Integration of Geriatrics and Palliative Medicine Into a Medical Student Clinical Reasoning Curriculum

Abstract

Introduction: Integration of geriatrics and palliative medicine principles into preexisting medical student curricula is imperative to train future physicians to care for older adults and those facing serious illness.

Methods: We developed a case of an older adult presenting with a change in mental status within a preexisting small-group case-based interactive clinical reasoning curriculum. The 1-hour and 50-minute session embedded the 4Ms framework (mentation, medications, mobility, and what matters most) in a clinical case to allow students an organic opportunity to apply the 4Ms in practice while using their communication, clinical reasoning, and hypothesis-driven physical examination skills. Students and faculty completed an end-of-session survey, and each small group's differential diagnoses were reviewed.

Results: Seventy-five second-year students and 26 faculty participated in the session. On retrospective pre-post surveys, student confidence in all the learning objectives significantly improved. Both students and faculty felt that the integration of geriatrics and palliative medicine was effective. Students valued the topic, appreciated the pedagogical approach and the relevance to clinical preparation, and identified opportunities for continued learning. Students' differential diagnoses demonstrated application of components of three of the four Ms in the 4Ms framework (mentation, medications, and mobility). Notably, many learners did not apply the fourth M (what matters most) to the case without prompting.

Discussion: This curriculum was well received and effective and can be easily adapted for use with various levels of learners. Faculty should look for additional opportunities to integrate content into preexisting curricular structures.

Keywords: Application; Clinical Reasoning/Diagnostic Reasoning; Geriatrics; Hospice & Palliative Medicine; Integration.

Figure 1.. Retrospective pre- versus postsession student confidence ratings on a 5-point Likert scale (1 = not confident, 2 = slightly confident, 3 = moderately confident, 4 = confident, 5 = very confident). N = 72. For all comparisons, p < .001.

Figure 2.. Thematic analysis of student exit surveys. Abbreviations: MOLST, Medical Orders for Life-Sustaining Treatment; PE, physical exam.

Figure 3.. Faculty assessment of how effectively the learning objectives were accomplished as rated on a 5-point Likert scale (1 = not at all effectively, 2 = a little bit effectively, 3 = somewhat effectively, 4 = very effectively, 5 = extremely effectively). N = 23.