. Firstly, the students are not licensed medical doctors; and secondly, the intent of the SCPP is forming a partnership rather than establishing a physician-patient relationship.

Preparation for the first visit begins by providing students with the SCPP Student Guide and giving them opportunity to request clarification of the SCPP coordinator. Students then fulfill mandatory health and legal requirements (such as Police clearances and vaccination certificates). Student pairs are formed next. Together they discuss suggested topics and prompting questions from the SCPP Student Guide to establish initial rapport, demonstrate professionalism and maintain confidentiality. The student pairs arrange visits directly with their older partner, who signs their attendance log. Six visits are scheduled in the first year to establish trust, followed by a minimum of biannual visits for the remaining years.

Students are encouraged to practice their communication skills as taught in clinical skills; establish and maintain rapport; and deepen their understanding of the social, psychological, environmental and health impacts on the life of their older partner. This is guided by addressing the learning objectives within each year. For example, Year 2 students demonstrate inter alia knowledge of the ageing process from a biopsychosocial perspective and older people’s access to appropriate and affordable healthcare.

During Years 1 and 2 (the early clinical years), students submit two reflective reports using the Gibbs Reflective Framework (Gibbs 1988) to address relevant learning objectives. Written feedback is complemented with three debriefing sessions in Year 1, and two sessions in Year 2. Tutors facilitate these sessions during a 90-min Clinical Skills Tutorial. The debriefing sessions allow students to discuss any challenges or negative experiences. They are invited to consider how these integrate into experiential learning and their possible relevance during their clinical years and future practice. In Year 3 and in the clinical years of 4 and 5, students continue to log their visits, although formal reports are not required.

Partnership dissolution can occur because of the older partner’s withdrawal due to ill-health or death. Students are offered counselling. In the case of death, students are granted attendance to the funeral subject to relatives’ permission and encouraged to write a sympathy card thanking the relatives for the older partner’s contribution to their medical training. At a respectful time, a new partnership is formed. If students repeat a year, the student-pair is preserved, and the partnership continues. If taking a leave of absence, continuation of the partnership is strongly encouraged. In rare instances, the remaining student visits the older partner alone.

Design

The research was designed as a mixed-methods descriptive study. It consisted of two sequential phases. Phase One was a quantitative cross-sectional questionnaire, followed by a Phase Two qualitative study of content analysis using the COREQ checklist for guidance (Tong et al. 2007). Curtin University Human Research Ethics Committee approved this study (approval HRE2021-0557). Only students enrolled in Curtin University’s MBBS degree and who had attended at least one older partner visit were eligible to participate.

Phase 1: Quantitative data collection and analysis

All students across the five years of the MBBS degree were invited to participate via the School’s learning management platform. In addition, an Information Statement was provided by clinical tutors in class to interested students in the early clinical years who then voluntarily consented to receive an anonymous Qualtrics® online link to the questionnaire.

Students responded to the questionnaire at their convenience on their own devices, of estimated 20 min’ completion. The questionnaire had 21 questions with Likert-scale responses, including seven items from a validated ageism questionnaire (Cherry and Palmore 2008). These items were selected because they were deemed appropriate to our study population; focus on relationship formation; and had been recently used in a similar study (Rababa et al. 2021). Other items were excluded to avoid repeating similar questions created specifically to evaluate the SCPP and thus reducing response burden. A further amendment was two open-ended questions which gave students the opportunity to comment on their experiences of SCPP. The questionnaire is included in Supplementary Materials.

Quantitative data were analysed using SPSS V27. Likert responses were re-categorised into ‘Agree,’ ‘Neither agree nor disagree’ and ‘Disagree’ groups. Descriptive data are shown as frequencies and percentages, separated by year group. Open-ended responses were systematically coded and categorised (Vaismoradi et al. 2013) into common themes (Willis et al. 2016) using a Microsoft Excel spreadsheet.

Phase 2: Qualitative data collection and analysis

At the end of the questionnaire (Phase One), only students in Year 1 of the early clinical years, and Years 4 and 5 of the clinical years were invited to participate in a focus group discussion (FGD). The exclusion criteria were students who had not responded to the questionnaire and who were in Years 2 or 3. The selection of years at the beginning and latter end of the MBBS degree would most likely identify differences in student experiences of the SCPP and their perception of older people. Students were provided an Information Statement and voluntarily consented if interested.

Prior to conducting the FGDs, the results of Phase One informed the research team about students’ overall perceptions of older people and their understanding of the SCPP’s purpose. This highlighted potential avenues to explore at greater depth and ensured the question rubric remained relevant (Table 1).

Table 1. Focus group questions.

We would like to hear about your experiences with the Senior Citizen Partnership Program. What insights about older people has your partnership provided? How has your partnership contributed to your learning? What else do you think is helpful about this program? What else would you like to share about your experiences with the SCPP?

The FGDs were conducted face-to-face for 50 min by FR, an experienced facilitator. To maximise attendance, FGDs were scheduled to coincide with students’ presence on campus, particularly during formal teaching weeks for Years 4 and 5 of the clinical years. An AUD 50 voucher was offered as acknowledgement of participation. Each FGD was audio-recorded and promptly transcribed verbatim by a reputable third-party agency. Transcripts were re-read with the recordings to ensure accuracy.

FGD data were managed with NVivo®. A six-phase protocol was adopted to thematically analyse the transcripts (Braun and Clarke 2013). All transcripts were analysed by FR, with a cross-section analysed by UH. Data was continually sorted, compared and coded (Fram 2013). FR and UH compared codes to validate independent coding. Preliminary interpretations were discussed amongst the team. Possible connections between code categories were explored to identify relationships that generate themes (Strauss and Corbin 1998). Reference to the transcripts maintained data dependability and facilitated the refinement of themes and subthemes.

Results

Quantitative data

In total, 258 questionnaire responses were received. The majority of responses were from early-clinical Year 1 and 2 students (62.4%, n = 161), followed by students from Years 3, 4 and 5 (37.6%, n = 97). Of survey respondents, a small proportion of students entered the MBBS degree via the rural pathway (16.3%, n = 42) and undertook tertiary study prior to commencing the MBBS degree (13.2%, n = 34). Students were asked whether they had been in contact with older people (e.g. grandparents) prior to participating in the SCPP. Approximately half of survey respondents reported they have been in contact ‘often and very often’ with older people (52.3%, n = 135).

Students’ understanding of the SCPP, its impact on their perceptions of older people and their accumulated experiences were explored. Most students agreed the SCPP provides them the opportunity of a trusting partnership with an older person; increases their awareness about older lives within society; and helps them understand the impact of the social environment for older wellbeing. Furthermore, most students agreed the SCPP improves understanding of the needs of older people and, to a lesser degree, understanding of the influence of earlier lifestyle on older people’s quality of life (Supplemental Table 1).

The impact of the SCPP on students’ perceptions about older people was investigated. A higher proportion of Year 1 students agreed that the SCPP helped overcome initial hesitations to approach older people and gain a better understanding of healthy ageing. Most early-clinical-year students agreed that the SCPP challenged stereotypes, whereas approximately half of the clinical years’ respondents agreed. Students agreed that SCPP supports their better understanding of older people through authentic interaction. This aspect appeared to have made the largest impact across all years irrespective of SCPP participation duration (Supplemental Table 2).

When exploring students’ SCPP experiences, the majority of students enjoyed interacting with their older partner. A higher proportion of Year 1 and Year 5 students looked forward to the meetings with their older partner than other year groups. Compared to other year groups, a higher proportion of Year 2 students agreed that the SCPP allowed them to practice their communication skills learnt in Clinical Skills Tutorials and helped their confidence to care for older patients as a future doctor (Supplemental Table 3).

Qualitative: open-ended questions

Table 2 presents themes and illustrative quotes from content analysis of open-ended responses. Students reported that their partnerships challenged preconceptions; facilitated an enduring friendship that helped build communication skills; and impacted students’ emerging identity as doctors-in-training. Suggested improvements included factoring in students’ location when allocating partners, including additional meetings and a review of monitoring attendance requirements.

Table 2. Analysis of open-ended questions.

Themes and subthemes		Illustrative quotes
Q: What are the SCPP’s highlights for you?
A refreshing encounter
	Challenging bias	Being able to unlearn the prior unconscious judgement or stereotypes I may have had (Year 1)
	A novel opportunity to connect	My grandparents are dead/overseas and I have no other older people in my life (Year 1)
	Story-telling	It is quite eye-opening listening to his stories (Year 1)
Friendship and mentoring
	Wisdom	Their myriad experiences are truly invigorating and intriguing, and their wisdom is engaging (Year 1)
	Authenticity	The interaction feels honest and meaningful (Year 1)
	Enduring friendship	Sharing gardening tips and cuttings, which I grow at home - a lovely reminder throughout the years of our relationship (Year 5)
Contribution to learning
	Understanding healthy ageing	I gained a deeper understanding of ageing, both the positive aspects as well as the more challenging (Year 3)
	Understanding older lives	First-hand information about the different factors that impact the day-to-day life for an older person (Year 3)
	Practicing communication skills	To apply clinical skills knowledge and to reflect upon how I respond to cues that my senior citizen gives me (Year 2)
	Professional identity formation	Helps me prepare for my future career interacting and caring for our older generations (Year 5)
Q: Is there anything else about the SCPP you would like to share?
	A worthy program	I think it was a valuable program, and would recommend it to future students (Year 5)
	Assignment of partners	The location that you live was not taken into account (Year 1)
	Additional meetings	More opportunities to interact (Year 5)
	Review of logging attendance requirements	The log sheet can make my senior feel as though seeing her is an obligation rather than something I really enjoy (Year 2)

Qualitative: FGDs

There were seven FGDs held with 33 students: three FGDs with Year 1 students (n = 14) and four with Year 4 and 5 students (n = 19). Saturation was determined by the sixth focus group (Bowen 2008).

Three main themes were identified: perception of older adults, SCPP’s impact on medical training, and SCPP’s impact on personal development. These are presented in Table 3 with illustrative quotes highlighting the twenty-one subthemes.

Table 3. Main themes and subthemes.

Theme	Subtheme	No. refs	Illustrative quote
1. Perception of older adults			Acknowledgement of perception prior to SCPP	Challenge to perception after SCPP
1.1	Healthy ageing	11	I assumed everyone that’s in a retirement village is in full-time care and they need a carer to look after their bodily functions. Y5FG1FA1*	The program helped me understand how a person who might look unwell on paper, they can still be very well 95% of the time. Y5FG2FA2
1.2	Ageing process	5	I didn’t have a good idea of how age does deteriorate a person at the end. I almost saw it as like, ‘oh well, they’re just not looking after themselves.’ Y4FG1MC2	My senior citizen who, through no fault of his own, had this very big deterioration in his health due to age and conditions and just general loss of function. Y4FG1MC2
1.3	Activity	15	I thought they’d be just sitting at home. Y1FG3FA2	They’re booked up for weeks on end. Y1FG1MC1 She’s a lot fitter than I am. She does like weight lifting, ballet, she teaches dance classes. Y1FG2FC1
1.4	Health literacy	3	I thought like they’re not really knowing much about what a doctor’s talking about. Y1FG1MC3	Her health literacy was very surprising. She knew what she was talking about. Y1FG3MC3
1.5	Up-to-date	10	I felt the older population is generally more conservative and have more traditional beliefs. Y1FG3FA1	When I got to know her, I realized, ‘Hang on a second. You’re actually pretty cool.’ Y5FG3MA4
1.6	Friendliness	13	They just seem a little more approachable than they did before. Y1FG1FX1	Older people can be your friends as well. Y5FG2FA2
1.7	Life challenges	7	I thought, ‘you retire, you get to kick your feet up and that’s it. You’ve had a hard life and now you get to relax.’ Y5FG1MA4	I didn’t realize how much ongoing financial stress older people have. Y5FG1MA4 I probably learned about the loneliness and slowly not being able to do things. Y5FG3MC5
1.8	Individuality	11	I didn’t really properly appreciate that each old person has such a long and rich story behind them. Y5FG3MA4	You really start to see how individual they can be. It really humanizes an entire population of people. Y1FG1FC2
2. SCPP impact on medical education
2.1	Holistic understanding	8	It’s not looking at them [older patients] like a problem to solve but treating them holistically. Y1FG2FC3 Behind every patient number, there’s a person who has a life outside the hospital … when I talk to patients, [the SCPP] helps me to be a bit less goal-and-outcome oriented. Y5FG2FA2
2.2	Empathy	11	You get to see what it’s like walking in their shoes a bit, I guess. And if you know about the elderly people, rather than just seeing slides and reading a textbook, and that’s just going to lead to better care. Y1FG2MC2 His values are so different to mine. However I can see where they’re coming from, of course, but I need to be able to understand and respect that and not make assumptions of any patient I have in the future. Y4FG1MC2
2.3	Building rapport	21	It’s important as future physicians to be able to build those relationships with only a few encounters with your patients, and learn about not just the medical side of things, but also their life in a way that doesn’t make them feel uncomfortable. Y1FG2FA1 It’s one of the hard things of medicine, which is getting to know people quickly and eliciting these concerns that they might not tell you if they don’t know you very well. Y5FG1MA4
2.4	Identity formation	6	They see us as doctors in training even though we, at that point, don’t think that we are fit to wear that crown. So I have learned that we have to conduct ourselves with a certain level of dignity and maturity. Y5FG1MA4
2.5	Setting boundaries	6	There’s a generational gap in what’s deemed appropriate and what’s deemed inappropriate, and I had to navigate that a few times with my senior citizen while keeping the rapport that we’ve built. Y4FG1MC2 You might have a particularly strong stance on things, but you can still take care of every other element of that patient’s care. Y4FG1FC3
2.6	Caring	9	I get it, sometimes you’re busy. But you can take time to just check those [services] and have a discussion with that patient about that, and put that on the discharge letter for the patient’s information. Y5FF3MC6 I'm more likely to check in on my older patients more often, even like on ward rounds, right, you go from one patient to another and you scroll quickly. Y5FG3FA3
2.7	Health systems	13	It’s things like the public health system and he wasn’t potentially the best at navigating it. Y4FG1MC2 Just having awareness about the challenges at home that elderly people face, like ‘do they have access to the support services they need?’ Y5FG3MA4
2.8	Longitudinal	6	You watch their medical history like unveil itself over the next five years, and as you go through med school you learn about the medications they’re on … you’ll actually be able to learn it all like as an experience to like become a good GP. Y5FG3MC4
3. SCPP impact on personal development
3.1	Friendship	8	It’s like hanging out with a friend, but like a grandparent. Y1FGFX1 Like last time he called me, I was having the worst day, and he’s like, ‘would you like to come over for coffee?,’ and it just made a really big impact on me. Y4FG1FC3
3.2	Inspired to take action	8	Sometimes I think, ‘oh, I can’t be bothered doing this thing.’ I kind of remember, ‘oh, she’s got however many conditions, I should probably go do that thing.’ Y1FG2FA1 He literally goes on hikes all the time. He does swimming. He does gym stuff. He does tandem bike. Yeah. And the thing is, he’s blind. I was like, ‘wow, if he can do all these things with the disability and being elderly, I should literally start.’ It’s a challenge. Y1FG3FA2
3.3	Life perspective	8	Speaking with somebody who’s been alive for three times as long as I have has helped me just see things in a little bit of a broader timeframe. And I would say that’s had a little bit of a calming effect on me. Y1FG3MC3 She was diagnosed with multiple terminal illnesses and chronic diseases. She was like, ‘right oh, I've been here 88 years, I'll just crack on.’ If that was said to me, I would be running around like a headless chick. Y5FG1MA4
3.4	Facilitating personal growth	9	This is a great program where 17-year-olds actually learn how to behave like an adult. Y5FG1MA4
3.5	Impact on other relationships	5	I started writing my grandparents letters, but I didn’t before the program. Y5FG3MC5 [SCPP] is like ingraining maybe even more to stay connected as I get older … like everyone has conditions, but what matters for them is that not only are they in pain, they’re in pain alone. Y5FG3MC6

* Y5FG1FA1: This indicates Year 5, focus group 1, female and remaining letters anonymise students.

Theme 1: Perception of older adults

Students shared the insights gained about older adults during their SCPP encounters. They recalled their earlier perceptions of older adults and reflected on how the SCPP had challenged bias. These are contrasted in eight subthemes. Predominantly clinical-year students reported a better understanding of healthy ageing (item 1.1) and the ageing process (item 1.2). Most early-clinical-year students appreciated challenges to stereotypes, including older adults’ functional capacity (item 1.3) and health literacy (item 1.4). The students emphasised that their views had changed regarding how older adults are up-to-date (item 1.5) and friendly (1.6). In addition, the students shared that they realised that older adults had challenges in life (item 1.7) and that they are distinct individuals with a long-life history (item 1.8).

Theme 2: Impact on medical education

The students shared how their partnership had contributed to their learning in eight subthemes. Both early-clinical-year and clinical-year students expressed that the SCPP facilitated a holistic understanding of older patients (item 2.1). This entailed the challenges of confronting diametrically opposed life values and learning to integrate differences whilst maintaining empathy for the older partner’s perspective (item 2.2). The early-clinical-year students valued the opportunity of ‘being able to practice our clinical skills’ (Y1FG1FC1), particularly communication for building rapport, whilst the clinical-year students recounted how they used these skills on their clinical rotation (item 2.3). The clinical-year students reflected that their partnerships had impacted their understanding of themselves as future doctors (item 2.4). They attributed a generational gap and differing points of view to risking negative experiences of the partnership. Nonetheless, they had learnt how to set boundaries whilst still preserving a relationship (item 2.5). The clinical-year students reported increased consideration and a better understanding of older patients’ needs while on clinical rotation, such as spending more time with older patients, checking them more frequently and ensuring they were aware of services on discharge (item 2.6). The clinical-year students disclosed that they better appreciated the challenges faced by older patients in navigating a complex health system (item 2.7). Finally, the students appreciated the five-year journey as longitudinal learning (item 2.8).

Theme 3: Impact on personal development

Students were invited to share other considerations or experiences of the SCPP. The impact on students’ personal development was collated in a theme with five subthemes. Both early-clinical year and clinical-year students reported that their partnership had developed into a caring friendship (item 3.1). Furthermore, when students compared their struggles to those of their older partner, they became inspired to take action in achieving their goals (item 3.2). The students also discovered a broader perspective of life (item 3.3). As undergraduate school leavers, several students realised that their partnership supported them transitioning into adulthood (item 3.4). Finally, some students reported that their partnership had positively influenced their efforts to stay connected with family and friends (item 3.5).

Discussion

Most students understood the holistic approach of the SCPP to fostering an authentic exchange and enduring partnership over time. The early-clinical-years students remarked on the novelty of engaging with older people; their storytelling and wisdom; and how it impacted their perception of older people by challenging their bias. The clinical-years students more likely commented on an enduring friendship and professional identity formation than the early clinical years.

Confirmation of SCPP’s value

Similar to other SMPs, students believed the SCPP offered valuable and positive experiences (Corwin et al. 2006; Heflin 2006). It enhanced students’ understanding of older adults’ healthcare needs and management (Fitzpatrick et al. 2006; Ratner et al. 2022) and the heterogeneity of healthy ageing (Corwin et al. 2006; Heflin 2006; Ratner et al. 2022), particularly as students understood that age-related factors contribute to declining health rather than personal neglect. Students also became aware of the diverse challenges in the daily life of older adults (Kilaberia et al. 2019).

Similar to other SMPs, the SCPP enabled students to practice communication skills (Fitzpatrick et al. 2006; Heflin 2006) and gain confidence when interacting with older people (Alford et al. 2001). As a result of encounters with their older partner, students’ previous stereotypes and negative attitudes were challenged (Fitzpatrick et al. 2006; Corwin et al. 2007; Basran et al. 2012), including perceptions about ageing (Corwin et al. 2006) and cognitive function especially for healthcare decisions (Fitzpatrick et al. 2006; Ratner et al. 2022). Students learned that older people could keep up-to-date (Fitzpatrick et al. 2006; Ratner et al. 2022), maintain functional independence and be socially active (Lu et al. 2010; Ratner et al. 2022).

Comparable to other SMPs, the SCPP provided students with an opportunity to form an intergenerational friendship (Stewart and Alford 2006), for which most expressed gratitude (Fitzpatrick et al. 2006). Several students also felt inspired by their older partner’s role modelling (Fitzpatrick et al. 2006), particularly coping with the challenges of ageing (Corwin et al. 2006; Ratner et al. 2022) while maintaining individual agency (Kilaberia et al. 2019). For some, this challenged them to persist in their personal endeavours. This suggests that the cycle of experiential learning (Kolb and Kolb 2018) impacted students’ personal development through witnessing and reflecting on their older partner addressing difficulties, then considering and engaging with their own challenges.

What makes the SCPP unique?

To our knowledge, the SCPP is likely the only five-year SMP reported in the literature (Ross et al. 2018). It is an example of ‘slow medical education’ (Wear et al. 2015) in a social and relational setting in which each brings their whole self: namely life experiences, backgrounds, beliefs and perspectives. This is supported by active reflective processes (Wald 2015) including real-life dialogue, written reflections and debrief. It is at this site of deliberately created student–older–partner interactions (Konkin and Suddards 2012) that students can build their emerging identity as future doctors (Goldie 2012). This opportunity to attach affective meaning to their exposure to the older generation (Stewart and Alford 2006) can be part of the emotional process of becoming a doctor (Wald 2015). SCPPs reflective processes encourages students to draw these affective and experiential experiences into their intellectual and cognitive domains. The iterative cycle of experience, reflection, thought and engagement (Kolb and Kolb 2018) is extended over the full duration of the 5-year MBBS degree. It is this sustained length of time in a consistent partnership which may allow for future older patient-centred care to be based on empathy rather than reduced to an instrumental search for medical solutions (Kumagai and Naidu 2015; Wear et al. 2015).

To support students’ personal and professional development, the SCPP’s reflective processes have a deliberately carved out ‘space’ which is characterised firstly by safety, separateness and liminality (Kumagai and Naidu 2015). Engaging in non-prescriptive and authentic dialogues facilitates students’ genuine interest in their older partner as a friend and/or mentor rather than as a patient. Secondly, an intentional designation of a time and location enables students to accompany their older partner and attentively listen to their stories (Wear et al. 2015). Finally, the SCPP marks two liminal phases in a typical undergraduate student’s life: initially from an adolescent school leaver to an adult, and ultimately from a medical student to a doctor.

An underlying premise for longitudinal SMPs is that the depth and quality of the relationship between the student and older partner could have a clinical impact (Corwin et al. 2006). This study’s results suggest that students’ emerging professional identity allows an ethic of caring. This was explored in longitudinal integrated clerkships characterized by empathy, meaningful engagement and taking responsibility (Konkin and Suddards 2012). The SCPP similarly sought to incorporate these characteristics. Examples of clinical-years students’ evolving ethic of caring include being receptive to and responsible for the older patients on the wards, namely: ease of establishing older patient rapport; more frequent checking in on ward rounds; active listening so that older patients are ‘heard’; and taking time to discuss the availability of support services at hospital discharge to ensure quality continuity of care.

The challenges of implementing the SCPP include recruiting and relationship management of retirement facilities (SwanCare, 2019); recruiting and managing expectations of older partners; administrative attention to detail in coordinating five student cohorts; and training tutors to provide constructive debriefing sessions. A potential risk is allowing the older partner to be considered akin to a simulated patient. Critical success factors include sustained partnerships; students’ adherence to mandatory health and legal requirements; students’ fulfilling the learning objectives; and on-going support from retirement facilities.

Strengths and limitations

The strengths of this study include the use of mixed methods whereby more than one method of collecting data for the same phenomenon adds validity to the design (Cohen et al. 2011). We acknowledge that the validity of the questionnaire was negated by the selective use of individual items and the addition of study-specific questions. Students participated voluntarily, conferring selection bias. However, sampling spanned all year groups. Furthermore, this study was conducted in one institution and is not necessarily generalisable, particularly schools with a graduate medical program and a different student demographic. Prior perceptions of older adults were recalled retrospectively, introducing recall bias which affects internal validity. To mitigate this, future studies could implement a robust pre- and post-test longitudinal design using validated measures of ageism to examine changes in attitude and perceptions over time.

Conclusion

This preliminary evaluation of the SCPP indicates that it delivers the benefits of other SMPs. New insights suggest that as a form of ‘slow medical education’, the SCPP may contribute to medical students’ identity formation as doctors who are better prepared to provide quality health care for the ageing population.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Funding

This research was supported by an award in 2021 from Curtin Medical School’s Seed Fund. Thanks are extended to Jodie Ween for her review of the manuscript.

Notes on contributors

Ute Hauck

Ute Hauck, PhD, MD, is a Medical Doctor Senior Lecturer at Curtin Medical School and the School of Medicine University of Notre Dame Fremantle. She completed her PhD (Medicine) at Albert-Ludwigs-University Freiburg Germany and was accredited as a Specialist Anaesthetist. To further enhance her educational expertise, Dr Hauck successfully completed the Graduate Certificate of Health Professional Education at the University of Notre Dame Fremantle in 2016. Dr Hauck actively engages in Scholarship and Innovation, such as her development of the Senior Citizen Partnership Program. She is also involved in developing the simulated patient training program for second- and third-year medical students at Curtin Medical School to act as simulated patients for Year 1 students. Dr Hauck is engaged in the Medic Vert research program at Curtin Medical School. Her research interests are in the community engagement of medical students and empowering students to actively contribute to efficient and reflective learning.

Felicity Roux

Felicity Roux, PhD candidate MATS BSc (Hons), is a Research Officer at Curtin Medical School. Her responsibilities include internal monitoring and evaluation of the School’s Teaching and Learning. This involves engagement with medical students to understand and report their learning experiences. She is completing her PhD in Population Health using mixed methods. Her research interests include experiential learning, longitudinal studies and identity formation.

Denise Demmer

Denise Demmer, PhD, BSc (Hons), is an Assessment Officer at Curtin Medical School. She is involved in implementing the School’s written assessment program across all MBBS cohorts and coordinates the workplace based assessment program for Years 4 and 5. She completed her PhD (Medicine) in Epidemiology at University of Western Australia. Her research interests include competency based medical education and assessment, growth mindset, and experiential and reflective learning.