Geriatric Palliative Care: Do Medical Students' Narrative Reflections After a Hospice Clinical Experience Link to Geriatric Competencies?

Abstract

Since the Association of American Medical Colleges geriatric competencies were released, educators are striving to incorporate them into medical student curricula. The purpose of this study is to examine medical students' reflections after an interdisciplinary, hospice staff-precepted clinical experience, and whether these reflections relate to the geriatric competencies which focus on palliative care. From July 2010 to June 2011, 155 2nd- and 3rd-year medical students participated in a required, half-day hospice experience, with 120 (77%) submitting narrative reflections for analysis. The narratives were analyzed using the constant comparative method associated with grounded theory, followed by consensus-building in an iterative process, to identify themes. Six themes were identified from the analysis of student narratives: demonstrating a new or expanded knowledge of hospice care (79%, 95/120), developing new insights about self and others (74%, 89/120), changing attitudes toward hospice care (63%, 76/120), linking patient needs with appropriate team members (43%, 52/120), understanding patient goals of care (43%, 51/120), and discussing palliative care as a treatment option (27%, 32/120). The authors conclude that a brief, interdisciplinary, hospice staff-precepted clinical experience is an effective model to inspire medical students to reflect on geriatric palliative care. Students clearly reflected on the geriatric palliative care competencies of symptom assessment and management, and gained insight into the role of the hospice team members and how hospice care can be a positive treatment option. Future educators should think about building on this type of high impact learning experience, and developing items to measure application of knowledge gained.

Keywords:

• competencies
• education
• geriatrics
• hospice
• palliative care

Acknowledgments

Funding for the implementation of elements of the Aging Theme in the Perelman School of Medicine were provided by a Donald W. Reynolds Foundation Award. Additional funding support came from the Health Resources and Services Administration (HRSA), Geriatric Academic Career Award K01HP20493-01-01 to Amy M. Corcoran. The information, content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by the Department of Health and Human Services, HRSA, Bureau of Health Professions, or the U.S. government. The authors wish to thank the Penn-Wissahickon hospice staff for precepting students: Meredith Dougherty for logistic support; Dr. Timothy Quill for encouragement; Andrew Jensen, Dana Kozubal, and Asher Schranz for serving as member checkers; and Dr. Ilene Harris for guidance.