Facilitating the Advance Care Planning Conversation with Patients: An Interactive Virtual 1.5-Hour Session.

OBJECTIVES: The Liaison Committee on Medical Education requires that the curriculum of medical schools includes end-of-life care. Most medical students feel reluctant to discuss end-of-life issues with their patients, but would like to learn more. METHODS: We created an educational session on using Five Wishes to facilitate the advance care planning conversation. Third- and fourth-year students were given a brief PowerPoint lecture detailing the importance of advance directives, barriers to advance care planning conversations, approaches for the conversation, and two brief video sample conversations. Students discussed their experiences related to advance directives and role-played a part of an advance care planning conversation. RESULTS: A total of 97 medical students participated in the didactic on advance care planning conversations from May 4, 2020 to October 24, 2020. Eighty-six (88.7%) of 97 students responded to the postcourse evaluation survey. Most of the respondents (96%) agreed or strongly agreed that the session was pertinent to learning needs and that the goals and objectives of the session were met. Ninety-two percent of respondents felt confident about having a conversation with a patient about advance directives and 88% of respondents felt comfortable starting and completing advance directives conversations. CONCLUSIONS: The brief didactic presented here on facilitating advance directives conversations constitutes an easily implemented and well-received session for medical students. Students reported high levels of confidence and comfort around having advance directive conversations after participating in this didactic session.

Twelve tips for teaching social determinants of health in medicine.

BACKGROUND: There has been a recent movement towards social accountability in medical schools, which includes integrating the social, economic, and cultural determinants of health into the curriculum. Medical schools and their guiding bodies have met this challenge of educating future physicians to provide effective care to diverse populations with varying response and successes. Because these topics have not been systematically taught in most medical school curricula, strategies are needed to teach them alongside clinical sciences. AIM AND METHOD: We provide 12 tips on how to teach social determinants of health and cultural competency to undergraduate medical students. These recommendations are based on a review of the literature and our experience in developing and delivering a longitudinal course over the last five years. CONCLUSION: Medical students must be taught to think critically about the social and cultural issues impacting health, and the intersection with the basic biology and clinical skills. Teaching social determinants of health in medicine requires keeping the material concrete and applicable. Educators must engage students in active learning strategies, reflection, and focus on how to make the material relevant to the clinical care of patients.

A community-based approach for integrating geriatrics and gerontology into undergraduate medical education.

Medical school accreditation requirements require educational opportunities in geriatrics. Twenty-six minimum graduating competencies in geriatrics have recently been identified for medical students. The authors describe how these competencies are being integrated into a new medical curriculum through coursework and community-based experiences. This approach is intended to expose students to older adults from diverse communities and adequately prepare students to address the complex and individual needs of these patients. Initial results indicate proficiency in the minimum geriatric competencies covered. The growth and diversity of the older adult population makes it important to integrate and evaluate geriatrics education in undergraduate medical education.

Effects of Exercise and Diet on Body Composition and Physical Function in Older Hispanics with Type 2 Diabetes.

Type 2 Diabetes mellitus (DM2) affects 9.3% of the U.S. population. Health disparities are evident in DM2; twice as many Hispanics as non-Hispanic Whites have DM2. The objective of this study was to pilot test the feasibility of implementing and evaluating trends of nutrition and exercise interventions to improve diabetes management and physical function in 29 disadvantaged older Hispanics with DM2. We delivered combined diet and exercise (n = 8) and diet-only (n = 6) interventions and compared the results to a control/no intervention group (n = 15). We cluster-randomized the participants into the three arms based on the senior center they attended. The interventions were delivered twice a week for 3 months (24 sessions) and assessments were conducted pre and post intervention. The results indicate the feasibility of implementing the interventions and slight improvements in both intervention groups compared to the control group. The diet-only group tended to have larger improvements on body composition measures (especially in muscle mass), while the diet + exercise group tended to have larger improvements on physical function (especially in chair stands). There was a high rate of attrition, especially in the diet + exercise group, but those who completed the intervention tended to have improvements in body composition and physical function.

Exercise and Older Adults.

Regular exercise is essential for healthy aging and offers many health benefits, including reduced risk of all-cause mortality, chronic disease, and premature death. Because physical inactivity is prevalent, greater focus is needed on integrating exercise into care plans and counseling, and developing partnerships that support exercise opportunities. Older adults should be as physically active as their abilities and conditions allow. For substantial health benefits, older adults need to do aerobic, muscle-strengthening, and stretching exercises weekly, and balance activities as needed. Appropriate planning must take account of factors such as prescribed medications, nutrition, injuries, hip and knee arthroplasties, and chronic conditions.