ࡱ> RUQk g8bjbjZ Z .V8cb8cbk/ .....BBB8zT$B$pb"8886$8$8$8$8$8$8$$a&)\$.8"88\$..q$8v..6$86$:",n# # "$$0$#R)\)n#).n#8888888\$\$888$8888)888888888 B : Learning by Living Project: Nursing Home Immersion Life Altering Nursing Home Immersion Research and Medical Education Project Introduction: The 91AV College of Osteopathic Medicine Learning by Living Project (referred to as Learning by Living in this prcis) was piloted in 2005. It was designed and implemented as an experiential medical education learning model by the Director of Geriatrics Education and Research within the Medical Schools Department of Geriatric Medicine. Since its inception, medical and other health professions students have been admitted into nursing homes to live the life of an elder nursing home resident for approximately two weeks 24/7 (24 hours a day/7 days a week) complete with a medical diagnosis and standard procedures of care. Thus far, thirty-eight medical students, two social work students, one gerontology student, and one architect have participated in the Learning by Living project in fourteen nursing homes in four northeastern states (NY-Maine). As of 2020, the project has been on a hiatus due to COVID. Purpose: The purpose of the Learning by Living Project is to provide medical students and other health professions students in training with firsthand experiences of living the life of an older adult nursing home resident to answer the question: "What is it like for me to live the life of an older adult nursing home resident?" And from this experience, be thoughtful about how the answers to this question can aid the student in becoming a better physician or health care practitioner. Background: Until this project, Long Term Care education in nursing homes was accomplished through traditional medical education methods~ episodic encounters in the environment with no continuity. According to White (2008), Long-term care services represent a growing aspect of our medical system that receives little attention in medical education (pg 75). Furthermore, medical student training and experiences in nursing homes is often viewed as negative, which mirrors the views expressed by the general public (White, 2008). The truth is, in our society, nursing homes receive negative attention. This project is based on two premises for medical education in nursing homes: (1) older adults residing in nursing homes are human beings deserving of good care, respect, and community connection; and (2) medical students can attain medical care skills including advanced relationship building skills with older adults from living the life of an older nursing home resident. Story Behind Project Inception: In 2005, the first medical student was admitted into a Maine nursing home to live the life of an elder nursing home resident. After a lecture by Dr Gugliucci to first year medical students at the 91AV College of Osteopathic Medicine (91AVCOM), a 23-year-old female medical student expressed a desire to learn how to speak with institutionalized elders. There was a pregnant pause as Dr Gugliucci mentally assessed what the student was asking and realized stating the obvious you would talk with older adults as you would talk with adults in general, was not the answer to augment student learning. Instead, Dr Gugliucci asked the student if she would live the life of an elder nursing home resident for 2 weeks so she could ascertain her own answer. The students eyes grew large and then she agreed. Rana Wakim, MS I, was admitted into Cedar Ridge Nursing Home in Skowhegan, ME in June 2005 as if she were an older adult. Each summer since then, Dr Gugliucci has admitted students into nursing homes, with one student spending 10 weeks living the life of an elder resident in 3 different nursing homes to fulfill a college gerontology internship experience. Project Details: Targeted population and geographic area: This program is intended to provide medical students in training with firsthand experience of living the life of an older adult. Maine nursing homes were initially utilized; however the program has expanded into 4 states. Although this program was designed for medical students, other health professions students now engage in the experience. Those in graduate level education are preferable; students need to be 21 years of age. Each student resides in the nursing home for 10-14 days 24 hours a day, 7 days a week. Process: Medical students (as well other students and an architect) volunteer to conduct this research. They are asked to fill out a form that lists demographic data as well as their assumptions about older adults and nursing homes. The student is oriented by Dr Gugliucci, who also orients the Nursing Home administrator and select staff prior to the students admission date. As part of ethnographic data collection methods, students are required to write a journal starting 3 days before admission (pre-fieldwork), while living in the nursing home (fieldwork), and for 3 days after discharge (post-fieldwork). While the student is living in the nursing home, Dr Gugliucci reviews student notes and maintains contact with the student during his/her stay as a daughter might for an elder parent. Constant review of students field notes is critical to ensure data collection is effective and meets qualitative research standards. This process also monitors each students well being as s/he experiences a new culture. Based on past developments in qualitative ethnographic research and in this project in particular, the 10-14 day period assists with: (1) allowing the nursing home staff and residents to become desensitized to the new resident (the student) so that daily activities fall into routine again (days 1-3); (2) allowing the student to experience the changes in shifts from weekdays to weekends (days 1-8); (3) providing the student with feeling that they are part of the culture (days 6-14); and (4) permitting time to build relationships with residents in the nursing home (days 8-14).To date, nursing homes have provided a bed, meals, activities, and care at no cost; they participate in the student debriefing session at the day of discharge and receive a copy of the completed journal. Data Analysis: Data for this project are collected in the form of subjective and objective note taking (field notes). Data (students quotes from their notes) are analyzed and categorized into themes revealing key impressions and experiences of life lived as an older adult nursing home resident, relationships formed, and lessons learned. Evaluation is ongoing as data continues to be collected with each new student admission. Project Outcomes and Assessment: To date, all students have completed their extended stay successfully and stated that this experiential learning project provided life altering medical education. Longitudinal data reveals that students maintain patient-centered attitudes and skills such as the use of eye contact, touch, body position, and voice cadence with patients of all ages. Barriers to working with older adults are decreased; understanding is gained by walking in an older persons shoes. Key factors in medical care knowledge learned by this experience are: (1) importance of physical touch when working with patients; (2) enhancement of communication by being at eye level with the patient, whether they are in a bed, a wheelchair, or on a treatment table; (3) communication with authenticity and sincerity ~ the importance of being comfortable within and sharing that with patients; and (4) connection with and treating the person rather than the diseases or frailties s/he presents with. These are remarkable lessons learned within a 2-week span of time and have been shown to be maintained as students continue their clinical training in medical education. Nursing home administrators expressed that the staff learning resulting from this experience works better than many of their in-service training sessions on care of elder residents. Having a student live the life of an elder resident raises consciousness for all involved and in past cases has resulted in nursing home environment enhancements for their residents and increased staff sensitivity. The fact that the students were so into their roles enhanced staff sensitivity and compassion. This was real and provided a window of opportunity to learn from the inside out (Administrator, Sarah Neuman Home). It appears that 91AV COM is currently the only medical school in the country (possible worldwide) to be admitting students into nursing homes for extended periods to live the life of an elder resident. This program was recognized with the: Society of Osteopathic Medical Educators (SOME) Marguerite Elliot Innovations in Clinical Medical Education Award ~ American Association of Colleges of Osteopathic Medicine. Peer Reviewed award for Learning by Living: Life Altering Nursing Home Immersion Research and Medical Education Project, 2013 There have been multiple publications and media coverage on this project. Some notable media are the New York Times, Boston Globe, CBS Evening News and Sirius World Wide Radio. One publication was jointly written with the Nursing Home president and Dr. Gugliucci: Gugliucci, M.R. & Weiner, A. (2012) Learning by Living: Life Altering Medical Education through Nursing Home Based Experiential Learning, Journal of Gerontology & Geriatrics Education, Vol 34/Issue 1,(60-77), DOI:10.1080/02701960.2013.749254. The other publications were written by students with Dr. Gugliucci. _______________________________________________________ Footnote: White, H.K. (2008) The nursing home in long-term care education, JAMDA, 9:75-81. Select Media Links: Aging Without Wrinkles Radio Show, Alliance, OH, Host: Harriet Traimer. Discussion Topics: Learning by Living Nursing Home Immersion Project and the 48 Hour Hospice Home Immersion Project. October 5, 2016  HYPERLINK "https://www.youtube.com/watch?v=hsIeiBzGwbY&feature=youtu.be" https://www.youtube.com/watch?v=hsIeiBzGwbY&feature=youtu.be Bangor Daily News, Bangor ME, Authors: Joshua Allen, OMS III & Marilyn Gugliucci, PhD. Opinion Editorial Article Title: What a medical student learned after living in a nursing home for 10 days. August 26, 2016.  HYPERLINK "http://bangordailynews.com/2016/08/19/opinion/contributors/what-a-medical-student-learned-after-living-in-a-nursing-home-for-10-days/" http://bangordailynews.com/2016/08/19/opinion/contributors/what-a-medical-student-learned-after-living-in-a-nursing-home-for-10-days/ CBS Nightly News, (November 26,, 2010) CBS News Correspondent: Jim Axelrod, Producer: Andy Wolff; Story on Learning by Living Project featuring M. Sharbaugh, 91AVCOM MS II, Chelsea Soldiers Home, Chelsea MA; S. C. Kim, UMDNJ MS IV, Jewish Life Care Home, Manhattan, NY; and M. Gugliucci.  HYPERLINK "http://www.cbsnews.com/stories/2010/11/26/eveningnews/main7092796.shtml" http://www.cbsnews.com/stories/2010/11/26/eveningnews/main7092796.shtml The DO Journal (March 29, 2011)  HYPERLINK "http://www.do-online.org/TheDO/?p=50291" \o "Matthew E. Sharbaugh, OMS II, hopped in his truck and set off to sign into a nursing home." Age-old insights: 91AVCOM student experiences life inside a nursing home.  HYPERLINK "http://www.do-online.org/TheDO/" http://www.do-online.org/TheDO/. Osteopathic Medical Student Spotlight Article. Boston Globe, Metro Section, (July 19, 2010) Learning by Living Project Article entitled: Hes Not a Patient, But Plays One for Class: Medical Students Learn Geriatrics in Role of Patient. Staff Writer: June Wu. Note: This article was posted on 200 websites, pp.B1 &B3. New York Times Article, Health Section, (August 24, 2009) Learning by Living Recognition: Experiencing Life, Briefly, Inside a Nursing Home, ~ Learning by Living Project designed and implemented by M Gugliucci: Medical students live the life of an elder nursing home resident for 2 weeks (24/7). Article in the NY Times was reprinted in 181+ newspapers nationally.  HYPERLINK "http://www.nytimes.com/2009/08/24/health/24nursing.html?_r=0" http://www.nytimes.com/2009/08/24/health/24nursing.html?_r=0     Marilyn R. 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