This study quantitatively and qualitatively evaluated the PAIRS Program’s impact on first year medical student education. Results indicate quantitative improvements in dementia knowledge that are unrelated to prior professional or personal exposure to AD, offering support of the program’s first objective of increasing student knowledge about AD and related cognitive impairment. Qualitative essay results further support this finding, as students reported directly observing cognitive and behavioral symptoms, such as difficulties with memory, verbal fluency, communication skills, and inhibition. The buddy interactions were augmented by group discussion and guest lecturers during monthly meetings with program leadership and staff. Because each student formed a unique relationship with a different patient, discussion of experiences exposed students to multiple perspectives and situations not encountered with their own buddy. Students reported that the guest lecturers covering neuropathology, diagnostic advances, and emerging therapeutic targets complimented their experiential learning. Collectively, these data imply that a combination of formal and experiential education facilitated acquisition of a deeper understanding of AD.
Qualitative findings further support the program’s second objective to enhance student awareness of care and support-related issues encountered by patients and their families. By establishing a personal relationship, students were exposed to the psychosocial challenges of coping with a chronic disease that extend beyond a prescribed set of symptoms. Students reported witnessing the psychosocial and physical impact of caregiving, reflecting recognition of the disease’s impact on the entire family system. Qualitative results suggest program participation increased students’ awareness of the human side of AD and their compassion for elders experiencing dementia.
Results from the reflective essays also support the third program objective, namely enhancing students’ communication skills and patterns when interacting with older individuals. Students reported feeling more comfortable with their communication skills and more confident that their newfound understanding of AD would translate into more compassionate and considerate care of elders. Students reported improved attitudes toward older and cognitively impaired individuals and discussed the value of maintaining respect and optimism when delivering a diagnosis or recommendations. Finally, students described increased awareness of elder-centric healthcare needs and expressed increased interest in or comfort working with elders.
The fourth program objective was to introduce students to career opportunities in geriatrics and related fields. Some students reported that their buddy experiences favorably influenced or even confirmed their decision to specialize in geriatrics or neurology. Other students developed an interest in contributing to AD research, either during medical training or later in their career. Such specialization outcomes will require follow-up of the student cohort, as only 18 of the 45 student participants to date have completed the residency matching process.
Collectively, our quantitative and qualitative findings support the notion that the Buddy ProgramTM
model can be successfully replicated and that this program model enhances first year medical student educational experiences. The program structure compliments a recent progression of medical curriculum toward experiential learning initiatives. Contemporary medical school curricula are dissolving traditional divisions of pre-clinical and clinical training with a trend toward early exposure to practical experience and patient populations
]. In fact, the Liaison Committee on Medical Education recently changed accreditation policies to incorporate service-learning, defined as a structured learning experience that combines community service with preparation and reflection. Medical schools must now provide sufficient opportunities for medical students to participate in service-learning. Our program model not only meets such service-learning criteria but can be replicated by other institutions to enhance their service-learning opportunities.
Innovative educational programs that enhance the acquisition of knowledge, skills, and positive attitudes regarding geriatric healthcare are more important than ever. As life expectancy increases, the demand for physicians qualified to handle complex geriatric healthcare will exceed physicians available
]. Knowledge and skills in geriatric care, regardless of specialty, is essential to providing quality, cost-effective healthcare to elders with chronic conditions, including dementia. Therefore, core medical school training would benefit from geriatric-based programs and sensitization to geriatric issues to ensure competency among future physicians caring for older adults. As an example, senior mentor programs introduce students to healthy community-based elders to help students view aging as a multidimensional process
]. Such programs have enhanced students’ attitudes towards elders
], improved students’ communication skills
], and taught students the value of interdisciplinary care
]. Our findings suggest that the PAIRS Program
and The Buddy ProgramTM
expand the fundamentals of existing mentor programs with a unique focus on needs of older adults with cognitive impairment. Therefore, in addition to fulfilling a service-learning need, the PAIRS Program
responds to the need for medical school curriculum to improve attitudes toward elders.
The present study has several strengths. Our program is the first formal replication of The Buddy ProgramTM
, and our quantitative and qualitative outcomes support the reproducibility of the model for fulfilling the student training objectives put forth. Second, while experiential educational programs between students and elders currently exist, these programs emphasize healthy older adults, often screened to exclude individuals with chronic disease or cognitive impairment. The Buddy ProgramTM
and PAIRS Program
model is among the first to exclusively expose medical students to cognitively impaired elders and represents a unique educational initiative responding to the increased prevalence of dementia and efforts to provide medical students with service-learning opportunities. Finally, the combination of qualitative and quantitative methodology provides a comprehensive examination of program data and extends prior outcomes from The Buddy ProgramTM
In light of our small sample size (n
45) and the purposeful selection of our students, generalizability of our findings to a larger medical student population may be limited. Because only students interested in the program goals elected to apply and the students selected were among the more enthusiastic and committed students who interviewed, it is possible that our participants’ engagement in the program does not reflect that of the average first year medical student. It is noteworthy that comparison of our participants with applicants not selected for participation suggests comparable pre-existing exposure to and personal/familial familiarity with AD. However, it is still plausible that all applicants, whether selected or not selected for participation, are fundamentally different from their classmates who did not apply for the program. Another noteworthy limitation is that while there was a modest improvement on the pre-and post-tests of Alzheimer’s disease and dementia knowledge, the source of improvement is unknown. That is, it is unknown if enhanced knowledge over the academic year was due to the monthly student luncheons with supplemental education, monthly buddy interactions, or some combination of these curricular elements. Themes from the student’s reflective essays support the notion that a combination of the monthly luncheons and the buddy interactions enhanced student knowledge; however, future evaluation methods should attempt to better understand the most valuable element of the program in enhancing student knowledge.
Future directions include continued assessment of the PAIRS Program and expansion of existing evaluation methods. We will continue to track the residency selections for program alumnae with each class of graduating students. In program year 5, we introduced quantitative assessment of changes in students’ attitudes, stigma, and empathy via survey tools pre- and post-program participation. These measures are designed to more comprehensively monitor the development of key elements of humanism in medicine. Research is also needed to evaluate prospective replication of the program model among other student cohorts, such as nurses, social workers, and undergraduate students. Finally, evaluation methods could be enhanced by addition of buddy and care partner feedback.