During recent lab sessions in DMU’s Munroe Building, groups of students struggled with their vision, hearing, mobility and dexterity. There wasn’t anything wrong with them; rather, they had to complete a number of tasks while outfitted with vision-distorting goggles, sound-muffling earplugs, tight-fitting gloves and wheelchairs, crutches and wheeled walkers.
In other words, students in these geriatrics labs experienced what older adults live with daily, and they learned how those impairments and restrictions can affect health, quality of life and medical care.
“This lab helped me to better understand the experiences of older adults by allowing me to understand the visual, proprioceptive, auditory and sensory deficits that older adults endure on a daily basis,” wrote Kristina Giddens, a second-year student in DMU’s doctor of osteopathic medicine program (D.O.), in her reflection after the lab. “I learned of not only the difficulties of the tasks I was trying to do while impaired but also of how isolating life could become if dealing with these tasks alone. Daily life would look very differently if I didn’t have the means to walk around the grocery store, get up to go to the bathroom whenever I needed or couldn’t hear the things happening around me.”
Of the lab’s four stations, D.O. classmate Kathryn Doerner said the mobility station to be most intimidating. Students found it impossible or nearly so to open Munroe’s heavy doors long enough to get through on crutches or in wheelchairs, much less navigating the task of going to the Student Education Center (SEC) to fetch a cup of water.
“With just the short distance, I found myself exhausted, not even able to keep my weight completely off of my ‘affected’ leg, out of breath, and with blisters on my hands,” she stated in her reflection. “Beyond that, I was terrified going down the slight decline from Munroe to the SEC in the crutches, and I was afraid the entire time I was outside that I was going to fall or sprain my ankle. What made the experience more powerful was actually watching a woman with a walker, moving just as slowly as me outside, and realizing how lucky I was that I could remove my goggles to make sure I was safe, but that she could not.
“While I was laughing through my fear as I plodded along, I knew that she was likely coping with similar fears every time she had to leave her home, but her fears were so much more real and unavoidable. I felt compelled to stop my activity to go help her to get where she was going safely, because it was the closest I could give her to being able to remove the goggles and fears,” Kathryn added. “I intend to use the feeling that I had in that moment to think critically about preventative care, mobility devices and in general my patience with older adult patients.”
Lab instructor Paul Volker, M.D., FAAFP, assistant professor of osteopathic clinical medicine and a physician/geriatrician in the DMU Clinic, says the lab brings together second-year students in DMU’s D.O. and doctor of podiatric medicine (D.P.M.) programs and first-year students in the physician assistant (PA) program for an interprofessional experience. Over three weeks, 320 students participated in 14 lab sessions.
“Important concepts in geriatrics include the four ‘Ms’ – what matters, the patient’s health outcome goals and care preferences; mobility; mentation; and medication,” he says. “What matters most is taught in a didactic way, but this lab allows students to experience what it’s like to be impaired or disabled.”
First-hand experiences with the challenges of aging have been incorporated in DMU clinical students’ education for years, thanks in large part to Wayne Terry, Ph.D., professor emeritus of physiology and pharmacology. Adviser to the DMU Geriatrics Club for more than 20 years, Dr. Terry played a key role in growing DMU’s annual student-run Senior Health Fair, where people ages 50-plus can get age-appropriate information and screenings. Also an instructor of physiology and advanced cardiac life support courses, he was known for both challenging and supporting students and for reminding students, at the conclusion of the geriatrics sessions he taught, to call their grandparents.
During the recent lab, Dr. Volker and lab co-instructor Julia Van Liew, Ph.D., assistant professor of behavioral medicine, medical humanities and bioethics, roamed the room, asking thought-provoking questions to probe students’ thinking and understanding. At one station, students wearing goggles and tight gloves had to organize a prescription regimen involving six types of “pills” (candies). They struggled with opening the childproof pill containers while gloved and handling the little “pills” with goggle-distorted vision. One of the pills needed to be taken every six hours.
“So when do you go to bed? Are you going to set your alarm to take that pill at two o’clock in the morning?” Dr. Volker asked a student portraying a patient. Turning to the student acting as the physician, he asked, “How many times a day is your patient taking pills? What could you do to simplify this?”
He discussed options with students during a lab debrief, such as prescribing an extended-release medication that wouldn’t have to be taken as often. Also important, he said, is reviewing the patient’s entire regimen to determine whether any medications can be discontinued.
“We label patients as noncompliant when we give them a complicated regimen and they don’t follow it,” Dr. Volker said. “How sick is that?”
D.O. student Royal Cole stated in his reflection that he found the medication station to be “the most eye-opening experience” of the session.
“I can see how terribly easy it would be to prescribe some medication ‘every 6 hrs for breathing,’ and leave it at that – feeling like you’re such a good, compassionate doctor for giving this patient what they need. But it affects the patient and his or her caregiver in ways you may not expect,” he said. “How many trips to the pharmacy are they making a month for refills? Are they really supposed to wake up at night to take this pill? How are they supposed to keep track of all these medications? What are they all for, anyway?
“I came away promising to myself that I will always take some time with the patient when prescribing a new medication – reviewing the medication list; educating the patient and caregiver on when, how and why to take this new one; and taking time to answer questions and address concerns,” he added.
That’s important for older patients who aren’t able to rush through appointments, remember instructions or even hear them correctly. D.O. student Salankara Bandyopadhyay said in her reflection that the lab “impressed upon me the sheer difficulty of living life and doing seemingly simple tasks that I had until today taken for granted.”
“Prior to this lab, although I was somewhat cognizant of the trials that older adults face in their daily lives and in their interactions with medical professionals, I had absolutely no idea how it would feel to actually be the older adult patient in the scenario!” she wrote. “This lab showed me just how important it is to consider the patient’s point of view and to see beyond myself and fully through their eyes.”
She and other students left the lab with a greater appreciation of the importance of enunciating and speaking slowly, if needed, with older adult patients; understanding and being more empathetic with their challenges; listening and being patient.
“In my future clinical work, I will be more patient with older adults and more intentional in focusing on their needs,” Kristina Giddens wrote in her reflection. “Paying attention to the tone and volume of my voice, making sure my clinic is accessible and spending extra time to go over their medications to ensure understanding are a few things I can do in the future.”