Treating patients with dementia can be viewed as a difficult task for doctors, but Penn State College of Medicine researchers say that storytelling may be one way to improve medical students' perceptions of people affected by the condition. Participation in a creative storytelling program called TimeSlips creates a substantial improvement in student attitudes.
Daniel George, assistant professor of humanities, tested the effects of the TimeSlips program in an elective course he teaches at the college. Fourth-year medical students worked with patients at Country Meadows, a Hershey-based assisted living community. These patients are affected by advanced dementia and live in a memory-support unit requiring a locked environment.
Medical students commonly perceive persons with dementia as being challenging to work with.
"We currently lack effective drugs for dementia, and there's a sense that these are cases where students can't do much to benefit the patient," George said. "The perception is that they're hard to extract information from, you don't know if that information is reliable, and there are often other complicated medical issues to deal with."
TimeSlips is a non-pharmacological approach to dementia care that uses creative storytelling in a group setting and encourages participants to use their imagination rather than focusing on their inability to remember chronologically. Pictures with a staged, surreal image --for example, an elephant sitting on a park bench -- are shared with all participants, who are encouraged to share their impressions of what is happening in the picture. As part of George's elective, medical students spent one month facilitating TimeSlips with groups of five to 10 residents and helping the residents build stories in poem form during their interactions.
"All comments made during a session -- even ones that do not necessarily make logical sense -- are validated and put into the poem because it is an attempt to express meaning," George said. "The sessions become energetic and lively as the residents are able to communicate imaginatively, in a less linear way. In the process, students come to see dementia differently. It is very humanizing, revealing personality and remaining strengths where our culture tends to just focus on disease, decline and loss."
Student attitudes were measured before and after the TimeSlips experience using a validated instrument called the Dementia Attitudes Scale. A significant improvement in overall attitude was observed over the course of the program, and students also demonstrated significant increases on sub-scales measuring comfort with people with dementia and knowledge about interacting with and treating these patients. Results were reported in the journal Academic Medicine.
"In talking with my students, they consistently express their anxieties about medical school training them to see patients as a diagnosis rather than as a fully-fledged person," George said. "An activity like TimeSlips, which emphasizes the creative spirit in people with fairly advanced dementia, helps give students a richer sense of who the person was and what made them tick."
At Penn State College of Medicine, which emphasizes the humanities in medical care and established the first Department of Humanities at a medical school in the nation, George hopes to expand TimeSlips volunteer opportunities to include all medical students and not exclusively fourth-year students. By reaching students earlier in their education and exposing them to a creative activity involving people with dementia, he hopes that TimeSlips could help nudge more trainees into geriatric medicine.
"As the incidence of dementia-related conditions is rising globally, the demand for high-quality, humanistic geriatric care is becoming more urgent," George said.
There has already been an effort to extend TimeSlips volunteer opportunities to nurses, faculty, staff and patients.
"Several patients from our hospital, Penn State Milton S. Hershey Medical Center, have already begun taking part in the program," he said. "Even though they are experiencing their own illnesses, they are able to find purpose in helping another vulnerable population through creative storytelling."
Co-authors of the study are Heather Stuckey, assistant professor, Department of Medicine, and Megan Whitehead, research assistant, Department of Humanities, both of Penn State College of Medicine.
George has volunteered on an advisory board for Timeslips with no financial stake in the project. No funding was provided for this study.