University of Massachusetts Medical School
The Navigator Program is a novel University of Massachusetts Medical School (UMMS) geriatric curricular initiative that targets first and second year medical and nursing students. Initially conceived by a UMMS medical student, the Navigator Program is based around the health care encounters of older patients in the ambulatory setting. Students are paired with older patients, whom they “navigate” through outpatient medical encounters to help the patient more fully understand health problems and treatments.
After completing the Navigator Program, the medical or nursing student learner will be able to:
- Consider the complexity of multiple medical 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.
- Recognize health literacy issues affecting older patients.
- Consider how integrative geriatric care is managed across specialties, particularly cardiology, orthopedics, psychiatry, and oncology.
The pilot Navigator Program was instituted during the 2009-2010 academic year through which 11 medical students were trained as Student Navigators (SNs), serving a total of 22 patients in an outpatient cardiology clinic (http://www.pogoe.org/node/2458). Based on pilot program evaluation data and a student focus group discussion facilitated by geriatrician faculty advisors, the intention of the program has been changed such that each student is now paired with one older patient whom they navigate throughout an academic year in order to provide a more longitudinal patient-centered experience. Geriatrician faculty advisors and preceptors in the UMMS Longitudinal Preceptor Program now allow SNs to see patients in their respective practices while longitudinally following those patients to sub-specialist appointments.
Faculty advisors and student leaders jointly developed a Student Navigator Resource Handbook for the new Navigator 2.0 program, which includes relevant geriatric literature and teaching modules specifically in the areas of effective older patient-physician communication with older adults, geriatric prescribing and medication reconciliation, and geriatric specialty-specific considerations (cardiology, orthopedics, psychiatry). During the academic year, geriatrician faculty advisors facilitate three small group sessions with participating SNs to teach the module.
The Navigator Program 2.0 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.
One of the keys in piloting the Navigator Program at UMMS was the involvement of a Student Navigator Leader, one of the leaders of the medical school’s student-run Geriatrics Interest Group (GIG). The Student Navigator Leader is a second year medical student who is responsible for the day-to-day management of the program, including the oversight of Student Navigator orientation and the collection of all Navigator program evaluation data. (To encourage and support these student leaders, the co-leaders of the GIG receive a modest stipend through our Reynolds grant, in part, for Navigator Program leadership.) Prospective Navigators are recruited through GIG-sponsored luncheons and student group meeting presentations, as well as through direct classmate recruitment by the GIG leaders and members.
Two geriatrician faculty in the Division of Geriatric Medicine, appointed as faculty advisors to the Navigator Program, are responsible for weekly meetings with the Student Navigator Leaders, mentoring student leadership development, and oversight of data collection and analysis.
New SNs are trained jointly by geriatrician faculty advisors and experienced SNs using a “Train-the-Trainers” model. Current Navigators train new Navigators, who are given a newly developed Student Navigator Resource Handbook upon enrollment, which includes professional literature specific to geriatric prescribing, medication reconciliation, effective communication with older persons, and geriatric specialty-specific considerations. The Student Navigator leaders oversee new SN training and meet weekly with the geriatricians for mentoring. The geriatrician faculty advisors facilitate small groups with participating SNs three times during the academic year to teach the modules presented in the Handbook.
Once trained, the SN accompanies their assigned older patient into the examination room, taking notes on a standardized template to document vital signs, test results, assessments, instructions, and medication changes. Immediately following the visit, the SN summarizes the information with the patient (and caregiver) and provides a copy of the standardized encounter form which includes a reconciled medication list that has been signed by the participating physician.
Additional features built into Navigator 2.0 include an exit interview with the patient (and family) to discuss their respective experiences with the program, as well as how the Navigator Program influenced the SN's own communication style and outlook before entering residency. Additionally, the SN is required to navigate their patient a minimum of three times during the academic year to receive credit for participation. It is also expected that the Navigator Program will become an officially sanctioned Optional Enrichment Elective through the UMMS Office of Medical Education.
Four Program Evaluation forms are used in the Navigator Program, and have been revamped for Navigator 2.0 to represent the updated goals and geriatric competencies of the new curricula (three modules in the newly developed Handbook).
- Student Survey
- Patient Survey
- Provider Survey
- Overall Student Survey
Patients are asked to complete an evaluation form, which may either be completed and returned to the SN at the end of the session or later mailed to the Student Navigator Leader in a self-addressed stamped envelope provided to the patient. The Student Navigators are responsible for returning completed evaluation forms to the Student Navigator Leader, who oversees the collection of all evaluation data. The Student Navigator Leader also collects monthly evaluations from participating physicians. After collecting all these various forms, the Student Navigator Leader forwards all evaluation data to the UMMS Division of Research and Evaluation.
For more information on this program at UMMS, go to http://umassmed.edu/AGE/Navigator.aspx.