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Creating Better Doctors

Would-be physicians learn to care for older people by living with them

Gianna Petrone, 23, had a choice: spend the Fourth of July week with her boyfriend, go to a friend's annual cookout and watch fireworks, or celebrate the holiday in a wheelchair, in a memory care facility, seeing what it's like to be an 83-year-old with dementia. No Facebook, texting or Twitter.

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Student in wheelchair - Learning by Living program sends medical students into nursing homes to learn how older people live.

Medical student Kristen Murphy spent 10 days as a resident in a nursing home. — Photo by Nicole Bengiveno/The New York Times/Redux

The decision was an easy one for Petrone. "There will be other Fourth of Julys, but this is a valuable experience," says the soon-to-be second-year medical school student from the University of New England College of Osteopathic Medicine (UNE COM) in Biddeford, Maine. "No matter what field I choose, I will be dealing with older people and many will have dementia," she says on this midsummer day, speaking from her wheelchair at the Monarch Center memory care facility in Saco, Maine. "I had always hoped to be a compassionate doctor, but now I will have much more understanding of people with this disease, their families, and what it's like to actually live in long-term care."

A treatment plan

In the summer of 2011, Petrone and five other medical students are taking part in a program called Learning By Living. It is the brainchild of University of New England geriatrics professor Marilyn Gugliucci. Started in 2005, Learning By Living places volunteer medical students in nursing homes and assisted living settings for 10 days to two weeks so they can learn first-hand about geriatrics and the life of an older person. They receive no academic credit.

Since the program's inception, 28 people, including 26 medical students, have stayed in 14 facilities in Maine, Massachusetts, New York and Ohio. One of them has checked into three different nursing homes.

"When I was in architecture school, the big thing was green and energy efficiency," says Evan Carroll, 29, of Portland, Maine, who plans to "play" resident this fall so he can design better nursing homes. "I see aging and baby boomers as the new thing I need to know about to be competitive. Learning By Living is part of trying to educate myself. I want to see first-hand what is good about nursing homes and what residents don't like."

Gugliucci's goal is to create a national fellowship program where applicants vie for nursing home placements nationwide. The geriatrician already has a group of medical schools interested in the concept.

How it works

The nursing home staff gives the student a diagnosis — in Petrone's case, it's congestive heart failure and dementia, but it might be a stroke, pneumonia or other age-related conditions — and treats him or her like a regular resident.

Petrone is awakened by staff at 6 a.m. for medication (different colored M&Ms in her case), and has her 24/7 wheelchair and hospital bed on an alarm so they know if she tries to get up (a safety concern). The first few days she's fed pureed food for her "weakened state." Petrone is in a single room, but some "patients" in the program share rooms with residents.

Even alone in her room, she stays in her wheelchair. Other faux patients have had to cart around an oxygen tank (a tube is clasped to their nose, but without the tank turned on), use a special walker for people paralyzed on one side and have help with toileting.

"I expected people to be forgetful, but didn't realize how much they struggle every day with simple things we take for granted," says Petrone. "One resident had to be shown how to put one foot in front of the other to walk."

Next: Attracting medical students to the field of geriatrics. >>

Ordering more geriatricians

A program like this, Gugliucci hopes, not only imbues health care professionals with empathy and insight, but will attract more medical students to the field of geriatrics. At a time when the boomer masses are aging, the ratio of geriatric specialists is falling.

According to the American Geriatrics Society, there are 7,000 U.S. geriatricians, or just one for every 2,600 Americans age 75; most counties have none. In 2030, the figure is estimated to decrease to one geriatrician for every 3,800 older Americans. More bad news: In 2005, 112 medical students entered geriatric medicine fellowship programs; in 2009, it was 86.

Boomers' aging highlights shortage of geriatric doctors

It's a matter of money, and of how much our society fears aging. Salaries for geriatricians are among the lowest of all medical specialties. And working with older patients is a tough sell. "It's amazing how much our society views people based on how wrinkled, debilitated and sick they are. Here our students look beyond it," says Gugliucci. "Can you imagine what kind of care providers they're going to be?"

Rosanne Leipzig, M.D., professor of geriatrics at Mount Sinai School of Medicine, agrees. "Someone young often has little experience in the world, let alone being impaired. The program allows them to see residents as real people." Most medical education, she points out, occurs in the hospital when people are vulnerable, often confused, and unable to communicate or move around. "It becomes easy to forget the humanity. When you live with them in their own environment, it's a very different experience," Leipzig says.

Everyone gains

Having someone from "the other side" with a different mind-set can provide insight to those delivering the care, too. "I think our staff does a great job, but Gianna will help us with fine tuning. We want to make sure we are treating residents with integrity, dignity and respect on a daily basis," says Joline Pothier, executive director of the Monarch Center and a nurse by training.

Facilities waive the $300-$500 daily fee they ordinarily charge residents. Neither the student nor UNE COM is charged for the experience.

Right before they leave, the temporary residents offer feedback to the facility about their experience. "It should be helpful to us," says Cordelia Ives, Monarch's assistant director of nursing, who has cared for Petrone. "I hope she tells everyone what it's really like so they'll have more respect for the elderly and understand how difficult it is to grow old."

Test results

Learning By Living is not a "sweet" little experiment. It is based on a qualitative ethnographic research model. Gugliucci stays in daily contact with her students, monitoring their well-being and reviewing and commenting on journal notes they are required to write at the end of each day. The entries chronicle their activities, interactions and observations. Data collected from students' journals are analyzed.

Next: Practicing medicine differently with people of all ages. >>

The prognosis for the program's effectiveness? Follow-up data after four years show Learning By Living graduates believe that, as a result of their geriatric stay, they practice medicine differently with patients of all ages, not just older patients. Alums report they communicate more effectively with patients, realize the importance of physical touch and being at eye level with older people (in bed, in a wheelchair or on a treatment table), and view them as individuals rather than a collection of diseases.

Even a small dose of nursing home life is life-changing, say students.

Relationships trump age

Petrone had misconceptions before her Monarch Center stay because it was her first exposure to patients with dementia. She didn't expect to have much social interaction "because I thought residents wouldn't remember who I was. Yes, some ask me repeatedly what I'm doing here and I tell them I'm a medical student, but they're very warm. They tell me stories about their husbands, falling in love, and their children," she says.

In the first four days at the Monarch Center, Petrone has become fast friends with Martha (not her real name), a resident down the hall. "She's spunky and cracks a joke a minute and doesn't put others down if they forget something, the way some residents do" even though they also have memory loss, says Petrone."We sit together every night and have ice cream and talk. I look forward to it and think she does, too." After Petrone walks out of Monarch, she plans to visit Martha.

Gugliucci sees close relationships develop in all her placements despite a 60- to 70-year age difference. "After a little while, age and cognitive differences and residents' frailties melt away, and the medical student connects heart to heart with the people they're living with," she says.

So far, no program participants have left early to return to their regular lives. At the end of their stay, in fact, many have mixed feelings about leaving. Michael Light, 23, who spent 10 days at the Maine Veterans' Home in Scarborough, recalls his departure as "bittersweet. I made a lot of friends, and I am going to miss them."

Even a small dose of nursing home life is life-changing, say students. In his journal entry, Light wrote: "I have touched the lives of patients just because I was there to listen. I have helped the staff because I was younger and challenged elder stereotypes. I have helped the medical profession just by wheeling a mile in the shoes of elders and making strides toward better medical education. They have made me a better human, a better doctor."

Those seeking a second opinion about Learning By Living can consult Petrone: "I think every medical school student should do it. You don't learn this stuff in a classroom," she says.

Sally Abrahms writes about boomers and aging. She is based in Boston.

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