Medical Student Education

Alzheimer's Disease Summer Externship
The WAI offers an eight-week long summer externship for first year medical students at the University of Wisconsin School of Medicine and Public Health and the Medical College of Wisconsin. Medical students are paid a stipend at the end of the experience and financial support is provided to the clinics involved for their staff's involvment. Click here for the 2008 summer externship online application...

The externship addresses an urgent health concern affecting all of us—the need to educate medical students in the diagnosis and management of persons with Alzheimer’s disease (AD) and related dementias. Studies indicate that almost one-half of persons with AD go undiagnosed and therefore untreated. In a statewide needs assessment, physicians cited lack of knowledge about the diagnostic process, lack of a cognitive or diagnostic screening tool, inadequate reimbursement and the structure of primary care practice as major barriers to the diagnosis and treatment of dementing disorders. In a recent study at the University of Wisconsin’s Department of General Internal Medicine and Geriatrics, almost one out of every five “healthy adults” over the age of 65 was found to have unrecognized AD or mild cognitive impairment, a precursor to AD. The externship introduces medical students to the issues associated with diagnosing and treating AD as well as the need to provide adequate support and education to family members. It provides medical students with unique experiences that they will not receive throughout the rest of their education, but which is essential if they are to adequately care for the 10% of their patients over age 65 that will be affected by dementing illnesses.

Staff from WAI-affiliated dementia diagnostic clinics serve as preceptors to the students. Each clinic varies in geographic location, the number of patients seen, the composition of the interdisciplinary team, and the culture of those it serves. The extern is exposed to a variety of experiences by spending a few weeks at each clinic and working side-by-side with various physicians and interdisciplinary health care teams. In addition, the extern accompanies physicians and nurse practitioners on nursing home rounds, visits adult day and senior centers, and attends AD support groups. This provides the extern with an example of a physician’s day-to-day responsibilities as well as the importance of building relationships with patients, their families, and other health professionals, and provides an overview of resources available in the community. The extern also completes reading assignments during the experience.

Impact of the Externship: Because of its disease-specific nature, it is important that the extern be genuinely interested in working with this population and learning about AD. The impact of the externship in a student's medical training and for their future in health care is best summarized in the following statements from a past extern:

This externship turned out to be one of the most touching and enlightening experiences of my life. The Wisconsin Alzheimer’s Institute provided me with a rare opportunity to spend time in clinic, at not just one, but several different locations throughout Wisconsin. In my eight weeks, I managed to fit in memory clinics, numerous outpatient clinics, nursing home visits, day center visits, Hospice home visits, caregiver support groups, education about community resources in different locations, and so much more.

Alzheimer’s Disease is a topic that hits particularly close to home for me, because my grandfather, who has lived with my family for the majority of my life, has been diagnosed with it. Luckily, he is still relatively early on in the disease, and he still lives at my house, with my mom being his primary caregiver. During this externship, I was exposed to people similar to him, people in earlier stages than he is, and people in much more progressed stages of the disease.

I had countless other interactions with people who were at all different stages of dementia, and it was truly remarkable to learn how each person responded best to different tactics and treatments. I was impressed to see how each of my preceptors dealt with patients with AD in clinic. The respect and care that they all showed is something that I will not soon forget, and will do my best to take with me through my career. It was also incredible to learn how drastically caregivers have to change their daily lives based on how far along their loved one’s dementia is, and I was astounded at how selfless the caregivers I encountered were. To see from a different perspective what my mom has to go through when she takes care of my grandpa made me realize just how difficult it is to be a caregiver and what a remarkable person it takes to carry that title.

Prior to this summer, I did not realize how broad the spectrum of dementia is. My numerous interactions with patients, clinicians, and caregivers have given me a new respect for people whose lives are touched by AD. This externship has allowed me to grow in so many ways. It has enhanced my clinical skills, my interpersonal skills, and it taught me a tremendous amount about disease processes and aging as well as caring for the diseased. In fact, I am pretty set on doing Geriatric Psychiatry. But who knows…I’m still so early on in training I have plenty of time to change my mind. But I definitely plan on doing something with the geriatric population.