Reflections of medical students regarding the care of geriatric patients in the continuing care retirement community.

OBJECTIVE: There is growing recognition that students training to provide care for older adults need to be trained in all settings where older adults receive care, including retirement communities. The purpose of this study was to allow medical students to see older patients living and participating in activities in the long-term care setting and examine the effects that this experience had on the students. METHODS: Medical students were assigned to write an open-ended reflection paper about a community health experience. Forty-eight students wrote their reflection papers on their experience in a continuing care retirement facility. Three independent reviewers examined these reflective narratives for common themes. RESULTS: After analyzing the students' narratives, 6 themes emerged: (1) The initial exposure to dementia, (2) confronting death and dying, (3) the diversity of care and services for the elderly, (4) the cost of care for the elderly, (5) seniors can lead active lives if given the opportunity, and (6) the rewards of the health care team-patient relationship. CONCLUSION: The students' reflective narratives provide valuable insights into how medical students view retirement communities, the physician's role in the care of geriatric patients, the importance of interdisciplinary health care, the cost of care for elderly patients, and their views on dementia and dying. Through this experience, students received valuable lessons about taking care of older adults in the community that their interactions with patients in the hospital and ambulatory medical offices had not provided.

Experience with hospice: reflections from third-year medical students.

Nationally, there is a growing emphasis on experiential education and an interest in palliative care for health professionals. Hospice visits were added to the family medicine community rotation for third-year medical students to provide them with first-hand exposure to the hospice experience. Seven significant themes emerged from the students' reflection papers: (1) the value of hospice and the supportive role of the hospice team, (2) the value of empathy, (3) the distinction between acceptance and resignation, (4) the changing face of hope, (5) an understanding of death as a natural event, (6) the quality of family caregiving, and (7) the role of the physician in caring for the dying. The implications for medical education discussed include the value of home visits as a setting for experiences in palliative care and the effectiveness of narrative assignments for encouraging student reflection.

Cancer risk assessment from family history: gaps in primary care practice.

OBJECTIVE: To determine whether an adequate amount of family history is being collected and recorded by family practitioners to appropriately identify patients at increased risk for cancer. STUDY DESIGN: Retrospective chart audit. POPULATION: Charts from 500 randomly chosen patients, 40 to 60 years of age, were audited. Of those charts, 400 were from a large academic family practice and 50 charts each were from 2 small community family practices in the greater Philadelphia area. OUTCOMES MEASURED: General features of family history taking were recorded, including presence of a family history and date when recorded, evidence of updated family history data, and presence of a genogram. Cancer features recorded included mention of family history of cancer or colon polyps and, if positive, identification of which relative was affected, site of cancer, and age of diagnosis or death. RESULTS: Most charts (89%) had some family history information recorded, and 55% listed a family history of cancer, either positive or negative. Of the 356 relatives affected with cancer, an age of diagnosis was documented in only 8%; of 183 first-degree relatives with cancer, only 7% had a documented age of diagnosis. Two percent of all charts had any mention of a family history of colon polyps. Sixty-five percent of family histories were recorded at the first visit, and only 35% had any updated family history information. CONCLUSIONS: The number and type of family histories currently being recorded by family practitioners are not adequate to fully assess familial risk of cancer. New strategies will need to be developed to better prepare providers for risk-based clinical decision making.