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Highlighting Patient-Centered Care

As the proportion of the population that is over age 65 climbs from 14% today to 22% by the year 2040, the need for health care professionals to understand this diverse patient group will be even more apparent. Within the context of population aging then, it is critical for health profession students to understand that many, or even most, of the patients they encounter in their practice will be older adults. Emory University’s interdisciplinary Senior Mentor Program aims to foster constructive student perspectives towards older persons, not only in their roles as patients, but as active and engaged members of society.

The Institute of Medicine defines patient-centered care as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and to ensuring that patient values guide all clinical decisions”.¹ Interdisciplinary community-based mentoring programs provide students with a unique opportunity to engage with older adults on a personal level and thus offer an innovative approach to teaching effective patient-centered care. The interpersonal and communication skills that are honed by such programs help healthcare providers and trainees to be more sensitive to patients’ needs, values, and the larger social context of their lives.

Good clinical care requires a broad understanding of the human element of aging and health. Classroom instruction is essential to developing clinical skills and providing a solid understanding of the complex physiological mechanisms that underpin the aging process. However, the human experience of health cannot be grasped within the confines of a classroom. Mentoring programs offer an important curricular enhancement for learning outside of the constraints of the clinic and classroom. Students learn to engage with older adults first as people, and to understand the consequences of health problems as they are actually experienced — as messy, complicated, and intimately tied to a patient’s personal history and identity.

This program provides the Senior Mentors with an opportunity to influence health care professionals of the future by contributing a new perspective on aging and patient-centered care to their education.  By flipping the usual health provider-patient power structure, trainees are placed in a position where they begin to see the person behind the diagnosis and learn from them as people.  The students engage with older adults who dispel typical aging myths and have full and busy lives, i.e. lives outside the healthcare setting. Participants begin to appreciate the value of older adults’ ability to remain engaged with their communities, providing valuable insight into the needs and challenges but also the capacities of this rapidly growing patient population. The coming changes in the demographics of the United States underscore the significance of such community integrated aging education programs in preparing the health care workforce of the future.

https://www.youtube.com/watch?v=HQnBol6UQvw?rel=0

Background of the Senior Mentor Program

The Senior Mentor program began in 2011 as a collaborative effort among faculty from Emory’s School of Medicine, the School of Nursing, and Emory College. The goal of the Senior Mentor program was to provide students with inter-generational experiences as part of their clinical health training.  Currently in its fifth year of operation, the program now involves graduate students from the medical school, the physician assistant program, the physical therapy program, and the school of nursing. The program has established lasting ties with community stakeholders across metropolitan Atlanta.  Initial support for the program came from Emory’s Office of University and Community Partnerships, and the federally funded Atlanta Regional Geriatric Education Center.  Critical to the success of the program was recruiting hundreds of older adults from across the city of Atlanta who were willing to meet with health profession students monthly to discuss issues relevant to health, happiness, and way of life. The philosophy of the Senior Mentor Program is simple: older adults are more than the objects of health professions training; they are a resource whose wisdom and experience can help develop better health professionals.

The program pairs first-year students from the medical, nursing, physical therapy, and physician assistant programs with an adult over the age of 65 from the greater Atlanta community. Students meet with their senior mentors at the mentor’s home or other mutually agreed upon venue (e.g. coffee shop, community living center common area), requiring students to step out of their academic comfort zone and engage with their mentors in a less formal, non-clinical, non-academic environment.  Students are provided with discussion topics for each month that are organized into twelve curricular modules, each corresponding to issues of aging and health. The modules are designed to facilitate conversation, highlight similar interests and concerns, and emphasize the value of different perspectives. Module topics include: Nutrition, Friendship, Physical Function, Health Decision Making, Aging Economics, and Interactions with Healthcare Providers. These modules are used as a jumping off point to develop meaningful relationships between health science students and older adults.

Inter-Professional Experience

In addition to bridging the generational gap between students and mentors, interdisciplinary community-based mentoring programs can be a valuable tool for promoting shared experiences among allied health students.  This is the second core component of the Senior Mentor Program. Twenty-first century medical care is increasingly built on a patient-centered team approach in which nurses, physical therapists, physician assistants, and physicians bring their separate areas of expertise together for the benefit of patients.  To deepen interdisciplinary learning opportunities, the program incorporates blogs, online discussion groups, and lunch meetings of students across the health professions schools to discuss their mentor experiences with each other, and to analyze case studies where they can apply knowledge gained both from the program and from the classroom.  In the process, students learn about and gain respect for each others’ training and perspectives.

https://www.youtube.com/watch?v=FMWJ90NKtEo?rel=0

Who Are Senior Mentors?

In this program, a Senior Mentor is a person over the age of 65 living in the Atlanta area, active in their community and committed to nurturing and guiding the next generation of healthcare providers. Participating mentors have described resoundingly positive experiences with the program and the majority of them have re-enrolled to meet with new cohorts of first year health students year after year.  In surveys conducted at the beginning and end of one year of the program, mentors reported reduced concern over experiencing ageism, and in open-ended interviews mentors spoke of how meaningful participating in the program has been to them.²

Marshall and Louise Sussin are “repeat” mentors who got involved with the program as a way to meet people when they first moved to the Atlanta area. They have since kept in touch with three rounds of student mentees long after the requirements of the program have ended. As life long learners and educators, both Marshall and Louise exemplify the values of integrity, honesty, and cross-generational engagement that are the foundation of the Senior Mentor program.  They are sources of wisdom and guidance for first year students who are commonly overwhelmed with the demands of their academic curriculum. They are able to bridge the generational gap between themselves and students, not by pandering to cultural fads and trends, but by authentically and earnestly engaging students in their lives and interests. While each Senior Mentor brings their own combination of culture, personality, and background to the student meetings, all are committed to dispelling myths about aging and fostering communication with future health care providers.

https://www.youtube.com/watch?v=llmYFl3B7As?rel=0

Student Perspectives – Bridging the Generational Gap

Reflections from a second year physical therapy student:

I remember learning about the Senior Mentor program as a first year physical therapy student in our Geriatrics class. I was apprehensive, defiant, and narrow-minded, thinking that in no way would I learn anything from meeting with my Senior Mentor. I was dreading the fact that I had to take time out of my rigorous academic schedule to meet with strangers I did not know. Reflecting back as a second year student, a year older and more cognizant, I can say that I extremely underestimated the value of this relationship.

I was fortunate enough to be placed with two mentors, as well as a medical student, forming a diverse collection of people with unique experiences in life and in healthcare. The very first time we met, my doubts were swiftly defeated as my mentors expressed to me how much they valued our relationship and being able to participate in this experience. From that moment on, I knew that this was going to be something special. During every one of our monthly meetings, we engaged in intellectual discussions, which we all entered singular, with our own perspectives in hand, and left feeling enlightened and more connected. It was no longer about the mentors teaching the mentees, but it transformed into a forum where all opinions were valued and we all learned from one another. It was a bridging of the generation gap: bringing two seemingly different populations together to interact as equals.

This program afforded me the opportunity to hear patients’ perspectives first-hand, which is something that no amount of simulation can reproduce in the classroom. It taught me to silence my preconceptions, remain open-minded, and remember that a patient is a person, not just a job, and each one has their own story to share if you listen closely. Not only did this experience provide me with valuable skills to use throughout my future career, but it also gave me three new friends whom I now regard as family. This experience has challenged me to look at my life through a new perspective, and I have since become a much more positive, insightful, and compassionate person, for which I am truly grateful.

So my advice to any students involved in a similar program – do not treat this unique opportunity for interacting with older adults as merely an assignment to check off your list, because its value extends far beyond that. Enter it with an open mind and two open ears; you never know what you might gain.

The value of mentorship programs for health students and mentors is well recognized within the pedagogic literature.^3,4 To learn more about this unique program please visit Emory’s Center for Health in Aging at http://www.aging.emory.edu/senior_resources/mentor_program.html.

The authors would like to thank Carolyn Clevenger, Nell Hodgson Woodruff School of Nursing, for her vision and enthusiastic work in getting the program started, and Jessica Wilson, Center for Health in Aging, for cheerfully and energetically coordinating all aspects of the program, but especially the recruitment of mentors from the community.  We would also like to thank all of the students in Emory University’s schools of Medicine, Nursing, Physical Therapy, and Physician Assistants, for helping us to make this a better program.  Above all, we are indebted to the Senior Mentors for their wisdom and guidance of the next generation.

1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21^st Century. Washington, D.C: National Academy Press; 2001.

2. Halpin S, Dillard R, Idler E, et al. The benefits of being a senior mentor: cultivating resilience through the mentorship of health professions students”. Gerontol Geriatr Educ. doi:10.1080/02701960.2015.1079707. Published online Aug 7, 2015.

4. Frei E, Stamm M, Buddeberg-Fischer B. Mentoring programs for medical students – a review of the PubMed literature 2000 – 2008. BMC Med Educ. 2010; 10:32. doi: 10.1186/1472-6920-10-32.
5. Kashiwagi D, Varkey P, Cook D. Mentoring programs for physicians in academic medicine: a systematic review. Acad Med. 2013;88(7):1029-37. doi: 10.1097/ACM.0b013e318294f368.