The Undergraduate Gerontology Internship 

[Excerpts taken from the article "Learning outside the classroom: The undergraduate gerontology internship" by D. D. VonDras and K. Miller (2002),  Educational Gerontology, 28, 881-894.]

The undergraduate internship emphasizes the development of mentoring relationships with the professional in the field as well as with the sponsoring professor so that the student may integrate theory and practice in ways that promotes deep understanding and fosters personal growth.

The undergraduate gerontology internship administered through the Human Development Program at the University of Wisconsin-Green Bay requires the student to spend at least 100 hours over the course of a semester at the internship site, read assigned articles, keep an activity diary, and write a formal report. To insure that students are appropriately prepared, individuals applying for an internship should demonstrate academic excellence (e.g., have a 3.0 cumulative grade point average and a 3.25 grade point average in at least four human development, psychology, or related field courses) and be of junior or senior standing. These criteria suggest that the student possesses intellectual resources and a relatively mature understanding that will afford their continued learning outside the classroom and success in the internship.

Selecting an Internship and Onsite Supervision

There are many areas where an undergraduate gerontology internship may be served. Adult-day care centers, nursing homes, hospitals, rehabilitative and geriatric medicine centers, community outreach services, and human resource offices of local businesses all provide a wide range of activities and opportunities for student involvement and learning. These sites also provide a variety of professionals and staff with whom the student may interact. Excellent onsite supervision is essential in providing an optimal experience for the student. Prior to the internship, the student should be encouraged to make contact with a potential onsite supervisor so as to develop professional rapport, and develop a list of learning goals to insure the performance of meaningful activities that will be closely monitored. Long et al. (2001) listed questions useful in evaluating potential student internship sites and activities. Three key aspects of a potential internship site to evaluate include whether or not there is a wide range of high quality experiences to meet the learning objectives of the student internship, whether or not the institution is in good standing with outside supervisory organizations and the onsite supervisor is professionally accredited, and if there is an environment where the student will come in contact with appropriate role models, find enthusiastic support for their internship, and receive constructive feedback (Long et al., 2001). It is important that all parties endorse the philosophy and goals of the internship (i.e., an opportunity for the student to integrate theory and research with "real world" experiences and practices, develop professional skills, and enhance personal growth). 

Learning Goals

 In general the learning goals of the internship are to assist the student in integrating theory and research learned in the classroom with the practical experiences encountered in the internship. In practice, specific goals will vary from individual to individual. Ideally, however, the internship will provide opportunity for the transfer of learning from the classroom to professional career area, where skills and knowledge may be extended beyond the narrow contexts in which they were initially learned (Bransford et al., 1999). Initial conversation and discussion of student's learning goals should occur prior to the internship, and these goals should be scaffolded according to the student's abilities and skills. Bloom's (1956) taxonomy of educational objectives (i.e., knowledge, comprehension, application, analysis, synthesis, and evaluation) is a useful model for both the student and professor to discuss as they consider learning goals of the internship. Within each of Bloom's (1956) categories there is opportunity for new learning, but there is also an ascending hierarchical progression from the fundamental educational objectives of acquiring knowledge, developing comprehension, and making use of knowledge in application, to the more complex educational objectives of analysis, synthesis, and evaluation where knowledge may be critiqued and considered from many different perspectives and reassembled to solve problems. These former educational objectives reflect fundamental goals of any active-learning experience, where as the latter educational objectives may be considered important goals to strive toward in an undergraduate internship or pre-professional graduate school internship. Importantly, the fundamental learning goals and experiences of an undergraduate internship should help the student develop a greater awareness and in-depth understanding of gerontological issues and practices. A scaffolded list of potential learning goals for an undergraduate internship in a nursing home, juxtaposed with Bloom's (1956) taxonomy of educational objectives, is shown in Table 1. Importantly, the learning goals listed in Table 1 are not exhaustive, but rather represent potential beginning points scaffolded to more complex goals to consider in developing internship learning goals with students.

To further enhance the quality of the internship experience, opportunities for verbal and written reflection should be provided. A regular, one hour, bi-weekly meeting of the student with supervising professor to discuss internship experiences and relevant issues is important to promote critical reflection. 

An assigned list of readings is recommended so as to provide additional information about the professional area and specific information about important skills, topics, and issues relevant to the internship. The continued development of the student's writing and scholarly expression of ideas should be facilitated by an internship diary and a final internship report. The internship diary is a compilation of the student's daily internship experiences, in which the student may informally describe and discuss activities, ideas, and feelings. The final report of approximately 20 to 40 pages in length, is intended to provide additional intellectual insight and growth as the student reflects, rethinks, and summarizes experiences in a more formal and scholarly style of writing. This final report also provides evidence indicating the degree to which the student attained important learning goals of the internship. An example of an undergraduate gerontology internship, depicting comprehension, application, analysis, and synthesis of knowledge integrated with internship experiences, is presented in the following section.

A Case Study: Insights from a Student Gerontology Internship in a Nursing Home Unit Caring for Individuals with Alzheimer's Disease and Related Disorders

The second author interned as an Assistant Activities Director in a nursing home unit that cares for residents with Alzheimer's Disease (AD), as well as individuals suffering from Parkinson's disease, strokes, and other health problems. The internship was served over five consecutive months, from August through December, 2000, and constituted more than 200 hours of supervision. Primary duties were to facilitate residents' participation in a variety of activities (e.g., reminiscing, socials, sing-along, exercises, everyday tasks, games) and to conduct one-on-one visits with residents who were unable or unwilling to participate in activities so as to ensure that they had some social contact and cognitive stimulation during the day. The goal of providing activities for nursing home residents' is to incorporate physical, cognitive, and sensory stimulation, as well as time for socialization throughout the day (Winograd, 1985). In order to accomplish this goal, residents' participation in the activity should always be voluntary, have some clear purpose and relevance (e.g., exercising to increase blood circulation, time to share personal feelings, opportunity to make new friends), and provide some satisfaction when finished (Zgola, 1987). As observed during the internship, residents suffering from a dementing disorder are likely to forget many things, including the various steps of any activity instruction. Therefore, simple instructions given one at a time and repeated when necessary, help residents stay on task and engaged in the activity. Positive reinforcement in the form of verbal praise is often an effective way of assisting residents in taking part in the activity. It was a common observation that activities that allowed residents the opportunity to talk about their lives and interests helped to increase their feelings of self-worth. Some residents experienced depression and feelings of inadequacy because they had difficulty with, or could no longer take part in, activities of independent living such as cooking, dish washing, cleaning, and straightening magazines. All of these activities, however, are tasks that many residents were still able to assist with in the unit. For example, several residents were able to help in folding napkins before lunch or straightening up after a social event and often expressed enjoyment in doing so. Homemaking activities such as baking and gardening also provided residents the opportunity to participate in everyday activities they used to perform. Thus, involving residents in simple everyday tasks allowed them an opportunity to gain some sense of being included and needed.

Residents exhibited a wide range of behaviors. Some residents suffering from AD exhibited aggressive behaviors or other emotional and behavioral problems. Although this may be due to the underlying neurological disorder, it might also be a result of the individual's inability to instantiate a sense of purpose and life structure for self (Holm et al., 1999). Wandering was observed in both ambulatory and wheelchair-bound residents. Research by Logsdon et al. (1998) suggest that people with AD may wander for several reasons, one of which is because they lack something constructive to do. Other residents exhibited agenda behavior (Logsdon et al., 1998) and were wandering to go somewhere. For example, some residents were going on a trip, others to see their children, and some to see their parents. Several residents were frequent wanderers, who at times could be redirected to a structured activity that offered some behavioral consistency as well as an outlet for any negative emotions that they may have been experiencing.

Another phenomenon observed was sundowning. Sundowning refers to increased agitation, delirium, and activity near evening and continuing throughout the night (Thorson, 2000). Many of the residents who attended weeknight activities were sundowners. Nighttime activities were often difficult to manage because as some residents became increasingly restless and agitated, it was difficult to continue to keep them engaged in an activity. Most residents seemed to enjoy music, however, and even those who were extremely restless could sing and dance, which often tired them (see, Clark, Lipe, & Bilbrey, 1998, Kydd, 2001, for examples of how music therapy may be beneficial in treating or managing dementia symptoms).

It was also observed that although residents suffered from AD or some other physical or mental disease, they all seemed to retain some portion of their identity. Aspects of personality and a unique personal history were clearly evident in residents who still functioned at a relatively high cognitive level. Those who had progressed to the later stages of AD still maintained aspects of personality, although it became more difficult for them to express themselves. Each individual possesses a unique personal orientation to the activities and social experiences they become involved in, and it is important for family members, staff, and students to realize this individual uniqueness when interacting with the residents.

Reminiscence is one activity indicated as an intervention for patients with AD (Gamroth, Semradek, & Tornquist, 1995). Although most people who suffer from AD have significant memory impairment, they do recall some remote memories. Thus, reminiscence provides individuals suffering from dementing illness the opportunity to express their unique personhood as they share memories and realize, even if it is only for a short period of time, that they have a history. Although some residents often did not know that they remembered a certain experience or event until they started talking and recollecting, once they began to share their past memories they often showed some surprise that they recalled a certain memory and seemed to enjoy talking about past events just as many normal older adults do. Some of the topics discussed by residents were their childhood, children and family, and their profession. Interestingly, these topics are similar to topics of conversation younger people engage in during group discussion (Richards & Lonborg, 1996). For a student, recognizing that older adults, even individuals suffering from dementia, are similar in many ways to young people provides a bridge and awareness of a connection between young and old generations. Reminiscing also provides a way for the intern to gain the trust and friendship of the residents by not only inquiring about the residents' past, but also by sharing one's own personal experiences and feelings. Moreover, it appeared as if the reminiscence activity helped alleviate feelings of loneliness and isolation, especially for residents who did not have visitors or could not leave the nursing home.

This gerontology internship provided several opportunities for personal growth. Working with this population takes a great deal of patience and emotional resources. Going more slowly during activities, repeating instructions, and often listening to the same resident's perseveration of conversational themes throughout the day is taxing. It is noted that because each resident differs in personality and level of impairment, communication can at times be difficult. Thus, some people need more guidance and reinforcement, and others want activities to move faster and do not need continuous motivation to participate. During weekend activities, it was not uncommon to have 25 residents in the room. At times it was difficult to keep everyone focused and interested in the same thing for an hour, and as a result there were several incidents where the residents became upset. These situations were manageable, however, by providing alternative activities and using various approaches (e.g., explaining the purpose or benefit) to get residents back on task. Another personal growth experience during the internship is when a resident died, which occurred a few times during the internship. This experience provided an opportunity to deal with a situation that is emotionally difficult but yet one we all will likely face many times in the future. Throughout the internship, opportunity to have discussion with professional staff and a few minutes of personal-time in which one could sift through feelings and thoughts provided an important break from responsibilities. Beyond acquiring a deeper understanding of dementing illness and associated behavior, this type of internship experience offered a great opportunity to learn and to gain insight into the person and their adaptive quest.

Conclusion

The undergraduate gerontology internship is unique in that allows a scaffolding between a brief service-learning activity and a pre-professional graduate school internship. Descriptively, the undergraduate gerontology internship is most appropriate for an advanced student. Field activities should last at least one semester. Optimally, mentoring relationships with the professional in the field and sponsoring professor should emphasize the student's development of professional skills, critical reflection, analysis and synthesis of internship experiences, and personal growth....Thus, throughout their internship, students develop a new understanding based on the unique personal meanings of their experiences.... (that) may lead students to an awareness similar to that suggested by Missine (1990), an awareness that,

 "Young people need older people just as older people need young people in order to become more themselves and more human . . . (and thereby) will teach us that there is a child behind the mask of each older face, just as there is already an older person behind the mask of each young face" (pp. 9-10).

Moreover, as suggested in the following testimonial, the internship is an essential method for providing a deeply insightful and uniquely personal learning experience.

 "No matter where college experiences lead me, be it counseling, research, or geriatric medicine, I will always know that I am making the right decision by focusing my new career on something that will benefit the elderly. My internship experience has confirmed that this is the population I want to work with, and that I am capable of doing so. So far, it has been the most valuable learning experience of my college career (Miller, 2000, p. 19)."

References

_____Bloom, B. S. (Ed.). (1956). Taxonomy of education objectives: The classification of educational goals: Handbook I, cognitive domain. New York: Longman, Green & Co.

_____Bransford, J. D., Brown, A. L., & Cocking, R. R. (Eds.). (1999). How people learn: Brain, mind, experience and schooling. Washington, DC: National Academy Press.

_____Clark, M. E., Lipe, A. W., & Bilbrey, W. (1998). Use of music to decrease aggressive behaviors in people with dementia. Journal of Gerontological Nursing, 24(7), 10-17.

_____Gamroth, L. M., Semradek, J., & Tornquist, E. M. (Eds.). (1995). Enhancing autonomy in long-term care: Concepts and strategies. New York, NY: Springer.

_____Holm, A., Michel, M., Stern, G. A., Hung, T., Klein, T., Flaherty, L., Michel, S., & Maletta, G. (1999). The outcomes of an inpatient treatment program for geriatric patients with dementia and dysfunctional behaviors. The Gerontologist, 39, 668-676.

_____Kydd, P. (2001). Using music therapy to help a client with Alzheimer's disease adapt to long-term care. American Journal of Alzheimer's Disease and Other Dementias, 16, 103-108.

_____Logsdon, R. G., Teri, L., McCurry, S. M., Gibbons, L. E., Kukull, W. A., & Larson, W. B. (1998). Wandering: A significant problem among community-residing individuals with Alzheimer's Disease. Journal of Gerontology: Psychological Sciences, 53B, 294-299.

_____Long, A. B., Larsen, P., Hussey, L., & Travis, S. S. (2001). Organizing, managing, and evaluating service-learning projects. Educational Gerontology, 27, 3-21.

_____Miller, K. M. (2000). Working with Alzheimer's Disease patients. Unpublished manuscript, University of Wisconsin-Green Bay.

_____Missine, L. E. (1990). Reflections on aging: A spiritual guide. Liguori, MO: Liguori Publications.

_____Richards, P. S., & Lonborg, S. D. (1996). Development of a method of studying thematic content of psychotherapy sessions. Journal of Consulting and Clinical Psychology, 64, 701-711.

_____Thorson, J. A. (2000). Aging in a changing society (2nd ed.). Philadelphia: Brunner/Mazel.

_____Winograd, I. R. (1985). Prisms: A look at interventions in an Alzheimer's Disease Day Hospital Program. Milwaukee, WI: Medical College of WI & Geriatrics Institute, Mt. Sinai.

_____Zgola, J. (1987). Doing things: A guide to programming activities for persons with Alzheimer's Disease and related disorders. Baltimore: Johns Hopkins University Press.