Hartford Trustees Kathryn D. Wriston, left, and Lile R. Gibbons, at a recent reception honoring them as personal supporters of the MSTAR program.
Over the past 20 years, the Medical Student Training in Aging Research (MSTAR) program—a summer internship that draws physicians-in-training into the field of geriatrics and aging research—has supported more than 2,000 medical students.
We celebrated the program’s 20th anniversary and its remarkable record last week with a reception honoring John A. Hartford Foundation Trustees and other individuals who have personally donated to the sustainability of this initiative, administered by the American Federation for Aging Research (AFAR).
Ever since I began working as a program officer at the John A. Hartford Foundation, I’ve tried to do my best to put myself in the shoes of the health professionals with whom we’ve worked and whose education and training historically has been one of our main concerns.
I’ve often found memoirs and other lightly fictionalized accounts to be the best way to get into the culture and daily experience of these health professionals. I’ve read Samuel Shem’s The House of God, countless memoirs of nurses and physicians, and even a very affecting memoir of a nurse’s aide in a nursing home.
One of the tricks of such reading is that we experience what our imagination and the author’s words together conjure in a special state of willing suspension of disbelief. Psychological research suggests that this process of imagination and purposeful lowering of critical skepticism is, in fact, what makes fiction so persuasive and engenders the feeling that novelists understand a truth about human character that other ways of knowing can’t match.
Daniella Schocken, a student at the Icahn School, presents on her research on a Mount Sinai emergency department program that deploys EMTs to help older adults transition home after hospitalization.
What did you do for summer vacation? While many of us head to the beach or elsewhere to relax and get away from it all for a while, 149 enterprising students across the country instead devoted the break between their first and second year of medical school to learning about geriatrics and aging research.
Through the Medical Student Training in Aging Research (MSTAR) program, these future physicians engaged in geriatrics training and a mentored research experience at medical schools with outstanding geriatrics programs.
Last year, I was concerned and puzzled by what looked like continuing and consistent declines in first-year geriatric fellows in Internal Medicine (IM) and Family Medicine (FM) based programs, despite improving financial incentives. This year, there is an abrupt improvement, with first-year fellows in IM and FM rising by almost 20 percent.
It’s funny, the things we remember from our school days. We all have fond memories of friends and favorite teachers, and, hopefully, things we learned and experiences that helped make us the persons we are today.
But what matters most is being able to link your education—lessons learned through study, experimentation, and experience—to your life and your chosen field in a way that helps others. Or, in the case of the new funding portfolio I now oversee, what we call “Linking Education to Practice.”
Communicating with persons and their families about serious illness and complex health care decisions is a skill that requires training and practice just like any other medical procedure, according to Diane Meier, director of theCenter to Advance Palliative Care. Dr. Meier offers health care professionals ten critical steps to follow when having difficult conversations, such as with someone whose scans have shown progression of an incurable cancer.
While physicians, nurses, and others specializing in palliative care — which adds an extra layer of support to provide relief from symptoms, pain, and stress associated with serious illness — can be expected to have mastery over this kind of communication, most health care providers don’t receive adequate training in this essential skill. Delivering “bad news” is something that all health professionals need to be ready to do, in a way that gives patients ownership and control over the exchange of information, focuses on listening to the patient more than talking, and allows people to be the “captain of their medical ship,” just as Dr. Meier describes.
Normally one of the advantages of expecting the worst is that all one’s surprises are good ones. But this year, I am both surprised and dismayed at the new figures on physician enrollment in geriatric fellowship training reported in the December 5 education issue of the Journal of the American Medical Association.
Somehow, despite all of the hullabaloo surrounding health reform, which has done some very good things for pay and attention given to geriatrics and geriatricians, the number of first-year fellows has fallen again from last year’s precarious situation, discussed in Falling Leaves, Falling Numbers.
While the number of internal medicine-based fellowship programs has risen by one (from 104 to 105), the number of first-year fellows has fallen from last year’s reported 215 down to 195, a drop of nearly 10 percent. Similarly, the number of family medicine-based programs has increased by one and the number of first-year fellows has fallen from 64 to 56.
If you have been following our blog series covering the 2011 Annual Report, then you know that our team has captured moving stories from older adults themselves who have benefited from the programs and services funded by the Hartford Foundation. I would like to highlight one such video about Patty, who has dementia but whose family observed a complete personality change in her after she fell and fractured her hip.
Delirium, for the inexperienced health care provider, is hard to differentiate from dementia. Patty was fortunate to have had Dr. Lalith-Kumar Solai, a psychiatrist from the University of Pittsburgh Center of Excellence in Geriatric Psychiatry, as her doctor. He adjusted Patty’s medications and was able to determine that Patty also had an untreated urinary tract infection. With antibiotics, the infection cleared and so did Patty’s delirium. The family was relieved to see their mother return to her usual calm and loving personality.
As the Grants Manager at the Foundation, my access to grantees is mostly limited to the reports they periodically send to us and the occasional evaluation site visit I attend. So, my focus is usally on the numbers: how grantees spend the money we awarded them and whether they are up to date on their requirements. But these numbers giveonly half the story of what we, as a Foundation, fund and how those funds contribute to improving the health of older adults.
Last week, along with many of my Foundation colleagues, I attended an event at the Weill Cornell Medical College featuring the exciting “end products” of one of our projects, the Medical Student Training in Aging Research Program (or MSTAR). The program enables medical students from across the country to learn about geriatric medicine and conduct research projects that aim to improve the care of older adults.
Shown in the picture are seven of the students and their mentors who participated in the program at the Cornell Division of Geriatric Medicine in New York (also a Hartford Center of Excellence in Geriatric Medicine). Their work showed me the wide range of problems that can befall an elderly patient and the solutions that can improve their care and produce better health outcomes.
Looking for a feel-good read this summer? Check out the “Diary of an MSTAR” blog on the American Federation for Aging Research website. The postings from participants in AFAR’s Medical Student Training in Aging Research (MSTAR) program will give you hope that we’ll have future scientists finding cures for diseases like Alzheimer’s and physicians who will have the skills and compassion needed to take care of us as we age.
Take this excerpt from a July 10 post by Jerome Atputhasingam of the University of California, San Francisco. He is one of 140 scholars spending his summer at a top medical school geriatrics division, participating in the MSTAR mentored research, clinical, and educational experience:
When I entered the examination room at the UCSF’s Memory and Aging Center (MAC), I was completely unaware of who I would meet inside. Having just started my MSTAR project, I was only beginning to get a grasp of my environment and barely had a clue about the types of patients seen at MAC. On this particular day, I was greeted by an older aged woman and her husband. As I began to introduce myself, I realized that the woman struggled to introduce herself back to me. She had a hard time speaking words, much less complete sentences.