22. IMPACT OF MEDICAL STUDENT INTERACTIONS WITH GERIATRIC PSYCHIATRY OUTPATIENTS

Abstract

Introduction

The burgeoning elderly population in the US has catalyzed attention to both healthcare and manpower challenges. For example, since recent reports indicate that loneliness and social isolation in older individuals range from 18% - 33% and are associated with a wide range of adverse health outcomes (including chronic diseases, mental health disorders, cognitive decline and increased mortality), these undesirable and at times painful psychological states have emerged as important psychosocial targets. However, despite the demographic imperative of aging, several reports indicate that interest in geriatric care amongst medical students is generally low, but that exposure to and positive experiences with older adults during education can improve such interest. To address these issues, a unique intergenerational program was developed linking medical students to socially isolated patients being treated in an academic geriatric psychiatry clinic.

Methods

A six-month program called SHIELD (Students Helping Isolated Elders) was launched in the Geriatric Psychiatry Clinic of Zucker Hillside Hospital/Northwell Health in April 2024. Medical students in a Psychiatry Interest Group at Northwell’s affiliated medical college (Zucker School of Medicine at Hofstra/Northwell) were solicited to participate in a friendly visitor volunteer program to non-demented patients with depression and/or anxiety diagnoses occurring in the context of social isolation and loneliness. Twenty patients and twenty medical students (ranging from 1st to 3rd year) were recruited and individual patient-student pairs then linked for in-person interactions. In addition to typical conversational exchanges, students were directed to encourage patient reminiscence, play board games, accompany patients to medical appointments, and act as patient advocates. Frequency of visit guidelines were set between once/week to once/month at a minimum. Qualitative impressions of the program and their interactions with students were solicited from participating patients. At six months, a 5-point Likert-like scale (5 being highest [i.e. most interested] rating) was sent to the medical students surveying pre- and post-program potential interest in careers in Psychiatry, Geriatric Psychiatry and Geriatric Medicine.

Results

Three patients initially signed up for SHIELD but then changed their mind about participating; and another met with a student several times and then withdrew. Three students withdrew from the program citing time constraints and schedule conflicts. Qualitative feedback from patients were uniformly positive, with nearly all reporting that visits were happily anticipated and interactions rewarding. Fifteen of 17 students completed the survey. Pre-program, 33% of students were interested in pursuing a career in Psychiatry; 13% in Geriatric Psychiatry; and 20% in Geriatric Medicine. Post-program 73% of students were interested in a career in Psychiatry; 47% in Geriatric Psychiatry; and 47% in Geriatric Medicine.

Conclusions

A six-month intergenerational program characterized by weekly to monthly in-person visits between paired medical students and socially isolated and lonely geriatric psychiatry outpatients was able to be successfully implemented in urban/suburban communities in metropolitan New York. Following the program, participating medical student surveys extended prior reports that direct and gratifying exposure to non-psychiatric older adults was associated with notably enhanced interest in geriatric careers. Given that current graduates of general psychiatry and internal medicine residencies have alarmingly low respective enrollments in geriatric psychiatry and geriatric medicine fellowship programs, present findings support the importance of early and positive interactions with older patients during medical training to potentially impact the looming crisis in expert gerontological manpower.