University of Massachusetts Medical School
The Navigator Program is a geriatric education curriculum for medical students based on a service program for older patients. Students are paired with older patients, whom they “navigate” through their medical encounters to help them more fully understand their health problems and treatment. Through this structured curriculum and pre-clinical immersive experience, students gain important knowledge in how to communicate with older patients, the complexity of chronic disease management, medication reconciliation, and the role of family supports. The Navigator Program was developed by the University of Massachusetts Medical School Advancing Geriatrics Education (AGE) program, which is supported by a grant from the Donald W. Reynolds Foundation.
After completing the program, the medical student learner will be able to:
- Consider the complexity of multiple medical co-morbidities, polypharmacy, involvement of family members and/or caretakers, and possible cognitive impairment when communicating with older persons in the ambulatory clinical setting.
- Demonstrate how to accurately reconcile a patient’s medications, including prescribed, herbal, and over-the-counter medications.
- Develop communication skills for effectively relating to older patients and apply them during their clinical years.
- Weigh standard recommendations for health screenings and treatments with the age, functional status, and the goals of care for their older patients.
- Reflect upon the psychological, social, and spiritual needs of their patients with advanced illness and their family members.
- Recognize health literacy issues affecting older patients.
Getting Started – Recruitment:
a) Faculty Advisors – Faculty Advisors work closely with medical students involved in the Medical School’s Geriatrics Interest Group (GIG). One GIG student is appointed the Student Navigator Leader and Faculty Advisors meet bi-monthly with the Student Navigator Leader to offer counsel, review the past month’s Navigator data, and discuss recent evaluation data from students, patients, and faculty. A Student Navigator Resource Handbook is developed by the Faculty Advisors and distributed to new Student Navigators with relevant articles in the areas of effective older patient-physician communication, polypharmacy in the elderly, and the burden of multiple co-morbidities on older patients.
b) Medical student champions – One of the keys to success in piloting the Navigator Program at our Medical School was the early involvement of a student champion, a GIG co-leader who initially conceived of the project. GIG leaders have continued as the Student Navigator Leader, the student in charge of the day-to-day management of the program, orientation of Prospective Navigators, and collecting and collating evaluation data. To encourage and support these student champions, the co-leaders of the GIG receive a modest stipend through our Reynolds grant, partly for their efforts in leading the Navigator Program. Medical student leadership is central to the program, which is designed to promote student leadership development through the mentorship of the Faculty Advisors. To ensure the ongoing training of new Student Navigators, a “train-the-trainer” model is used, with second-year Student Navigators responsible for training entering first year Student Navigators. Students are recruited through GIG-sponsored lunches and presentations at student group meetings, and by direct recruitment of classmates by the GIG leaders and members.
c) Outpatient clinic sites: Initially, we recommend piloting the Navigator Program at a single outpatient clinic site especially receptive to the goals of the program. We identified the physician director of a specialty clinic who has been supportive of geriatrics education. The clinic director recruited other clinic physicians to participate in the program. Faculty Advisors and Student Navigator Leaders meet with all clinic staff, including the nurse manager, nurses, medical assistants, and the desk staff. Space is also an important consideration in clinic choice to guarantee privacy for the student and patient to meet after the doctor’s visit and should be actively sought.
d) Recruiting older patients: Patients are recruited through diverse outreach efforts, including GIG leader presentations at local senior centers, and the distribution of English-Spanish bilingual brochures both as part of these presentations as well as in the participating clinics. An email account and a telephone number with voice mail have been set up for patients to conveniently request a Student Navigator. The Student Navigator Leader is responsible for monitoring both the email and voicemail accounts as well as the follow-up phone calls to patients confirming arrangements for an assigned Student Navigator to be present at an upcoming appointment. Participating physicians can also identify patients in their practice they believe would benefit from the Navigator Program and notify the Student Navigator Leader. Such patients are contacted by Student Navigators several days prior to their scheduled appointment to determine if they would like to participate in the program.