An Intergenerational Storytelling Program in Medical Education: A Mixed-Methods Evaluation

An Intergenerational Storytelling Program in Medical Education: A Mixed-Methods Evaluation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article An Intergenerational Storytelling Program in Medical Education: A Mixed-Methods Evaluation Anastasia Nicole Ryhanych, Heidi Marie Banh, Jessica Olivia Young, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7255538/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Intergenerational programs benefit participants across generations by reducing ageism and promoting empathy and resilience. Despite compelling evidence supporting their effectiveness, formal integration into medical education remains limited. This study evaluated the impact of a narrative-based intergenerational program on medical students and older adults. Methods An eight-week elective course paired medical students with residents at a local senior living community for interviews focused on life experiences and personal stories. Standardized pre- and post-program surveys were administered to participating medical students and older adults, as well as to a comparison group of medical students not enrolled in the program. Surveys measured empathy, compassion, social connectedness, resilience, mental well-being, and wisdom. Paired t-tests evaluated within-group changes between pre- and post-program responses. A Mann-Whitney U test was used to compare outcomes between enrolled and non-enrolled medical students. Qualitative feedback was analyzed thematically. Results Statistically significant improvements were observed in medical students’ self-reported social connectedness ( p = 0.037), empathy ( p = 0.034), compassion ( p = 0.010), and age-related perceptions ( p = 0.013), as well as in older adults’ self-reported wisdom ( p = 0.012) from pre- to post-program. Compared to non-enrolled peers, medical students in the program demonstrated significantly higher social connectedness ( p = 0.004), empathy ( p = 0.009), compassion ( p = 0.046) and age-related perceptions ( p = 0.004). Thematic analysis revealed that students valued opportunities to connect with community members in non-clinical settings, actively reflect on unconscious biases, and develop more positive attitudes toward older adults. Older adults provided constructive feedback on the program's logistics and noted the highlight of their experience as spending time with medical students in an individual setting. Conclusions These findings highlight the potential of narrative-based intergenerational programming to enhance key competencies in medical trainees while promoting wisdom in older adults. Integration of such programs into medical curricula may promote more empathetic and compassionate, age-inclusive healthcare while strengthening meaningful cross-generational connections. Medical Education Intergenerational Programs Narrative Medicine Storytelling Age-Inclusive Healthcare Geriatrics Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Background Ageism and Its Impacts With our increasingly global aging population ( 1 ), there is a growing need to train community-oriented, compassionate physicians who have the competence and compassion to care for older adults. During medical school, students begin to develop their identities as future physicians including their attitudes towards patients. Ageism has well-studied negative effects on the physical and mental health of older adults, and in healthcare specifically, ageism links to poorer quality of care ( 2 ). Ageism has become so prominent in society that the World Health Organization launched a campaign against ageism in 2018 ( 3 ). Furthermore, a 2021 United Nations report found that 1 in 2 people in the world is believed to have ageist attitudes, which is associated with poorer health and quality of life for older adults and communities, as well as social isolation and earlier deaths ( 4 ). Economically, a 2020 study showed that the consequences of negative age stereotypes and self-perceptions cost societies billions of dollars ( 5 ). Intergenerational Programs in Medical Education Intergenerational activities intentionally structured to build empathy and compassion while addressing ageist beliefs can inform the ways medical students practice patient-centered care for years to come. Programs fostering intergenerational connections have shown positive benefits and experiences for all involved ( 6 ). Intergenerational experiences in medical education hold the potential to decrease ageism, improve medical trainees’ attitudes towards older adults, and positively impact the quality of patient care ( 6 ). Connecting medical students and older adults over the collection of a life story can increase connection, empathy, compassion, and resilience; research demonstrates the positive correlations between social connectedness, resilience, and mental well-being for both older adults and medical students alike ( 7 , 8 ). A growing body of literature emphasizes the effectiveness of intergenerational programs, experiential learning, and targeted educational interventions in reducing ageist attitudes among medical students and healthcare professionals ( 9 ). These studies collectively suggest that structured engagement with older adults - through volunteerism and real engagement, curriculum-based initiatives, and clinical exposure - not only fosters more positive perceptions of aging but may also contribute to improved health outcomes for older populations ( 6 , 9 – 15 ). Incorporating intergenerational interventions in medical education have great potential to combat the harmful development of negative stereotypes and discrimination. For example, research studies studying a narrative program originating at Veterans Affairs (VA) hospitals, “My Life, My Story,” as implemented in a medical school curriculum showed positive effects on trainees’ empathy, burnout ( 16 ), and patient-centered care competencies ( 16 , 17 ). According to a 2022 meta-analysis of interventions in undergraduate health and social sciences students, interventions based on empathy have the greatest positive effect on attitudes towards older adults ( 18 ). Another systematic review of 27 geriatric-based interventions aiming to change physicians’ and medical students’ attitudes towards older adults found that studies that included an empathy-building task, including encountering older adults directly or listening to their experiences, were correlated with a greater likelihood of positive attitude change ( 19 , 20 ). In contrast, interventions that focused solely on building knowledge about the care of geriatric patients, such as teaching the effects of aging and common geriatric diagnoses and treatment, did not lead to positive attitude change ( 20 ). Most existing studies on the promising impact of intergenerational programs implemented into medical education have focused on evaluating changes in the students’ attitudes and age-related perceptions towards older adults. There is a need for more research evaluating the other potential impacts on medical students and older adults, including empathy, compassion, social connectedness, as well as resilience and mental well-being, as wisdom encapsulates qualities of emotional regulation, pro-social behaviors, insight, and decision-making in social contexts, it is also an outcome of interest. Our Novel Intergenerational Storytelling Program UC San Diego School of Medicine partnered with Belmont Village Senior Living in La Jolla, California to provide medical students with an opportunity to engage with older adults in the local community and collect their life stories and experiences. Our study aimed to measure the impact of an original 8-week intergenerational narrative storytelling elective on medical student and older adult participants on six main outcome measures ‒ empathy, compassion, social connectedness, resilience, mental health, and wisdom ‒‒ through validated, standardized surveys administered prior to program initiation and after program conclusion. We hypothesized that the interactions between medical students and older adults would enhance these six outcomes. We also hypothesized that for the medical student participants, there would be greater positive attitudes about aging and increased interest in caring for older adults in their future medical careers. Methods I. Participants, Demographics, and Community Partners Researchers obtained approval for a new pre-clinical elective at UC San Diego School of Medicine entitled, Intergenerational Narratives . The elective was advertised via elective listing, email announcements, and the school’s social media platform. The community partner, Belmont Village Senior Living in La Jolla, California, advertised through their program coordinator in addition to hosted informational sessions led by the research team. Participants were recruited from December 2022 to January 2023. Medical students who enrolled in the elective had the option to participate in the optional research component, which included completion of surveys at pre- and post-program implementation. Informed consent was obtained from all participants through an exempt-abbreviated consent form approved by the UC San Diego Institutional Review Board, presented at the start of the Qualtrics survey; agreement to complete the survey served as participants’ consent. Incentives to participate in the program included elective credit counted towards graduation requirements (for 1st and 2nd year medical students, if enrolled) and $ 10 gift cards per survey completed (total of 2 surveys). The medical student intervention group (MS-Intervention) consisted of 1st and 2nd year medical students who enrolled in the Intergenerational Narratives elective course. The MS-Control group also consisted of 1st and 2nd year medical students; however, they were not enrolled in the elective and were recruited via a message distributed on a student-wide communication platform. The study participants included 9 medical students (11 total, including 2 research team members who participated to ensure equal pairings) and 11 older adult residents from Belmont Village Senior Living. The majority of medical students in the intervention group identified as female (89%), with a median age of 21–25 years and ethnic distribution of 55% Asian or Asian American, 33% White, and 11% Hispanic or Latino. The control group had a similar age range, with 60% identifying as female, 30% as male, and 10% undisclosed; ethnically, it was 50% Asian or Asian American, 30% White, 10% Black or African American, and 10% Other. Older adult participants were 55% female, 45% male, with a median age of 86–90 years, and a racial/ethnic distribution of 91% White, 9% Asian or Asian American. Table 1 Demographic Data Demographics (n) MS-Control ( 10 ) MS-Intervention ( 9 ) OA ( 11 ) Median Age : 21–25 21–25 86–89 Gender : % Female 60 89 55 % Male 30 11 45 Race/Ethnicity : % Asian/Asian American 50 55 9 % Black/African American 10 0 0 % Hispanic/Latino 0 11 0 % White 30 33 91 % Other 10 0 0 II. Sample Size and Power This pilot and feasibility study was powered for large effect size (Cohen’s d > 0.8) results from one-tailed paired t-test comparisons between pre- vs. post-program outcomes tested at alpha level of 0.05 and beta power of 0.8 with sample size of ~ 10 participants in each group (n = 10 MS-Control/ n = 8 MS-Intervention/ n = 11 OA). Sample size and power calculations were conducted using G*Power 3.1 ( 21 ). One-tailed comparisons were justified as we only hypothesized improvement at post- relative to pre-program surveys. We were not powered for multiple comparison corrections across surveys and all between group data analyses were exploratory aligned with sample sizes observed in prior preliminary intervention studies ( 22 , 23 ). Thus, although this pilot study had limited sensitivity, its results provide important proof of intervention feasibility and persuade a larger sample size study of the intergenerational intervention. III. Study Design The program was 8 weeks long consisting of 8 weekly hour-long sessions, including 1 orientation, 4 group discussions, and 3 individual sessions. Prior to and at the conclusion of the program, all three cohorts (e.g. MS-Control, MS-Intervention, and OA) received a pre- and post-program survey, respectively. A medical student on a research gap year and a faculty member at the School of Medicine served as program facilitators. The orientation was conducted separately for medical students and older adults, during which expectations and program structure were outlined. In group sessions, facilitators invited participants to discuss themes such as patient-centered care, positive psychological health, wisdom, social justice, and cultural humility. Participants were invited to share their experiences and ranging perspectives about a given topic with prompts and activities organized by the program facilitators in a non-judgmental setting that promoted curiosity and empathy. In addition to 4 group sessions, each medical student engaged in 3 one-on-one sessions with an older adult partner during which the student conducted the life-story interviews with the older adult. The medical students were provided background readings, a guide, and access to program leadership support. In between one-on-one and group sessions, the medical students reflected on their experience through weekly reflective writing exercises (i.e. discussion board posts using the school’s secure learning management system). Reflection prompts invited medical students to share their experiences in the elective and to explore the bio-psycho-social-spiritual-cultural factors influencing their partners’ lives and perspectives. Students were also encouraged to reflect on how these lessons could be applied in clinical settings and patient interactions. The reflection posts were used in the thematic analysis. At the conclusion of the 8-week elective, the medical students were tasked to write their partners’ life story highlights and had the option of sharing the writeup with their partner. IV. Data Collection and Privacy The surveys administered were stored in secure, password-protected cloud storage maintained by Qualtrics International Inc., which has a contract with UC San Diego to provide HIPAA-compliant survey hosting and a survey programming platform. V. Surveys This study used a mixed-method, repeated-measures design to analyze the program’s potential effects. No personal identifiers were collected on the surveys (participants created a unique code allowing investigators to match pre-surveys and subsequent responses). Participants were asked to self-report their levels of social connectedness, resilience, mental well-being, wisdom, empathy, and compassion through the standardized and validated questionnaires listed in Table 2 . All of the surveys employed had a Cronbach's alpha greater than 0.8, indicating good to excellent internal reliability ( 24 ). Additionally, the research team included questions that were developed to further explore the program’s impact on outcome measures not captured by the 6 standardized questionnaires, including program improvement opportunities and age-related attitudes. Collectively, these also provided insight into overall quality improvement and possible adaptations for future programming. Table 2 Surveys Survey Quality Measured Reliability Inclusion of Other in the Self Scale (IOS) ( 25 )* Social Connectedness - Toronto Empathy Questionnaire (TEQ) ( 26 ) Empathy 0.85 Compassion Scale ( 27 ) Compassion 0.90 San Diego Wisdom Scale (SD-WISE-28), e.g. Jeste-Thomas Wisdom Index (JTWI) ( 28 ) Wisdom 0.83 Brief Resilience Scale (BRS) ( 29 ) Resilience 0.85–0.91 Mental Health Continuum Short Form (MHC-SF) ( 30 ) Mental Well-Being 0.89–0.95 Age-Related Attitudes Questions (AQ) Intervention Impact - Quality Improvement Questions** Intervention Improvement - Table 2 : Surveys : *IOS did not have a Cronbach alpha as it is a 1-item survey; **Quality improvement questions were only asked on the post-program survey. VI. Discussion Board Posts & Post-Program Focus Group The discussion board posts were hosted on the elective course’s learning management system page. There were four threads dedicated to group session reflections and three threads dedicated to individual reflections. In total, there were 57 discussion board posts, excluding responses to specific comments. Two post-program focus groups were held at the conclusion of the elective, one for the older adults and one for the medical student participants. The sessions were recorded and transcribed by “GoTranscript” ( 31 ) and comments from participants were included in the qualitative analysis. For the older adults who were unable to attend the focus group, individual exit interviews were conducted over phone calls with a member of the research team. VII. Data Analysis The evaluation component of this project followed an interrupted time series design utilizing prospective data collection for multiple comparison groups. Program effectiveness was assessed by collecting quantitative data from pre-program and post-program surveys. Of note, in order to ensure each older adult had a medical student partner, two members of the research team participated in the program but did not complete the surveys. Additionally, another participant failed to complete the entirety of the pre-survey, so their data was excluded. Five-point Likert scales and reverse coding were used to quantify positive and negative-framed items respectively throughout the various surveys. After quantifying the survey responses, statistical analysis was performed to compare pre-intervention and post-intervention scores, as well as responses between certain measures of the MS-Intervention and MS-Control groups, using online statistical tools from StatsKingdom ( 32 – 34 ). As we considered improvement in survey scores as meaningful change and given our small sample, we used one-sided paired t-tests to compare the pre-intervention and post-intervention survey data within each cohort. As the Age-Related Attitude Questions (AQ) were not normally distributed, a one-sided Wilcoxon Signed-Rank test was employed. However, due to minimal variability and a high frequency of tied values, the test could not be meaningfully applied to AQ 1–2 and 4–5 for the MS-Control cohort, AQ 2–5 for the MS-Intervention cohort, and AQ 1–2 for the OA cohort. In these cases, descriptive statistics were used to better characterize response patterns. Normality of measures was assessed and paired t-tests were used for normal measures else the Wilcoxon Signed-rank test was used for within-group comparisons. If the results for any of these within-group comparisons were significant for either of the medical student cohorts, we ran exploratory between-group tests to assess the difference between the MS-Intervention and MS-Control groups. Specifically, a change score was calculated (post-intervention minus pre-intervention scores) for each individual within each group, and a one-sided Mann-Whitney U test was used to assess if the change was greater in the MS-Intervention group compared to the MS-Control. The Mann-Whitney U test was chosen because the change score data did not meet the normality assumption. The qualitative data we analyzed came from the following sources: post-program survey free response questions, post-program focus groups, exit interviews (select older adults only who were unable to attend the focus group), and discussion board posts (medical students only). To evaluate the data, a thematic analysis approach utilizing an online qualitative analysis software “Delve” was employed, thus streamlining the process of categorizing comments into common themes ( 35 ). A few quotes were then selected from each category that best exemplified that theme. RESULTS I. Quantitative Analyses Results of the paired t-test matching each individual’s pre survey data to their post survey response within each of the three cohorts, are displayed in Table 3 . There were no significant results within the MS-Control cohort. Within the MS-Intervention cohort, the pre vs. post IOS Scale ( p = 0.037), TEQ ( p = 0.034), the Compassion Scale ( p = 0.010), and the Age-Related Attitude Q1 ( p = 0.0131), were statistically significant. Lastly, within the OA cohort, the pre vs. post SD-WISE-28 survey results were statistically significant ( p = 0.012). Table 3 Within Cohort Analysis MS-Control MS-Intervention OA Survey T or Z-Stat p-value T or Z-Stat p-value T or Z-Stat p-value IOS Scale -2.20 0.064 2.11 0.037* 0.16 0.439 TEQ -1.94 0.093 2.16 0.034* 0.17 0.436 Compassion Scale -0.05 0.959 3.11 0.010* 0.18 0.432 JTWI 0.94 0.380 1.14 0.150 2.76 0.012* Brief Resilience Scale 0.13 0.901 1.10 0.156 0.85 0.21 MHC-SF -0.10 0.920 1.61 0.079 -0.95 0.814 Age-Related Attitude Q1 - - 2.22 0.013* - - Age-Related Attitude Q2 - - - - - - Age-Related Attitude Q3 1.49 0.068 - - 0.889 0.187 Age-Related Attitude Q4 - - - - -0.849 0.802 Age-Related Attitude Q5 - - - - - - Table 3 : Within Cohort Analysis : * denotes statistically significant ( p -value < 0.05) As not all Age-Related Attitude Questions met the assumptions for the Wilcoxon Signed-Rank Test, the median and interquartile range of change scores were calculated for these items and are presented in Table 4 . Among the Age-Related Attitude Questions, the MS-Intervention group demonstrated a greater median increase in feeling respected by other generations (AQ1: 1.00 [IQR 1–1]) compared to no change in the MS-Control and older adult groups (0.00 [0–0]). All groups showed no median change in respecting other generations (AQ2). The MS-Control group reported the largest increase in perceived intergenerational barriers (AQ3: 0.53 [0–2.5]), whereas both the MS-Intervention and older adult groups showed no change. Regarding perceptions of aging (AQ4), the MS-Intervention group showed a shift away from viewing aging as decline (–1.00 [–1–0]), unlike the MS-Control and older adult groups, which showed no median change. Interest in geriatrics (AQ5) remained unchanged in both medical student groups, though the MS-Intervention group showed slightly greater variability. Table 4 Descriptive Statistics for Age-Related Attitude Questions MS-Control MS-Intervention OA Age Related Attitude Question Median (IQR) Median (IQR) Median (IQR) AQ1 : When interacting with individuals from different generations (age groups), I feel listened to, respected, and valued. 0.00 (0–0) 1.00 ( 1 – 1 ) * 0.00 (0–0) AQ2 : I listen to, respect, and value individuals from generations younger and older than me. 0.00 (0–0) 0.00 (0–0) 0.00 (-0.5-0) AQ3 : There are significant challenges or barriers to being able to connect meaningfully with individuals of different generations. 0.53 (0-2.5) * 0.00 (0–0) 0.50 (0–1) * AQ4 : When I think of aging overall, the first thoughts that come to mind relate to decline (e.g. decline in health, social connection) rather than growth (e.g. growth in wisdom, quality of life). 0.00 (-1.5-0) -1.00 (-1-0) 0.00 (-1-0.5) * AQ5 : ( MS only) I am interested in serving older adults in my future practice as a physician and/or exploring geriatrics as a career. 0.00 (0–0) 0.00 (0–1) - Table 4 : Descriptive Statistics for Age-Related Attitude Questions : The median and IQR were calculated based on the difference in score from the pre- to post-intervention surveys. * denotes results that met the criteria for the Wilcoxon Signed-Rank test for which the results are displayed in Table 3 . For the surveys in which there was a significant finding within the MS-Intervention cohort, we further analyzed the data by comparing those metrics to their MS-Control counterpart using a calculated change score and Mann Whitney U test. As shown in Table 5 , all four surveys (IOS Scale, TEQ, Compassion Scale, and Age-Related Attitude Q1) showed a statistically significant effect in the MS-Intervention group compared to the MS-Control group ( p -values = 0.004, 0.009, 0.046 and 0.004, respectively). Table 5 Between Cohorts Analysis Survey MS - Intervention (Mean ± SD) MS - Control (Mean ± SD) U-Stat p -value IOS Scale 1.38 ± 1.85 -0.88 ± 1.13 2.64 0.004* TEQ 2.875 ± 3.76 -2.13 ± 3.09 2.37 0.009* Compassion Scale 6.57 ± 5.59 -0.13 ± 6.69 2.09 0.046* Age-Related Attitude Q1 1.00 ± 0.57 0.00 ± 0.53 2.66 0.004* Table 5 : Between Cohorts Analysis : * denotes statistically significant ( p -value < 0.05) A. Inclusion of Other in the Self (IOS) Scale, where Other = Community The MS-Intervention group’s post survey score showed a statistically significant increase from their pre-intervention survey score (T = 2.11, p = 0.037). As depicted in Fig. 1 , the distribution of scores and the scores themselves (with higher scores representing greater overlap between sense of self and community) almost ubiquitously increased from the pre survey to post survey in the MS-Intervention group. On the other hand, the opposite trend holds true for the MS-Control cohort in that the distribution shrunk while the scores decreased. When comparing across the two cohorts, there was a statistically significant difference between the groups, with the intervention group’s change score being greater than that of the control group (U = 2.64, p = 0.004). This finding is more clearly displayed in Fig. 2 wherein the slope of the lines indicates the magnitude of change for each participant between the pre and post surveys. Interestingly, all of the IOS scores decreased or held constant for the MS-Control group while the MS-Intervention group scores all increased or held constant. B. Toronto Empathy Questionnaire (TEQ) The MS-Intervention group’s post survey score was statistically significantly increased from their pre survey score (T = 2.16, p = 0.034). In comparing the change score results, there was a statistically significant difference between the groups with the intervention cohort’s change score being higher than that of the control group (U = 2.37, p = 0.009). Figure 3 shows the progression of individuals’ survey scores from prior to the intervention to after the intervention. In examining the MS-Control group, it is evident that the spread of the post survey scores increases but the value of the scores (with higher scores indicative of a greater capacity for empathy) mostly declines or stagnates. Contrastingly, the spread of the post survey scores for the MS-Intervention cohort decreases with most of the scores, apart from one outlier, clustered in higher value ranges. Moreover, all but two of the medical students in the intervention group had an increased post survey score. C. Compassion Scale While the OA and MS-Control groups showed no statistically significant differences in total score on the Compassion Scale between the pre- and post-intervention survey timepoints, the MS-Intervention group did score statistically significantly higher on the post-intervention survey compared to the pre-intervention survey (T = 3.11, p = 0.010). In regard to the change score, there was a statistically significant difference between the groups (U = 2.09, p = 0.046). As evident in Fig. 4 , there are mixed trends amongst the MS-Control group with some individuals scoring higher while others scored lower on the post survey in comparison to their pre survey. Contrastingly, most individuals in the MS-Intervention cohort scored higher in the post survey compared to the pre survey. D. Jeste-Thomas Wisdom Index (e.g. 28-item San Diego Wisdom Scale, SD-WISE-28) In comparing the SD-WISE-28 pre-intervention to post-intervention scores within each cohort, only the OA cohort yielded a statistically significant change in score (T = 2.76, p = 0.012). Since there was no significant change within either medical student cohort, no further analysis was completed. E. Brief Resilience Scale There were no statistically significant results in the Brief Resilience Scale between the pre-survey and post-survey timepoints across all three cohorts (MS-Control: T = 0.13, p = 0.451; MS-Intervention T = 1.10, p = 0.156; OA: T = 0.85, p = 0.210). F. Mental Health Continuum Short Form There were no statistically significant results in the Mental Health Continuum Short Form between the pre-survey and post-survey timepoints across all three cohorts (MS-Control: T = -0.10, p = 0.540; MS-Intervention T = 1.61, p = 0.079; OA: T = -0.95, p = 0.814). G. Age-Related Attitudes Questions In response to the first question (“ When interacting with individuals from different generations (age groups), I feel listened to, respected, and valued .”), the MS-Control and OA groups’ answers did not significantly change over the course of the intervention (both with a median difference of 0). The MS-Intervention cohort, however, displayed a statistically significant increase in score (Z = 2.22, p = 0.013). As displayed in Fig. 6 , the distribution of responses in the MS-Control group was almost unchanged between the pre and post surveys. However, the MS-Intervention cohort’s responses all collectively increased with all participants either choosing “Agree” or “Strongly Agree” to the above statement. In comparing across groups, we found a statistically significant difference in change score between MS-Intervention and MS-Control (U = 2.66, p = 0.004) with the intervention group having a greater change in their response. As for the Age-Related Attitude Questions that met the criteria for the Wilcoxon Signed-Rank test (MS-Control AQ3, OA AQ3-4), there was no statistically significant change between pre- and post-intervention scores. For the remaining Age-Related Attitude Questions, there were no significant differences in median change score between the pre-survey and post-survey timepoints across all three cohorts (see Table 4 ). For the program participants only, one additional question asked how this experience has changed their attitude towards the other cohort overall. The answer choices were “more positive”, “no change”, or “more negative.” For the medical students, 100% reported a more positive attitude towards older adults after the Intergenerational Narratives elective. 30% of the participating older adults reported a more positive attitude towards physicians, while 70% had no change post program. Some open-ended feedback is captured as quotes in Table 6 of the Qualitative Analysis section. I. Quality Improvement and Satisfaction Questions As part of our post-intervention survey, we assessed participants’ satisfaction of the Intergenerational Narratives program through a series of Likert-scale questions and open-ended questions. The results of the Likert-scale questions are summarized below. Participants, particularly the older adults with more varied answers, were encouraged to elaborate on their reasonings and to give constructive feedback through free text responses and focus groups. Themes from these are summarized in a later section under Qualitative Analysis. We assessed if participants found the program and its main components (i.e. the individual interviewing sessions and group sessions) valuable and worth their time. Their responses to these 3 separate questions are summarized in Figs. 7 and 8 . Subsequently, we asked about how satisfied participants were with the perceived level of support they received from the program team. Specifically, we asked, “Did you feel supported throughout the program and that you could voice any questions, concerns, or feedback to the program team?” Their answers to the Likert-scale questions from “never” to “always” are summarized in Fig. 9 . We inquired how satisfied the participants were with the program’s length; the results of which are below in Fig. 10 . Lastly, while we already measured overall program satisfaction through another set of questions above as represented by Figs. 7 and 8 , we further assessed overall satisfaction through asking participants how likely they were to recommend the program to others. Figure 11 below shows their responses. II. Qualitative Analysis We gathered qualitative feedback from all participants through focus groups, exit interviews with select older adult participants unable to attend the focus groups, and open-ended questions in our post-program surveys. The key themes are listed below. Themes from Medical Student Participants : 1) Valued time in curriculum for connecting with local community members in non-clinical settings 2) Appreciated life story interviews as a method for empathy and compassion building, with a focus on self-reflection 3) Welcomed the opportunity to actively reflect on unconscious biases 4) More positive attitude towards older adults 5) Desires to learn more about age-related challenges and health disparities 6) Strengthened their connection to their purpose in pursuing medicine Themes from Older Adult Participants: 1) Value or appreciation overall in the intergenerational nature of the program 2) Value in time spent with one medical student partner in individual interview sessions; Desire for more bidirectional conversations with partners 3) Desire to talk about their medical topics and experiences in addition to their life stories 4) Lack of clarity in program objectives; Interest in more organizational overview, aims, and expectations 5) Frustrations over acoustics of the conference room used for group sessions at Belmont Village 6) More positive attitude towards medical students and physicians. Representative quotes supporting these themes are provided in Table 6 in a separate file titled Additional File 1. Discussion This pilot study evaluated a novel intergenerational program for pre-clinical medical students that was designed and implemented at the UC San Diego School of Medicine in partnership with Belmont Village Senior Living. Intergenerational Narratives brought together older adults and medical students in dyad and group settings, creating opportunities to collect life stories and engage in meaningful intergenerational dialogue. The newly approved elective was successfully implemented, attended, and the majority of medical students and older adult participants had positive perceptions of the program. Older adult and medical student participants reported high satisfaction ratings, with the majority of both groups reporting that the program was a valuable experience. Our findings are consistent with our research supporting the benefits of intergenerational programming (15,36–39). Quantitative Survey Data - Significant Findings Medical students participating in Intergenerational Narratives showed promising results related to feelings of closeness and one’s subsequent behavior from the IOS scale (25). A pre-post trend of increased interpersonal closeness was found among participating medical students in addition to a statistically significant difference in change score between the intervention and control groups suggesting that the conversations medical students had with their older adult partner throughout the intervention may have increased their feelings of connectedness to the community and subsequently encouraged interpersonal closeness. Given the national loneliness epidemic, opportunities to enhance social connection, especially during high stress training programs like medical school may serve as protective factors towards sustaining a career in healthcare (40). Students participating in Intergenerational Narratives displayed higher self-reported empathy before and after the program. There was also a significantly greater pre vs. post change score in the medical student intervention versus control group. These findings suggest that meaningful conversations with older adults in the community as a part of a supported learning activity may have positively contributed to medical student empathy which has implications for future patient care. Interestingly, the MS-Control group’s TEQ score decreased over the 8 weeks. We hypothesized that this was due to the increased stressors and workload that accumulated over the course of the quarter. As such, the post-intervention MS-Intervention group score might actually be higher if controlled for external variables, including school-related stressors. In addition to greater empathy, medical students in the intervention group showed a significant increase in compassion ratings from the pre-intervention to post-intervention timepoints suggesting the regular interactions medical students had with the Belmont Village residents augmented their feelings of compassion towards others. There was a significant difference in change scores between the MS-Intervention and MS-Control groups, with the MS-Intervention group showing greater change scores on average. It is possible that the students in the intervention may have become more compassionate over the course of the 8-week elective compared to their control counterparts. This may be linked to the community and experience created within the course. For the participating older adults, we assessed the complex construct of wisdom. Using the Jeste-Thomas Wisdom Index including six components of wisdom: 1) general knowledge of life and social decision making - ability to give good advice, life knowledge, and life skills; 2) emotional regulation - affect regulation and self-control; 3) pro-social behaviors - e.g., empathy, compassion, altruism, and a sense of fairness; 4) insight - the ability and desire to understand oneself and one's actions at a deep level; 5) value relativism (tolerance for divergent values) - being nonjudgmental and accepting of other value systems; and 6) decisiveness - the ability to make quick and effective decisions (28). After our 8-week program, we found that there was a significant increase in wisdom scores among older adults, indicating that the process of sharing their stories may have increased opportunity for reflection and greater wisdom. This notable finding from our small pilot sample size is promising, highlighting the potential of wisdom as an antidote for loneliness - a pressing issue among our older and aging population. It speaks to the potential impact this and similar intergenerational storytelling programs can have on the psychological and social health of older adults (41). Assessing whether different populations viewed their own value differently after interacting with another generation, we found no statistically significant difference in response for the OA population between pre and post intervention; however, the MS-Intervention group reported significantly higher scores. Additionally, the change score for the MS-Intervention group was significantly greater than that of the MS-Control group. Altogether, these findings suggest that Intergenerational Narratives led to medical students having a greater sense of camaraderie, respect, and value after interacting with older adults. This important finding may have promise when considering the known negative effects of ageism. Quality Improvement and Satisfaction Participants in the program rated the program highly overall. Ratings were overwhelmingly positive with 100% of medical students strongly agreeing and 91% of older adults either strongly or somewhat agreeing that the program was a valuable experience and worth their time. Across both cohorts, more participants strongly agreed that the individual sessions (MS: 100%, OA: 55%) were worthwhile compared to the group sessions (MS: 80%, OA: 27%). Although all medical students agreed to some extent that the group sessions were a meaningful learning experience, the responses from the older adults were more varied with 18% neither agreeing or disagreeing. Based on the qualitative feedback we received from the older adults, we speculated that this cohort found the group sessions less valuable largely due to some of the logistical challenges posed by the space in which these sessions were held, as some elaborated through their open text answers in the survey question immediately after as well as in the focus group. Specifically, select Belmont Village residents mentioned having difficulty hearing and seeing clearly due to the room’s acoustics and lighting, which made it challenging to fully engage. In regard to program support, all medical students and 91% of older adults reported feeling supported during the program, with students selecting “always” and older adults selecting “always” or “most of the time.” All participants were given the emails and phone numbers of the program facilitators; however, it is possible that medical students felt more comfortable using technologic methods to contact the program leads if needed. Furthermore, not all of the older adults regularly used computers/phones and preferred to communicate through the Belmont Village community director who then relayed any messages to the program facilitators. In regard to program length, while 90% of medical students felt the 8-week program was “just right,” older adults had more varied views, with 18% reporting it was “too long,” 27% “just right,” and 36% “too short.” This finding highlights a divergence in perceptions of program length between medical students and older adults. A strong majority of medical students found the 8-week duration appropriate, suggesting that the program was well-aligned with their schedules, learning expectations, and engagement levels. In contrast, older adults exhibited a broader range of opinions suggesting the older adults may have more diverse needs or expectations regarding pacing and content delivery. The contrast points to the importance of tailoring program duration or offering flexible formats to better accommodate different participant groups. Quantitative Survey Data - Nonsignificant Findings While there was no statistically significant difference after the program in medical student nor older adult responses to the Brief Resilience Scale or Mental Health Continuum Short Form questionnaires, it is important to note that countless factors can influence resilience and mental well-being. Whether it is balancing the demands of medical school or doctors’ appointments, or navigating life events and relationships, it is understandable that an 8-week intergenerational program that meets weekly may not significantly impact one’s overall sense of resilience or mental well-being. Qualitatively, however, many medical student participants noted getting a fresh life perspective from their older adult partners, which helped them reflect on their own life in a way that helped them feel less stressed. Some older adult participants shared feeling more connected with their greater community and looking forward to their weekly meetings with students. This positive feedback from participants is promising. In addition, there is literature to suggest the relationship between social connectedness, resilience, and mental well-being (7,8). Given the statistically significant increase we found in the MS-Intervention cohort’s subjective sense of community connectedness as measured by the IOS Scale, there is room for further studies to explore impacts of intergenerational initiatives on resilience and mental well-being. Although there was no statistically significant change in responses to Age-Related Attitudes Questions 2–5 among either medical students or older adults following the program, we believe this result—particularly for the MS-Intervention group—may have been influenced by their high baseline scores. Additionally, the limited range of the 5-point Likert scale may have constrained the potential for upward movement, especially for participants who already held positive attitudes at baseline. We suspect that the self-enrollment process of the program, at least partially, explains the high pre-program scores of the participants in that the individuals who chose to take part in an intergenerational program are more likely to have a more positive outlook towards aging, value connecting with those of different generations, and for the MS-Intervention group, have a higher baseline interest in serving older adults or exploring geriatrics as a career. Qualitative Survey Data We sought and received constructive feedback for future efforts which can inform quality improvement for feasibility and sustainability of this program for our community partners. Medical Students’ Feedback As noted above, participating medical students valued their time with older adults in the community, highlighting the connection to their purpose in pursuing medicine. They appreciated hearing life stories, embraced the opportunity to reflect on any unconscious biases, and developed a more positive attitude towards older adults along with curiosity about geriatric medicine. Through the discussion board posts and post-program survey, the medical student participants commonly expressed how much they valued the opportunity to interact with the older adults in the community. Several students wrote about feeling isolated in the “medical school bubble” but felt the program provided them with an opportunity to expand upon their existing tight-knit community in a non-medical setting. Additionally, students felt that the emphasis of the elective on storytelling allowed them to interact with other members of the community without the pressure or agenda of a clinical setting which consequently fostered more authentic connections. A significant amount of feedback from medical students included expressing gratitude for the opportunity to hear the older adults’ stories. Many medical students appreciated the narrative structure of the elective as a catalyst to build meaningful and compassionate connections with their partners. In the post session discussion boards, students summarized their conversations, often empathizing with their partners’ past struggles or celebrating their partners’ accomplishments. It was evident that all the students left the one-on-one sessions reflecting not only on their partners’ stories but also on their own life experiences. Frequently, students wrote about how something that came up in their conversation led them to think more deeply about their personal life, career goals, or in their future as a physician. Another commonly cited positive feedback was that interacting with the older community members actually challenged and reshaped many unconscious biases or preconceived notions about the geriatric population. Several medical students discussed how they initially saw aging in a negative light, but after talking with their partner, they realized many of the most exciting times and opportunities can come with older age and accumulated wisdom. Furthermore, numerous medical student posts emphasized how much they had in common with the Belmont Village residents. Lastly, others wrote about challenges often faced by the elderly and how we can make medicine, and society as a whole, more accessible to them. Finally, medical students shared how interacting with the Belmont Village residents reminded them of why they decided to pursue a career in medicine and further built upon their initial motivations. The students in the program mentioned the similarities between medicine and storytelling emphasizing that medicine, at its core, is a career based on human connections. Future Adaptations 1. Training and resources for students on geriatrics and common age-related challenges When asked about some challenges of the program, numerous students described wanting more formal guidance and tips on communicating with their partners who may be facing common age-related challenges, especially memory or cognitive decline. The difficulties they encountered are, more or less, typical changes related to aging. Students most often cited obstacles associated with declining hearing or memory. Consequently, several students suggested including an educational session prior to meeting with their partners so that they would be better informed of age-related changes and could strategize how to best accommodate their partners’ needs. Furthermore, other students highlighted that the program could benefit from additional resources on geriatric medicine which would not only help inform their interactions with their partners but would also be useful in their future training and careers working with older adults. Future adaptations of this program may include didactics featuring both the uplifting components of aging as well as common health challenges to provide a more holistic and realistic representation of the older demographic. Providing these ample resources throughout the program, from the pre-orientation session to process groups, could help medical students feel better supported. Older Adults’ Feedback Older adult participants expressed overall appreciation for the intergenerational nature of the program and valued the time spent with their individual medical student partners during interview sessions. Many noted a desire for more bidirectional conversations and the opportunity to share their own medical experiences in addition to their life stories. Some participants reported a lack of clarity regarding the program’s objectives and expressed interest in a more thorough organizational overview, including its aims and expectations. Logistical concerns were also raised, particularly regarding the poor acoustics in the conference room used for group sessions at Belmont Village. Despite these challenges, participants reported a more positive attitude toward medical students and physicians as a result of their involvement in the program. Bringing older community members and medical students together presents a unique educational opportunity to dialogue and learn directly from each other about healthcare experiences and topics. For some older participants, the program’s aims and expectations were less clear when limiting the main one-on-one activity to biographical storytelling (e.g. “I didn’t really understand the connection between hearing about my life and my physical health.” ) Some expressed not grasping how this activity was useful to medical students’ training. When working with this specific cohort of future physicians, many older participants expressed wanting, and even expecting, to share their personal health conditions and experiences living with them. They wanted to discuss personal health challenges, experiences with aging, examples of positive and negative healthcare encounters, and end-of-life topics. While the process of biographical life story interviewing itself yields many benefits, inviting older participants to share about both their wellness and illness experience, if they so choose, can provide medical students a valuable and balanced perspective on their partner’s aging experience. One’s medical conditions and experiences can be closely intertwined with their life stories, influencing their relationships, values, and perspectives. Speaking about their lives would naturally include telling stories about health and aging. These can add an extra layer to medical students’ training in empathy and compassion for their future patients, especially if students can appreciate diagnoses in context of a person’s larger life story. Lastly, many older adult participants voiced their desire for improved logistics and setting, specifically acoustics and lighting of the conference room where all group sessions took place. Participants with hearing challenges mentioned that the echoes in the room made it difficult to hear comments from others sitting across the room, thus negatively impacting their ability to fully engage in group conversations. During a few icebreaker activities where multiple conversations took place at once, it was often difficult to hear their partners’ voices despite sitting next to each other. In addition, the bright sunlight streaming in felt blinding for those with vision challenges. Collectively, this led to some dissatisfaction from some participants as it detracted from their experience and ability to stay fully engaged. From this feedback, we learned that it is critical to design programs with accessibility to accommodate a wide range of health and ability statuses. This includes, but is not limited to, those with challenges regarding cognition, hearing, vision, immunocompromised health status, and technological literacy. Every program round would require flexibility and adjustments depending on the individual and overall needs of each cohort. Future Adaptations 1. Incorporate clear conversation prompts focused on medicine and aging. However, to ensure privacy of participants’ health information, this would not be a requirement, but simply an open invitation. Consent would be gathered and expectations for confidentiality would be made explicit in the program’s orientations. 2. Host a group orientation and create a syllabus for older participants to clarify program objectives and tasks. During our pilot intervention, the orientation for older participants occurred via an individual phone call from one of the program’s directors. Initially, we felt this would be a personalized way to get to know each participant and address any questions, concerns, and accommodations. Additionally, as with any community-based initiative that requires adaptation, we were deciding between an in-person versus virtual orientation over Zoom. There was a range of participants’ preference and technological accessibility, therefore phone call orientations seemed most feasible. However, future program adaptations may include hosting an in-person group orientation that would serve the purpose of outlining the program’s purpose, objectives, and tasks. It would also allow dedicated time to discuss questions and concerns with the program team, helping them feel more heard and supported. 3. Logistics and setting could be improved and accommodated for older adults with common age-related challenges including hearing and vision difficulties. Identify any accommodations that would improve participant experience. In this pilot round, accommodation needs were assessed through the initial individual phone calls with each older adult participant. Alternative methods can be through surveys and pre-program focus groups with program leaders where we could gather a better sense of cognitive challenges and other concerns that may require specific accommodations and guidance for medical students. Participants’ Feedback on Specific Program Components Individual Sessions Based on feedback from participants, older adults and medical students unanimously enjoyed the individual sessions with their respective partners. Participants valued having a clear goal or task to work towards in these sessions (e.g. life story interviewing, medical students working on interpersonal communication and history taking skills). Some medical students mentioned appreciating the structure and physical guides with suggested question prompts, while also having the freedom and flexibility to personalize conversations. Older adults valued the opportunity to actively reflect on their lives and growth from core memories. Some older adult participants expressed a desire for more bi-directional conversations with their partners, including learning more about the students’ lives. Overall, participants valued getting to build one deeper relationship or friendship with a consistent partner over the course of the program. Participants from both cohorts spoke positively about finding common humanity despite age and other differences. Medical students welcomed the individual sessions especially as an opportunity to actively reflect on unconscious biases regarding age, socioeconomic status, and other factors. Group Sessions Feedback and satisfaction measures for the group discussions were more mixed. Some sessions emphasized more community building through icebreaker activities (e.g. sessions on identities, cultural and ethnic backgrounds, family history), while others were medicine-focused (e.g. discussing compassion in healthcare). The medical students unanimously enjoyed all group discussions, voicing appreciation for dedicated time in their curriculum to connect with a small cohort of their peers and the local community members in a non-clinical setting. They also appreciated the group discussions as opportunities to actively reflect on their unconscious biases regarding age, race, and other intersections of identity. Some constructive feedback included a desire for additional guidance in navigating communication with partners facing memory or cognitive challenges, as for some students, this was their first exposure to this. For the older adult participants, while many shared positive comments about the group sessions, constructive feedback was offered. A few mentioned a desire for less icebreaker activities and more discussions on medical topics. For example, they enjoyed the group discussion on the theme of “Compassion in Healthcare,” as the interaction between older participants and medical students had a more defined purpose beyond simply fostering community through conversation, which some felt was too broad. Suggested topics for future programming included aging, health challenges, personal healthcare experiences, and end-of-life topics that were relevant for those in their age group. Research Limitations While our pilot study yielded promising preliminary findings, there were many limitations to our research, a prominent one being the small sample size. Due to the recent opening of the Belmont Village La Jolla location, there were fewer older adults residing at the senior living community at the time available for recruitment. This also contributed to our decision to not recruit a control group for the older adults, further limiting our ability to determine if observed results were due to the intervention or other confounding factors. Regarding the medical student recruitment, the medical school has a wide selection of elective courses open to first- and second-year students, resulting in relatively low enrollment in any single course. Another limitation was the limited demographic diversity of both cohorts. The older adult participant population lacked racial and ethnic diversity, likely due to the socioeconomic and cultural factors associated with residing in a well-resourced senior living community. Among medical students in the intervention group, the self-identified gender was largely female — while reflective of the gender distribution at UCSD SOM — it limits the generalizability of the findings to the broader medical student population. Another limitation from a research perspective is that all six outcome measures were assessed using subjective, self-reported questionnaires. Although self-report measures are useful, they are limited by potential biases, including social desirability and fluctuations in emotional or situational context at the time of data collection. Future research could benefit from incorporating objective cognitive assessments or other mixed-methods approaches. In particular, the increase in self-reported wisdom among older adult participants could be further explored using validated cognitive or behavioral assessments. Wisdom is known to be associated with differential cognitive abilities across the lifespan (42), and further investigation is warranted to better understand this relationship in the context of intergenerational programming. While promising patterns emerged, future studies with larger, more diverse samples, multi-site implementation, and randomized controlled designs would be necessary to strengthen the evidence base and assess replicability. Conclusion The creation and implementation of a pilot Intergenerational Narratives program at a large medical school was positively received by both participating medical students and older adults. Preliminary results suggest that participation was associated with statistically significant changes in medical students’ social connectedness, empathy, compassion, and feelings of being respected and valued by other generations. Older adult participants also reported increases in wisdom after engaging in Intergenerational Narratives . These findings align with broader literature showing intergenerational programs improving empathy, attitudes toward aging, and social connection in both youth and older adults ( 15 , 39 , 37 , 43 , 44 ). While two of the six outcome measures — resilience and mental well-being — did not show statistically significant changes in either cohort based on standardized questionnaires, many medical student participants described the program as a meaningful source of connection and purpose. In qualitative reflections, students shared how hearing stories of adversity and resilience from their older partners helped them to reframe their own challenges, particularly those related to medical school, within a broader life context. These recurring reflections suggest that the program may have fostered meaningful benefits not fully captured by the quantitative measures used. This highlights the importance of further exploring not only resilience and mental well-being, but also burnout as a distinct and relevant construct in future studies of intergenerational interventions in medical education. These themes are especially relevant given broader concerns about medical student and physician burnout, which continue to challenge the culture and sustainability of medical training. Physician burnout is a growing national health crisis, with prevalence estimates at around 50% among United States physicians ( 43 ). Medical students, in particular, are at heightened risk ( 44 , 45 ), often navigating overwhelming academic pressures, emotional fatigue, and a sense of isolation. Evidence suggests that resilience, a strong sense of purpose, and social connection are key protective factors that can mitigate burnout, depression, and anxiety among medical trainees ( 7 ). While many wellness programs in medical school emphasize internal strategies such as mindfulness, self-compassion, reflective writing, or peer support ( 46 – 50 ), intergenerational storytelling offers a relational and community-based approach. Storytelling provides a powerful medium for exchanging wisdom and life experiences across generations, allowing lessons in perseverance and adaptability to be shared in meaningful ways ( 20 , 51 ). For medical students, listening to and engaging in stories can be both healing and impactful, reinforcing the bio-psycho-social-cultural-spiritual dimensions of holistic care central to medical training. These narrative encounters also promote social integration, helping students feel more connected and supported ( 43 – 45 ). When participants come from diverse backgrounds, storytelling further cultivates cultural humility and deepens awareness of health equity issues ( 52 ) by fostering humility and urging medical students to confront their own biases and privilege. Through these pathways, intergenerational storytelling may offer a promising approach to supporting the emotional well-being and professional identity development of medical students. Beyond supporting emotional well-being, intergenerational storytelling holds deep cultural significance, especially within traditions that honor the wisdom of elders. In many Indigenous cultures, elders are revered as knowledge-keepers and carriers of collective identity, with storytelling serving as a core mechanism for intergenerational learning, healing, and cultural continuity. Speech-based methods grounded in Indigenous epistemologies prioritize voice, oral tradition, and relational reciprocity ( 53 , 54 ). Incorporating this lens, our program sought not only to foster empathetic and compassionate communication skills, but also to elevate older adults as valued contributors to the professional development and humanistic growth of future physicians. In doing so, the program challenged ageist assumptions and affirmed the value of elder voices in shaping the next generation of physicians. In conclusion, amid an increasingly global aging population, there is a growing need to train community-oriented, compassionate physicians who develop and maintain positive attitudes towards older adults and aging ( 3 ). Through our structured Intergenerational Narratives program, medical students practiced compassionate communication skills in a setting that fostered both healthy aging and intergenerational connection. Older adult participants, in turn, experienced affirmation of their wisdom and sense of social purpose. While these findings are preliminary and exploratory as a pilot study, they point to the potential of such programs to foster humanism in medical education. Further research with larger, more diverse samples and longitudinal designs is needed to confirm and build upon these results. Drawing on traditions of storytelling and existing literature on intergenerational engagement, we sought to reignite the humanistic values and sense of purpose that often draw students to medicine. By inviting older adults to share their voices, experiences, and wisdom, we honored our diverse, multigenerational communities — and the rich perspectives they offer to those poised to serve them. Abbreviations BRS: Brief Resilience Scale IOS: Inclusion of Other in the Self Scale MHC-SF: Mental Health Continuum Short Form MS-Control: Medical Students in Control Cohort MS-Intervention: Medical Students in Intervention Cohort OA: Older Adults SD-WISE-28: 28-item San Diego Wisdom Scale also known as Jeste-Thomas Wisdom Index (JTWI) TEQ: Toronto Empathy Questionnaire UCSD SOM: University of California San Diego School of Medicine Declarations Ethics Approval and Consent to Participate This study was reviewed by the University of California, San Diego Institutional Review Board (Protocol #805143) and deemed exempt from full IRB oversight under 45 CFR 46.104. Informed consent was obtained from all participants through exempt-abbreviated consent forms approved by the UC San Diego IRB. These forms were embedded at the beginning of the pre-program surveys administered via Qualtrics, and participants indicated their consent by agreeing to complete the survey. This process met the IRB-approved criteria for a waiver of signed consent. Participation in the survey was optional and not required to take part in the program; however, all medical students and older adults opted to complete the survey. This study adhered to the ethical principles outlined in the World Medical Association’s Declaration of Helsinki. Clinical trial number: Not applicable. Consent for Publication Not applicable. Availability of Data and Materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests Not applicable. Funding The creation and implementation of this program and research study were made possible through the generous support of a grant awarded to Heidi Banh by the UC San Diego T. Denny Sanford Institute for Empathy and Compassion’s MedGap Scholars Program (2022-2023), under the valued mentorship of faculty Dr. Desiree Shapiro. Some additional funding was provided by the UC San Diego Child and Adolescent Psychiatry Inclusive Excellence (CAPIE) Program, funded by UnitedHealth Group and led by Dr. Shapiro. Authors’ Contributions H.B. and D.S. were responsible for the study concept and design and are guarantors of the integrity of the entire study. H.B. led the creation of the intergenerational program and research proposal, including course design, participant recruitment and support, and securing community partnerships and funding, with D.S. mentoring and collaborating in every step from its inception to implementation. A.R. contributed to program design and implementation and directed the research component of the study, overseeing its implementation, developing data collection surveys, and analysis. A.R. and J.O.Y. carried out data encoding, categorization, and analysis. J.O.Y. processed raw survey data, conducted statistical analyses, and created data visualizations. S.J. and J.M. supervised data analysis and provided interpretive guidance. H.B. and A.R. prepared the first and majority of the manuscript draft. D.S. contributed to manuscript editing and provided critical revisions throughout development. All authors read and approved the final manuscript. Acknowledgements The authors wish to thank the members of NEATLabs at UC San Diego for their collaboration, particularly undergraduate students Sripad Karne and Niharika Malhotra, who contributed meaningfully to the initial data categorization. We are also grateful to Dr. Marc Marino from the UC San Diego Division of Biological Sciences for his thoughtful guidance during the data analysis process. This project was made possible through the collaboration with our community partners. We extend our sincere appreciation to the UC San Diego Stein Institute for Research on Aging and the Center for Healthy Aging—especially Danielle Glorioso, Dr. Allison Moore, and Dr. Anthony Molina—for facilitating our partnership with Belmont Village Senior Living and welcoming us into the community-engaged work of the Living Lab. We are deeply thankful to the community at Belmont Village Senior Living in La Jolla. We are inspired by the participants who generously shared their life stories, and we appreciate the support of liaisons Paula Lemkuil and Deborah Rose, whose dedication helped bring this program to life and ensured its success. We are also grateful to the medical student participants, whose openness, curiosity, and care were central to the spirit of this work. Finally, we extend our heartfelt thanks to the UC San Diego Sanford Institute for Empathy and Compassion — particularly Dr. Lisa Eyler, Dr. Federica Klaus, and Jenna Tutjer, and Angela Elo-Rivera — for their generous support, collaboration, and ongoing partnership. Authors’ Information (optional) School of Medicine, University of California, San Diego, CA, United States Anastasia Ryhanych (ORCID: 0009-0006-1547-012X), Heidi Banh (ORCID: 0009-0000-3670-7559), Desiree Shapiro (ORCID: 0000-0002-1367-8713) Psychiatry Residency Program, UC Los Angeles/Veterans Affairs, Los Angeles, CA, United States Heidi Marie Banh NEATLabs, University of California, San Diego, CA, United States Jessica Olivia Young (ORCID: 0000-0002-1220-3070), Satish Jaiswal (ORCID: 0000-0002-3617-1106), Jyoti Mishra (ORCID: 0000-0001-6612-4557) Department of Psychiatry, University of California, San Diego, CA, United States Desiree Shapiro, Jyoti Mishra References Ageing and health [Internet]. [cited 2025 July 22]. 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Assessment. 2020 Jan;27(1):21–39. Thomas ML, Bangen KJ, Palmer BW, Sirkin Martin A, Avanzino JA, Depp CA, et al. A new scale for assessing wisdom based on common domains and a neurobiological model: The San Diego Wisdom Scale (SD-WISE). J Psychiatr Res. 2019 Jan;108:40–7. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: Assessing the ability to bounce back. Int J Behav Med. 2008 Sept;15(3):194–200. Keyes CLM. Mental Health Continuum--Short Form [Internet]. American Psychological Association (APA); 2017 [cited 2025 July 21]. (PsycTESTS Dataset). Available from: https://doi.apa.org/doi/10.1037/t30592-000 % Human-Made Transcription Services | GoTranscript [Internet]. [cited 2025 July 23]. Available from: https://gotranscript.com Mann-Whitney U test [Internet]. [cited 2025 July 23]. Available from: https://www.statskingdom.com/170median_mann_whitney.html Paired t test calculator - dependent t-test calculator [Internet]. [cited 2025 July 23]. 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Benefits of Intergenerational Contact: Ageism, Subjective Well-Being, and Psychosocial Developmental Strengths of Wisdom and Identity. Int J Aging Hum Dev. 2023 Mar;96(2):135–59. Office of the Surgeon General (OSG). Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community [Internet]. Washington (DC): US Department of Health and Human Services; 2023 [cited 2025 July 23]. (Publications and Reports of the Surgeon General). Available from: http://www.ncbi.nlm.nih.gov/books/NBK595227/ Lee EE, Depp C, Palmer BW, Glorioso D, Daly R, Liu J, et al. High prevalence and adverse health effects of loneliness in community-dwelling adults across the lifespan: role of wisdom as a protective factor. Int Psychogeriatr. 2019 Oct;31(10):1447–62. Grennan G, Balasubramani PP, Alim F, Zafar-Khan M, Lee EE, Jeste DV, et al. Cognitive and Neural Correlates of Loneliness and Wisdom during Emotional Bias. 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Available from: https://www.medrxiv.org/content/10.1101/2024.01.04.24300716v1 Jaiswal S, Purpura SR, Manchanda JK, Nan J, Azeez N, Ramanathan D, et al. Design and Implementation of a Brief Digital Mindfulness and Compassion Training App for Health Care Professionals: Cluster Randomized Controlled Trial. JMIR Ment Health. 2024 Jan 22;11(1):e49467. Daya Z, Hearn JH. Mindfulness interventions in medical education: A systematic review of their impact on medical student stress, depression, fatigue and burnout. Med Teach. 2018 Feb;40(2):146–53. Abrams MP, Salzman J, Espina Rey A, Daly K. Impact of Providing Peer Support on Medical Students’ Empathy, Self-Efficacy, and Mental Health Stigma. Int J Environ Res Public Health. 2022 Apr 23;19(9):5135. East L, Jackson D, O’Brien L, Peters K. Storytelling: an approach that can help to develop resilience: Relating personal experiences can help participants to cope with their conditions and improve research, explain Leah East, Debra Jackson, Louise O’Brien and Kathleen Peters. Nurse Res. 2010 Apr;17(3):17–25. Caleb AM, Lafferty‐Danner K, Marroquin A. Cultivating narrative humility in medical education through community‐based narrative encounters. New Dir Teach Learn. 2024 June;2024(178):25–33. Rieger KL, Horton M, Copenace S, Bennett M, Buss M, Chudyk AM, et al. Elevating the Uses of Storytelling Methods Within Indigenous Health Research: A Critical, Participatory Scoping Review. Int J Qual Methods. 2023 Oct;22:16094069231174764. Viscogliosi C, Asselin H, Basile S, Borwick K, Couturier Y, Drolet MJ, et al. Importance of Indigenous elders’ contributions to individual and community wellness: results from a scoping review on social participation and intergenerational solidarity. Can J Public Health. 2020 Oct 1;111(5):667–81. Table 6 Table 6 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table6AdditionalFile1.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 03 Oct, 2025 Reviewers agreed at journal 17 Sep, 2025 Reviews received at journal 16 Sep, 2025 Reviewers agreed at journal 12 Sep, 2025 Reviewers agreed at journal 12 Sep, 2025 Reviewers invited by journal 10 Sep, 2025 Editor assigned by journal 03 Sep, 2025 Editor invited by journal 11 Aug, 2025 Submission checks completed at journal 10 Aug, 2025 First submitted to journal 10 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7255538","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":516072440,"identity":"949cdcd0-6629-4630-ba72-0d0b45f0ce60","order_by":0,"name":"Anastasia Nicole Ryhanych","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIiWNgGAWjYHACNjBpwN4DJAsYEsA8HgYGxgaCWnjOgEgDUrRI5BCphX/2GbMHP3ccljeXfHvwwQ+DP3kMEsmPP7xhsJHdcAC7FolzOeaGvWcOG+6cnZds2GNgUMwgkWYmOYchzRiXFoYzPGYSvG2HEwxu55hJ8BgYJDZI5LAx8zAcTsSlRR6oRfIvSMvNM+Y//0C0MH/mYfiPU4sBUIs02JYbPGbMUFsYpHkYDuDUYniGrUxati3dcMOZHGNpGQPjxDaeZ0C/GCQbz8ShRe4M8zbJt23W8gbHzxh+fFMhl9jPDgqxCjvZPlzeZ+AwABLNCD40mnApBwH2B0CiDp+KUTAKRsEoGOkAAD9kW7Sx0jRMAAAAAElFTkSuQmCC","orcid":"","institution":"University of California San Diego School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Anastasia","middleName":"Nicole","lastName":"Ryhanych","suffix":""},{"id":516072441,"identity":"59b6059b-4b0a-4c18-82ca-94e93b640f0c","order_by":1,"name":"Heidi Marie Banh","email":"","orcid":"","institution":"University of California","correspondingAuthor":false,"prefix":"","firstName":"Heidi","middleName":"Marie","lastName":"Banh","suffix":""},{"id":516072442,"identity":"33bd680e-e559-4908-afdc-11c2d08e458a","order_by":2,"name":"Jessica Olivia Young","email":"","orcid":"","institution":"University of California","correspondingAuthor":false,"prefix":"","firstName":"Jessica","middleName":"Olivia","lastName":"Young","suffix":""},{"id":516072444,"identity":"4cff7c93-fa64-4fdb-b001-dc72172e3577","order_by":3,"name":"Satish Jaiswal","email":"","orcid":"","institution":"University of California","correspondingAuthor":false,"prefix":"","firstName":"Satish","middleName":"","lastName":"Jaiswal","suffix":""},{"id":516072446,"identity":"a5bc375b-930b-4ddd-af98-3944a05bd0ad","order_by":4,"name":"Jyoti Mishra","email":"","orcid":"","institution":"University of California","correspondingAuthor":false,"prefix":"","firstName":"Jyoti","middleName":"","lastName":"Mishra","suffix":""},{"id":516072448,"identity":"6305224e-99c4-4e9c-a228-5812ad4d192d","order_by":5,"name":"Desiree Shapiro","email":"","orcid":"","institution":"University of California","correspondingAuthor":false,"prefix":"","firstName":"Desiree","middleName":"","lastName":"Shapiro","suffix":""}],"badges":[],"createdAt":"2025-07-30 18:08:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7255538/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7255538/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91561786,"identity":"cdf2f476-ad43-4e05-9139-8b4e0f9e643c","added_by":"auto","created_at":"2025-09-17 18:50:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":114069,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMedical Student IOS Scores Pre vs. Post Intervention:\u003c/strong\u003e Raincloud plot of IOS scores. Lower scores reflect greater perceived separation between “self” and “community,” while higher scores indicate greater perceived overlap. Blue represents pre-program scores, and red represents post-program scores. ** denote statistically significant differences.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/6858a608631462aa505f6de3.png"},{"id":91562659,"identity":"ba16cdcb-2d7f-45ed-9dd0-58bc4c2883dd","added_by":"auto","created_at":"2025-09-17 18:58:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":71963,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMedical Student IOS Scores Pre vs. Post Intervention: \u003c/strong\u003eBox and whisker plot of IOS Scale scores across groups. Blue represents pre-program score while red represents post-program score. Grey lines represent the change in an individual’s score across timepoints.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/33f37ae2d624c41029409b8d.png"},{"id":91563211,"identity":"f15ffa5c-c460-4a40-a71e-b4eed7998865","added_by":"auto","created_at":"2025-09-17 19:06:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":79417,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMedical Student TEQ Scores Pre vs. Post Intervention: \u003c/strong\u003eBox and whisker plot of TEQ scores across groups. Blue represents pre-program score while red represents post-program score. Grey lines represent the change in an individual’s score across timepoints.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/29d206f1e59dd9ff13f4e7b5.png"},{"id":91562661,"identity":"a7e335a4-d0cc-4ee8-abc7-d6044a402845","added_by":"auto","created_at":"2025-09-17 18:58:08","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":76286,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMedical Student Compassion Scale Scores Pre vs. Post Intervention: \u003c/strong\u003eBox and whisker plot of Compassion Scale scores across groups. Blue represents pre-program score while red represents post-program score. Grey lines represent the change in an individual’s score across timepoints.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/d1a9d1cc09614ca78d1308b2.png"},{"id":91563212,"identity":"f21c47e4-fd3a-4a81-aa19-20c15f93637f","added_by":"auto","created_at":"2025-09-17 19:06:08","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":59763,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOlder Adult SD-WISE-28 Scores Pre vs. Post Intervention\u003c/strong\u003e: Box and whisker plot of SD-WISE-28 scores within the OA cohort. Blue represents pre-program score while red represents post-program score. Grey lines represent the change in an individual’s score across timepoints.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/41a653b2d4ea4cf55da3a714.png"},{"id":91561797,"identity":"b10bda45-2028-44ef-8b4f-1cf50a41de91","added_by":"auto","created_at":"2025-09-17 18:50:08","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":173246,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMedical Student Age-Related Attitudes Q1 Scores Pre vs. Post Intervention: \u003c/strong\u003eRaincloud plot of responses to Age-Related Attitude Question 1: \u003cem\u003e“When interacting with individuals from different generations (age groups), I feel listened to, respected, and valued.”\u003c/em\u003e Lower scores indicate stronger disagreement to the question while higher scores reflect stronger agreement. Blue represents pre-program scores, and red represents post-program scores. *\u003cem\u003eAsterisks denote statistically significant differences.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/3eb22a14d30670b0033ae5b4.png"},{"id":91562669,"identity":"47d736dd-3942-43ab-98a0-db79000d8bdd","added_by":"auto","created_at":"2025-09-17 18:58:09","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":269431,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMedical Students’ Satisfaction with the Program and Its Components: \u003c/strong\u003eBar graph of medical students’ perceived satisfaction with the different components of the program.\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/55be89680285e4330202044d.png"},{"id":91561799,"identity":"89f60c3e-0329-4a0b-8dcb-6a2012224b42","added_by":"auto","created_at":"2025-09-17 18:50:09","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":279605,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOlder Adults’ Satisfaction with the Program and Its Components: \u003c/strong\u003eBar graph of older adults’ perceived satisfaction with the different components of the program.\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/d14ea5c1163d5cf2e1b0b09e.png"},{"id":91562664,"identity":"0b04f460-7200-47d7-93a8-b2b097279c6c","added_by":"auto","created_at":"2025-09-17 18:58:08","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":303609,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParticipant Satisfaction with Program Support: \u003c/strong\u003eBar graph of all participants’ perceived satisfaction with the support offered throughout the program.\u003c/p\u003e","description":"","filename":"floatimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/8388ce8b06a2a0c868c91d60.png"},{"id":91561798,"identity":"00125cd2-2f71-4e35-be2d-1efb9c792e31","added_by":"auto","created_at":"2025-09-17 18:50:09","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":255332,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParticipant Satisfaction with Program Length: \u003c/strong\u003eBar graph of all participants’ perceived satisfaction with the length of the program.\u003c/p\u003e","description":"","filename":"floatimage10.png","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/d4b96257a129262afb18b897.png"},{"id":91562670,"identity":"11ec1089-0fad-4773-8dae-33f90a40abdc","added_by":"auto","created_at":"2025-09-17 18:58:09","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":261352,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOverall Program Satisfaction Represented in Recommendation Ratings: \u003c/strong\u003eBar graph of all participants’ reported recommendation rating.\u003c/p\u003e","description":"","filename":"floatimage11.png","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/5c20f693d6d8ead38c75e9c6.png"},{"id":91565292,"identity":"f7c2fd19-1fc9-497b-bb0d-2d376ea70212","added_by":"auto","created_at":"2025-09-17 19:22:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3495670,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/080d3868-5a66-4652-b981-2dd8ad3ab57c.pdf"},{"id":91561794,"identity":"69cb99dd-1896-4fbe-9e40-5ccfa26d8fb3","added_by":"auto","created_at":"2025-09-17 18:50:08","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":82020,"visible":true,"origin":"","legend":"","description":"","filename":"Table6AdditionalFile1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7255538/v1/ae1b71a515ac6eebb517d4dc.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"An Intergenerational Storytelling Program in Medical Education: A Mixed-Methods Evaluation","fulltext":[{"header":"Background","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003eAgeism and Its Impacts\u003c/h2\u003e\u003cp\u003eWith our increasingly global aging population (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), there is a growing need to train community-oriented, compassionate physicians who have the competence and compassion to care for older adults. During medical school, students begin to develop their identities as future physicians including their attitudes towards patients. Ageism has well-studied negative effects on the physical and mental health of older adults, and in healthcare specifically, ageism links to poorer quality of care (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Ageism has become so prominent in society that the World Health Organization launched a campaign against ageism in 2018 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Furthermore, a 2021 United Nations report found that 1 in 2 people in the world is believed to have ageist attitudes, which is associated with poorer health and quality of life for older adults and communities, as well as social isolation and earlier deaths (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Economically, a 2020 study showed that the consequences of negative age stereotypes and self-perceptions cost societies billions of dollars (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eIntergenerational Programs in Medical Education\u003c/h2\u003e\u003cp\u003eIntergenerational activities intentionally structured to build empathy and compassion while addressing ageist beliefs can inform the ways medical students practice patient-centered care for years to come. Programs fostering intergenerational connections have shown positive benefits and experiences for all involved (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Intergenerational experiences in medical education hold the potential to decrease ageism, improve medical trainees’ attitudes towards older adults, and positively impact the quality of patient care (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Connecting medical students and older adults over the collection of a life story can increase connection, empathy, compassion, and resilience; research demonstrates the positive correlations between social connectedness, resilience, and mental well-being for both older adults and medical students alike (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA growing body of literature emphasizes the effectiveness of intergenerational programs, experiential learning, and targeted educational interventions in reducing ageist attitudes among medical students and healthcare professionals (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These studies collectively suggest that structured engagement with older adults - through volunteerism and real engagement, curriculum-based initiatives, and clinical exposure - not only fosters more positive perceptions of aging but may also contribute to improved health outcomes for older populations (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e–\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Incorporating intergenerational interventions in medical education have great potential to combat the harmful development of negative stereotypes and discrimination. For example, research studies studying a narrative program originating at Veterans Affairs (VA) hospitals, “My Life, My Story,” as implemented in a medical school curriculum showed positive effects on trainees’ empathy, burnout (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and patient-centered care competencies (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to a 2022 meta-analysis of interventions in undergraduate health and social sciences students, interventions based on empathy have the greatest positive effect on attitudes towards older adults (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Another systematic review of 27 geriatric-based interventions aiming to change physicians’ and medical students’ attitudes towards older adults found that studies that included an empathy-building task, including encountering older adults directly or listening to their experiences, were correlated with a greater likelihood of positive attitude change (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In contrast, interventions that focused solely on building knowledge about the care of geriatric patients, such as teaching the effects of aging and common geriatric diagnoses and treatment, did not lead to positive attitude change (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMost existing studies on the promising impact of intergenerational programs implemented into medical education have focused on evaluating changes in the students’ attitudes and age-related perceptions towards older adults. There is a need for more research evaluating the other potential impacts on medical students and older adults, including empathy, compassion, social connectedness, as well as resilience and mental well-being, as wisdom encapsulates qualities of emotional regulation, pro-social behaviors, insight, and decision-making in social contexts, it is also an outcome of interest.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eOur Novel Intergenerational Storytelling Program\u003c/h3\u003e\n\u003cp\u003e UC San Diego School of Medicine partnered with Belmont Village Senior Living in La Jolla, California to provide medical students with an opportunity to engage with older adults in the local community and collect their life stories and experiences. Our study aimed to measure the impact of an original 8-week intergenerational narrative storytelling elective on medical student and older adult participants on six main outcome measures ‒ empathy, compassion, social connectedness, resilience, mental health, and wisdom ‒‒ through validated, standardized surveys administered prior to program initiation and after program conclusion. We hypothesized that the interactions between medical students and older adults would enhance these six outcomes. We also hypothesized that for the medical student participants, there would be greater positive attitudes about aging and increased interest in caring for older adults in their future medical careers.\u003c/p\u003e\n"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eI. Participants, Demographics, and Community Partners\u003c/em\u003e\u003c/p\u003e\u003cp\u003eResearchers obtained approval for a new pre-clinical elective at UC San Diego School of Medicine entitled, \u003cem\u003eIntergenerational Narratives\u003c/em\u003e. The elective was advertised via elective listing, email announcements, and the school’s social media platform. The community partner, Belmont Village Senior Living in La Jolla, California, advertised through their program coordinator in addition to hosted informational sessions led by the research team. Participants were recruited from December 2022 to January 2023.\u003c/p\u003e\u003cp\u003eMedical students who enrolled in the elective had the option to participate in the optional research component, which included completion of surveys at pre- and post-program implementation. Informed consent was obtained from all participants through an exempt-abbreviated consent form approved by the UC San Diego Institutional Review Board, presented at the start of the Qualtrics survey; agreement to complete the survey served as participants’ consent. Incentives to participate in the program included elective credit counted towards graduation requirements (for 1st and 2nd year medical students, if enrolled) and \u003cspan\u003e$\u003c/span\u003e10 gift cards per survey completed (total of 2 surveys). The medical student intervention group (MS-Intervention) consisted of 1st and 2nd year medical students who enrolled in the \u003cem\u003eIntergenerational Narratives\u003c/em\u003e elective course. The MS-Control group also consisted of 1st and 2nd year medical students; however, they were not enrolled in the elective and were recruited via a message distributed on a student-wide communication platform. The study participants included 9 medical students (11 total, including 2 research team members who participated to ensure equal pairings) and 11 older adult residents from Belmont Village Senior Living. The majority of medical students in the intervention group identified as female (89%), with a median age of 21–25 years and ethnic distribution of 55% Asian or Asian American, 33% White, and 11% Hispanic or Latino. The control group had a similar age range, with 60% identifying as female, 30% as male, and 10% undisclosed; ethnically, it was 50% Asian or Asian American, 30% White, 10% Black or African American, and 10% Other. Older adult participants were 55% female, 45% male, with a median age of 86–90 years, and a racial/ethnic distribution of 91% White, 9% Asian or Asian American.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic Data\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDemographics (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMS-Control (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMS-Intervention (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOA (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMedian Age\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21–25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21–25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86–89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e% Female\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e% Male\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRace/Ethnicity\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e% Asian/Asian American\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e% Black/African American\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e% Hispanic/Latino\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e% White\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e% Other\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003cem\u003eII. Sample Size and Power\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis pilot and feasibility study was powered for large effect size (Cohen’s \u003cem\u003ed\u003c/em\u003e \u0026gt; 0.8) results from one-tailed paired t-test comparisons between pre- vs. post-program outcomes tested at alpha level of 0.05 and beta power of 0.8 with sample size of ~ 10 participants in each group (n = 10 MS-Control/ n = 8 MS-Intervention/ n = 11 OA). Sample size and power calculations were conducted using G*Power 3.1 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). One-tailed comparisons were justified as we only hypothesized improvement at post- relative to pre-program surveys. We were not powered for multiple comparison corrections across surveys and all between group data analyses were exploratory aligned with sample sizes observed in prior preliminary intervention studies (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Thus, although this pilot study had limited sensitivity, its results provide important proof of intervention feasibility and persuade a larger sample size study of the intergenerational intervention.\u003c/p\u003e\u003cp\u003e\u003cem\u003eIII. Study Design\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe program was 8 weeks long consisting of 8 weekly hour-long sessions, including 1 orientation, 4 group discussions, and 3 individual sessions. Prior to and at the conclusion of the program, all three cohorts (e.g. MS-Control, MS-Intervention, and OA) received a pre- and post-program survey, respectively. A medical student on a research gap year and a faculty member at the School of Medicine served as program facilitators.\u003c/p\u003e\u003cp\u003eThe orientation was conducted separately for medical students and older adults, during which expectations and program structure were outlined. In group sessions, facilitators invited participants to discuss themes such as patient-centered care, positive psychological health, wisdom, social justice, and cultural humility. Participants were invited to share their experiences and ranging perspectives about a given topic with prompts and activities organized by the program facilitators in a non-judgmental setting that promoted curiosity and empathy.\u003c/p\u003e\u003cp\u003eIn addition to 4 group sessions, each medical student engaged in 3 one-on-one sessions with an older adult partner during which the student conducted the life-story interviews with the older adult. The medical students were provided background readings, a guide, and access to program leadership support.\u003c/p\u003e\u003cp\u003eIn between one-on-one and group sessions, the medical students reflected on their experience through weekly reflective writing exercises (i.e. discussion board posts using the school’s secure learning management system). Reflection prompts invited medical students to share their experiences in the elective and to explore the bio-psycho-social-spiritual-cultural factors influencing their partners’ lives and perspectives. Students were also encouraged to reflect on how these lessons could be applied in clinical settings and patient interactions. The reflection posts were used in the thematic analysis. At the conclusion of the 8-week elective, the medical students were tasked to write their partners’ life story highlights and had the option of sharing the writeup with their partner.\u003c/p\u003e\u003cp\u003e\u003cem\u003eIV. Data Collection and Privacy\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe surveys administered were stored in secure, password-protected cloud storage maintained by Qualtrics International Inc., which has a contract with UC San Diego to provide HIPAA-compliant survey hosting and a survey programming platform.\u003c/p\u003e\u003cp\u003e\u003cem\u003eV. Surveys\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis study used a mixed-method, repeated-measures design to analyze the program’s potential effects. No personal identifiers were collected on the surveys (participants created a unique code allowing investigators to match pre-surveys and subsequent responses). Participants were asked to self-report their levels of social connectedness, resilience, mental well-being, wisdom, empathy, and compassion through the standardized and validated questionnaires listed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. All of the surveys employed had a Cronbach's alpha greater than 0.8, indicating good to excellent internal reliability (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Additionally, the research team included questions that were developed to further explore the program’s impact on outcome measures not captured by the 6 standardized questionnaires, including program improvement opportunities and age-related attitudes. Collectively, these also provided insight into overall quality improvement and possible adaptations for future programming.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSurveys\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurvey\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuality Measured\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReliability\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInclusion of Other in the Self Scale (IOS) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSocial Connectedness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eToronto Empathy Questionnaire (TEQ) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmpathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompassion Scale (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCompassion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSan Diego Wisdom Scale (SD-WISE-28), e.g. Jeste-Thomas Wisdom Index (JTWI) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWisdom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBrief Resilience Scale (BRS) (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.85–0.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental Health Continuum Short Form (MHC-SF) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMental Well-Being\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.89–0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge-Related Attitudes Questions (AQ)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention Impact\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality Improvement Questions**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention Improvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: \u003cb\u003eSurveys\u003c/b\u003e: *IOS did not have a Cronbach alpha as it is a 1-item survey; **Quality improvement questions were only asked on the post-program survey.\u003c/p\u003e\u003cp\u003e\u003cem\u003eVI. Discussion Board Posts \u0026amp; Post-Program Focus Group\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe discussion board posts were hosted on the elective course’s learning management system page. There were four threads dedicated to group session reflections and three threads dedicated to individual reflections. In total, there were 57 discussion board posts, excluding responses to specific comments. Two post-program focus groups were held at the conclusion of the elective, one for the older adults and one for the medical student participants. The sessions were recorded and transcribed by “GoTranscript” (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) and comments from participants were included in the qualitative analysis. For the older adults who were unable to attend the focus group, individual exit interviews were conducted over phone calls with a member of the research team.\u003c/p\u003e\u003cp\u003e\u003cem\u003eVII. Data Analysis\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe evaluation component of this project followed an interrupted time series design utilizing prospective data collection for multiple comparison groups. Program effectiveness was assessed by collecting quantitative data from pre-program and post-program surveys. Of note, in order to ensure each older adult had a medical student partner, two members of the research team participated in the program but did not complete the surveys. Additionally, another participant failed to complete the entirety of the pre-survey, so their data was excluded.\u003c/p\u003e\u003cp\u003eFive-point Likert scales and reverse coding were used to quantify positive and negative-framed items respectively throughout the various surveys. After quantifying the survey responses, statistical analysis was performed to compare pre-intervention and post-intervention scores, as well as responses between certain measures of the MS-Intervention and MS-Control groups, using online statistical tools from StatsKingdom (\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e–\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). As we considered improvement in survey scores as meaningful change and given our small sample, we used one-sided paired t-tests to compare the pre-intervention and post-intervention survey data within each cohort. As the Age-Related Attitude Questions (AQ) were not normally distributed, a one-sided Wilcoxon Signed-Rank test was employed. However, due to minimal variability and a high frequency of tied values, the test could not be meaningfully applied to AQ 1–2 and 4–5 for the MS-Control cohort, AQ 2–5 for the MS-Intervention cohort, and AQ 1–2 for the OA cohort. In these cases, descriptive statistics were used to better characterize response patterns. Normality of measures was assessed and paired t-tests were used for normal measures else the Wilcoxon Signed-rank test was used for within-group comparisons. If the results for any of these within-group comparisons were significant for either of the medical student cohorts, we ran exploratory between-group tests to assess the difference between the MS-Intervention and MS-Control groups. Specifically, a change score was calculated (post-intervention minus pre-intervention scores) for each individual within each group, and a one-sided Mann-Whitney U test was used to assess if the change was greater in the MS-Intervention group compared to the MS-Control. The Mann-Whitney U test was chosen because the change score data did not meet the normality assumption.\u003c/p\u003e\u003cp\u003eThe qualitative data we analyzed came from the following sources: post-program survey free response questions, post-program focus groups, exit interviews (select older adults only who were unable to attend the focus group), and discussion board posts (medical students only). To evaluate the data, a thematic analysis approach utilizing an online qualitative analysis software “Delve” was employed, thus streamlining the process of categorizing comments into common themes (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). A few quotes were then selected from each category that best exemplified that theme.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cem\u003eI. Quantitative Analyses\u003c/em\u003e\u003c/p\u003e\u003cp\u003eResults of the paired t-test matching each individual\u0026rsquo;s pre survey data to their post survey response within each of the three cohorts, are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. There were no significant results within the MS-Control cohort. Within the MS-Intervention cohort, the pre vs. post IOS Scale (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.037), TEQ (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034), the Compassion Scale (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010), and the Age-Related Attitude Q1 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0131), were statistically significant. Lastly, within the OA cohort, the pre vs. post SD-WISE-28 survey results were statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eWithin Cohort Analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eMS-Control\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMS-Intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eOA\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurvey\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eT or Z-Stat\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT or Z-Stat\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eT or Z-Stat\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIOS Scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.037*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.439\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTEQ\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.093\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.034*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.436\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCompassion Scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.959\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.010*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.432\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eJTWI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.380\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.012*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBrief Resilience Scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.901\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMHC-SF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.920\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.079\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.814\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge-Related Attitude Q1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.013*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge-Related Attitude Q2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge-Related Attitude Q3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.889\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.187\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge-Related Attitude Q4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.849\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.802\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge-Related Attitude Q5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e: \u003cb\u003eWithin Cohort Analysis\u003c/b\u003e: * denotes statistically significant (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e\u003cp\u003eAs not all Age-Related Attitude Questions met the assumptions for the Wilcoxon Signed-Rank Test, the median and interquartile range of change scores were calculated for these items and are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Among the Age-Related Attitude Questions, the MS-Intervention group demonstrated a greater median increase in feeling respected by other generations (AQ1: 1.00 [IQR 1\u0026ndash;1]) compared to no change in the MS-Control and older adult groups (0.00 [0\u0026ndash;0]). All groups showed no median change in respecting other generations (AQ2). The MS-Control group reported the largest increase in perceived intergenerational barriers (AQ3: 0.53 [0\u0026ndash;2.5]), whereas both the MS-Intervention and older adult groups showed no change. Regarding perceptions of aging (AQ4), the MS-Intervention group showed a shift away from viewing aging as decline (\u0026ndash;1.00 [\u0026ndash;1\u0026ndash;0]), unlike the MS-Control and older adult groups, which showed no median change. Interest in geriatrics (AQ5) remained unchanged in both medical student groups, though the MS-Intervention group showed slightly greater variability.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive Statistics for Age-Related Attitude Questions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMS-Control\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMS-Intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOA\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge Related Attitude Question\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedian (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedian (IQR)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAQ1\u003c/b\u003e: When interacting with individuals from different generations (age groups), I feel listened to, respected, and valued.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.00 (0\u0026ndash;0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.00 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.00 (0\u0026ndash;0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAQ2\u003c/b\u003e: I listen to, respect, and value individuals from generations younger and older than me.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.00 (0\u0026ndash;0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.00 (0\u0026ndash;0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.00 (-0.5-0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAQ3\u003c/b\u003e: There are significant challenges or barriers to being able to connect meaningfully with individuals of different generations.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.53 (0-2.5) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.00 (0\u0026ndash;0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.50 (0\u0026ndash;1) *\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAQ4\u003c/b\u003e: When I think of aging overall, the first thoughts that come to mind relate to decline (e.g. decline in health, social connection) rather than growth (e.g. growth in wisdom, quality of life).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.00 (-1.5-0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.00 (-1-0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.00 (-1-0.5) *\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAQ5\u003c/b\u003e: (\u003cb\u003eMS only)\u003c/b\u003e I am interested in serving older adults in my future practice as a physician and/or exploring geriatrics as a career.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.00 (0\u0026ndash;0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.00 (0\u0026ndash;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e: \u003cb\u003eDescriptive Statistics for Age-Related Attitude Questions\u003c/b\u003e: The median and IQR were calculated based on the difference in score from the pre- to post-intervention surveys. * denotes results that met the criteria for the Wilcoxon Signed-Rank test for which the results are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eFor the surveys in which there was a significant finding within the MS-Intervention cohort, we further analyzed the data by comparing those metrics to their MS-Control counterpart using a calculated change score and Mann Whitney U test. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, all four surveys (IOS Scale, TEQ, Compassion Scale, and Age-Related Attitude Q1) showed a statistically significant effect in the MS-Intervention group compared to the MS-Control group (\u003cem\u003ep\u003c/em\u003e-values\u0026thinsp;=\u0026thinsp;0.004, 0.009, 0.046 and 0.004, respectively).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBetween Cohorts Analysis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurvey\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMS - Intervention (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMS - Control (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eU-Stat\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIOS Scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e-0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.004*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTEQ\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e2.875\u0026thinsp;\u0026plusmn;\u0026thinsp;3.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e-2.13\u0026thinsp;\u0026plusmn;\u0026thinsp;3.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.009*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCompassion Scale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e6.57\u0026thinsp;\u0026plusmn;\u0026thinsp;5.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e-0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.046*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge-Related Attitude Q1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e0.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.004*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e: \u003cb\u003eBetween Cohorts Analysis\u003c/b\u003e: * denotes statistically significant (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e\n\u003ch3\u003eA. Inclusion of Other in the Self (IOS) Scale, where Other = Community\u003c/h3\u003e\n\u003cp\u003eThe MS-Intervention group\u0026rsquo;s post survey score showed a statistically significant increase from their pre-intervention survey score (T\u0026thinsp;=\u0026thinsp;2.11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.037). As depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the distribution of scores and the scores themselves (with higher scores representing greater overlap between sense of self and community) almost ubiquitously increased from the pre survey to post survey in the MS-Intervention group. On the other hand, the opposite trend holds true for the MS-Control cohort in that the distribution shrunk while the scores decreased.\u003c/p\u003e\u003cp\u003eWhen comparing across the two cohorts, there was a statistically significant difference between the groups, with the intervention group\u0026rsquo;s change score being greater than that of the control group (U\u0026thinsp;=\u0026thinsp;2.64, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004). This finding is more clearly displayed in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e wherein the slope of the lines indicates the magnitude of change for each participant between the pre and post surveys. Interestingly, all of the IOS scores decreased or held constant for the MS-Control group while the MS-Intervention group scores all increased or held constant.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch2\u003eB. Toronto Empathy Questionnaire (TEQ)\u003c/h2\u003e\n\u003cp\u003eThe MS-Intervention group\u0026rsquo;s post survey score was statistically significantly increased from their pre survey score (T\u0026thinsp;=\u0026thinsp;2.16, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034). In comparing the change score results, there was a statistically significant difference between the groups with the intervention cohort\u0026rsquo;s change score being higher than that of the control group (U\u0026thinsp;=\u0026thinsp;2.37, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009). Figure \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e shows the progression of individuals\u0026rsquo; survey scores from prior to the intervention to after the intervention. In examining the MS-Control group, it is evident that the spread of the post survey scores increases but the value of the scores (with higher scores indicative of a greater capacity for empathy) mostly declines or stagnates. Contrastingly, the spread of the post survey scores for the MS-Intervention cohort decreases with most of the scores, apart from one outlier, clustered in higher value ranges. Moreover, all but two of the medical students in the intervention group had an increased post survey score.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eC. Compassion Scale\u003c/h3\u003e\n\u003cp\u003eWhile the OA and MS-Control groups showed no statistically significant differences in total score on the Compassion Scale between the pre- and post-intervention survey timepoints, the MS-Intervention group did score statistically significantly higher on the post-intervention survey compared to the pre-intervention survey (T\u0026thinsp;=\u0026thinsp;3.11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010). In regard to the change score, there was a statistically significant difference between the groups (U\u0026thinsp;=\u0026thinsp;2.09, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.046). As evident in Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e, there are mixed trends amongst the MS-Control group with some individuals scoring higher while others scored lower on the post survey in comparison to their pre survey. Contrastingly, most individuals in the MS-Intervention cohort scored higher in the post survey compared to the pre survey.\u003c/p\u003e\n\u003ch3\u003eD. Jeste-Thomas Wisdom Index (e.g. 28-item San Diego Wisdom Scale, SD-WISE-28)\u003c/h3\u003e\n\u003cp\u003eIn comparing the SD-WISE-28 pre-intervention to post-intervention scores within each cohort, only the OA cohort yielded a statistically significant change in score (T\u0026thinsp;=\u0026thinsp;2.76, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012). Since there was no significant change within either medical student cohort, no further analysis was completed.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eE. Brief Resilience Scale\u003c/h2\u003e\n \u003cp\u003eThere were no statistically significant results in the Brief Resilience Scale between the pre-survey and post-survey timepoints across all three cohorts (MS-Control: T\u0026thinsp;=\u0026thinsp;0.13, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.451; MS-Intervention T\u0026thinsp;=\u0026thinsp;1.10, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.156; OA: T\u0026thinsp;=\u0026thinsp;0.85, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.210).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eF. Mental Health Continuum Short Form\u003c/h2\u003e\n \u003cp\u003eThere were no statistically significant results in the Mental Health Continuum Short Form between the pre-survey and post-survey timepoints across all three cohorts (MS-Control: T = -0.10, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.540; MS-Intervention T\u0026thinsp;=\u0026thinsp;1.61, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.079; OA: T = -0.95, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.814).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eG. Age-Related Attitudes Questions\u003c/h2\u003e\n \u003cp\u003eIn response to the first question (\u0026ldquo;\u003cem\u003eWhen interacting with individuals from different generations (age groups), I feel listened to, respected, and valued\u003c/em\u003e.\u0026rdquo;), the MS-Control and OA groups\u0026rsquo; answers did not significantly change over the course of the intervention (both with a median difference of 0). The MS-Intervention cohort, however, displayed a statistically significant increase in score (Z\u0026thinsp;=\u0026thinsp;2.22, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013). As displayed in Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e, the distribution of responses in the MS-Control group was almost unchanged between the pre and post surveys. However, the MS-Intervention cohort\u0026rsquo;s responses all collectively increased with all participants either choosing \u0026ldquo;Agree\u0026rdquo; or \u0026ldquo;Strongly Agree\u0026rdquo; to the above statement. In comparing across groups, we found a statistically significant difference in change score between MS-Intervention and MS-Control (U\u0026thinsp;=\u0026thinsp;2.66, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) with the intervention group having a greater change in their response.\u003c/p\u003e\n \u003cp\u003eAs for the Age-Related Attitude Questions that met the criteria for the Wilcoxon Signed-Rank test (MS-Control AQ3, OA AQ3-4), there was no statistically significant change between pre- and post-intervention scores. For the remaining Age-Related Attitude Questions, there were no significant differences in median change score between the pre-survey and post-survey timepoints across all three cohorts (see Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eFor the program participants only, one additional question asked how this experience has changed their attitude towards the other cohort overall. The answer choices were \u0026ldquo;more positive\u0026rdquo;, \u0026ldquo;no change\u0026rdquo;, or \u0026ldquo;more negative.\u0026rdquo; For the medical students, 100% reported a more positive attitude towards older adults after the \u003cem\u003eIntergenerational Narratives\u003c/em\u003e elective. 30% of the participating older adults reported a more positive attitude towards physicians, while 70% had no change post program. Some open-ended feedback is captured as quotes in \u003cstrong\u003eTable\u0026nbsp;6\u003c/strong\u003e of the Qualitative Analysis section.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eI. Quality Improvement and Satisfaction Questions\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eAs part of our post-intervention survey, we assessed participants\u0026rsquo; satisfaction of the \u003cem\u003eIntergenerational Narratives\u003c/em\u003e program through a series of Likert-scale questions and open-ended questions. The results of the Likert-scale questions are summarized below.\u003c/p\u003e\n \u003cp\u003eParticipants, particularly the older adults with more varied answers, were encouraged to elaborate on their reasonings and to give constructive feedback through free text responses and focus groups. Themes from these are summarized in a later section under Qualitative Analysis.\u003c/p\u003e\n \u003cp\u003eWe assessed if participants found the program and its main components (i.e. the individual interviewing sessions and group sessions) valuable and worth their time. Their responses to these 3 separate questions are summarized in Figs. \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eSubsequently, we asked about how satisfied participants were with the perceived level of support they received from the program team. Specifically, we asked, \u0026ldquo;Did you feel supported throughout the program and that you could voice any questions, concerns, or feedback to the program team?\u0026rdquo; Their answers to the Likert-scale questions from \u0026ldquo;never\u0026rdquo; to \u0026ldquo;always\u0026rdquo; are summarized in Fig. \u003cspan class=\"InternalRef\"\u003e9\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eWe inquired how satisfied the participants were with the program\u0026rsquo;s length; the results of which are below in Fig. \u003cspan class=\"InternalRef\"\u003e10\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eLastly, while we already measured overall program satisfaction through another set of questions above as represented by Figs. \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e, we further assessed overall satisfaction through asking participants how likely they were to recommend the program to others. Figure \u003cspan class=\"InternalRef\"\u003e11\u003c/span\u003e below shows their responses.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eII. Qualitative Analysis\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eWe gathered qualitative feedback from all participants through focus groups, exit interviews with select older adult participants unable to attend the focus groups, and open-ended questions in our post-program surveys. The key themes are listed below.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eThemes from Medical Student Participants\u003c/strong\u003e:\u003c/p\u003e\n \u003cp\u003e1)\u0026nbsp; \u0026nbsp;Valued time in curriculum for connecting with local community members in non-clinical settings\u003c/p\u003e\n \u003cp\u003e2)\u0026nbsp; \u0026nbsp;Appreciated life story interviews as a method for empathy and compassion building, with a focus on self-reflection\u003c/p\u003e\n \u003cp\u003e3)\u0026nbsp; \u0026nbsp;Welcomed the opportunity to actively reflect on unconscious biases\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4)\u0026nbsp; \u0026nbsp;More positive attitude towards older adults\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5)\u0026nbsp; \u0026nbsp;Desires to learn more about age-related challenges and health disparities\u003c/p\u003e\n \u003cp\u003e6)\u0026nbsp; \u0026nbsp;Strengthened their connection to their purpose in pursuing medicine\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eThemes from Older Adult Participants:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1)\u0026nbsp; \u0026nbsp;Value or appreciation overall in the intergenerational nature of the program\u003c/p\u003e\n \u003cp\u003e2)\u0026nbsp; \u0026nbsp;Value in time spent with one medical student partner in individual interview sessions; Desire for more bidirectional conversations with partners\u003c/p\u003e\n \u003cp\u003e3)\u0026nbsp; \u0026nbsp;Desire to talk about their medical topics and experiences in addition to their life stories\u003c/p\u003e\n \u003cp\u003e4)\u0026nbsp; \u0026nbsp;Lack of clarity in program objectives; Interest in more organizational overview, aims, and expectations\u003c/p\u003e\n \u003cp\u003e5) \u0026nbsp; Frustrations over acoustics of the conference room used for group sessions at Belmont Village\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6) \u0026nbsp; More positive attitude towards medical students and physicians.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRepresentative quotes supporting these themes are provided in \u003cstrong\u003eTable 6\u0026nbsp;\u003c/strong\u003ein a separate file titled \u003cstrong\u003eAdditional File 1.\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis pilot study evaluated a novel intergenerational program for pre-clinical medical students that was designed and implemented at the UC San Diego School of Medicine in partnership with Belmont Village Senior Living. \u003cem\u003eIntergenerational Narratives\u0026nbsp;\u003c/em\u003ebrought together older adults and medical students in dyad and group settings, creating opportunities to collect life stories and engage in meaningful intergenerational dialogue. The newly approved elective was successfully implemented, attended, and the majority of medical students and older adult participants had positive perceptions of the program. Older adult and medical student participants reported high satisfaction ratings, with the majority of both groups reporting that the program was a valuable experience. Our findings are consistent with our research supporting the benefits of intergenerational programming (15,36–39).\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eQuantitative Survey Data - Significant Findings\u0026nbsp;\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eMedical students participating in \u003cem\u003eIntergenerational Narratives\u0026nbsp;\u003c/em\u003eshowed promising results related to feelings of closeness and one’s subsequent behavior from the IOS scale (25). A pre-post trend of increased interpersonal closeness was found among participating medical students in addition to a statistically significant difference in change score between the intervention and control groups suggesting that the conversations medical students had with their older adult partner throughout the intervention may have increased their feelings of connectedness to the community and subsequently encouraged interpersonal closeness. Given the national loneliness epidemic, opportunities to enhance social connection, especially during high stress training programs like medical school may serve as protective factors towards sustaining a career in healthcare (40).\u003c/p\u003e\n\u003cp\u003eStudents participating in \u003cem\u003eIntergenerational Narratives\u003c/em\u003e displayed higher self-reported empathy before and after the program. There was also a significantly greater pre vs. post change score in the medical student intervention versus control group. These findings suggest that meaningful conversations with older adults in the community as a part of a supported learning activity may have positively contributed to medical student empathy which has implications for future patient care. Interestingly, the MS-Control group’s TEQ score decreased over the 8 weeks. We hypothesized that this was due to the increased stressors and workload that accumulated over the course of the quarter. As such, the post-intervention MS-Intervention group score might actually be higher if controlled for external variables, including school-related stressors. In addition to greater empathy, medical students in the intervention group showed a significant increase in compassion ratings from the pre-intervention to post-intervention timepoints suggesting the regular interactions medical students had with the Belmont Village residents augmented their feelings of compassion towards others. There was a significant difference in change scores between the MS-Intervention and MS-Control groups, with the MS-Intervention group showing greater change scores on average. It is possible that the students in the intervention may have become more compassionate over the course of the 8-week elective compared to their control counterparts. This may be linked to the community and experience created within the course.\u003c/p\u003e\n\u003cp\u003eFor the participating older adults, we assessed the complex construct of wisdom. Using the Jeste-Thomas Wisdom Index including six components of wisdom: 1) general knowledge of life and social decision making - ability to give good advice, life knowledge, and life skills; 2) emotional regulation - affect regulation and self-control; 3) pro-social behaviors - e.g., empathy, compassion, altruism, and a sense of fairness; 4) insight - the ability and desire to understand oneself and one's actions at a deep level; 5) value relativism (tolerance for divergent values) - being nonjudgmental and accepting of other value systems; and 6) decisiveness - the ability to make quick and effective decisions (28). After our 8-week program, we found that there was a significant increase in wisdom scores among older adults, indicating that the process of sharing their stories may have increased opportunity for reflection and greater wisdom. This notable finding from our small pilot sample size is promising, highlighting the potential of wisdom as an antidote for loneliness - a pressing issue among our older and aging population. It speaks to the potential impact this and similar intergenerational storytelling programs can have on the psychological and social health of older adults (41).\u003c/p\u003e\n\u003cp\u003eAssessing whether different populations viewed their own value differently after interacting with another generation, we found no statistically significant difference in response for the OA population between pre and post intervention; however, the MS-Intervention group reported significantly higher scores. Additionally, the change score for the MS-Intervention group was significantly greater than that of the MS-Control group. Altogether, these findings suggest that \u003cem\u003eIntergenerational Narratives\u003c/em\u003e led to medical students having a greater sense of camaraderie, respect, and value after interacting with older adults. This important finding may have promise when considering the known negative effects of ageism.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQuality Improvement and Satisfaction\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants in the program rated the program highly overall. Ratings were overwhelmingly positive with 100% of medical students strongly agreeing and 91% of older adults either strongly or somewhat agreeing that the program was a valuable experience and worth their time. Across both cohorts, more participants strongly agreed that the individual sessions (MS: 100%, OA: 55%) were worthwhile compared to the group sessions (MS: 80%, OA: 27%). Although all medical students agreed to some extent that the group sessions were a meaningful learning experience, the responses from the older adults were more varied with 18% neither agreeing or disagreeing. Based on the qualitative feedback we received from the older adults, we speculated that this cohort found the group sessions less valuable largely due to some of the logistical challenges posed by the space in which these sessions were held, as some elaborated through their open text answers in the survey question immediately after as well as in the focus group. Specifically, select Belmont Village residents mentioned having difficulty hearing and seeing clearly due to the room’s acoustics and lighting, which made it challenging to fully engage.\u003c/p\u003e\n\u003cp\u003eIn regard to program support, all medical students and 91% of older adults reported feeling supported during the program, with students selecting “always” and older adults selecting “always” or “most of the time.” All participants were given the emails and phone numbers of the program facilitators; however, it is possible that medical students felt more comfortable using technologic methods to contact the program leads if needed. Furthermore, not all of the older adults regularly used computers/phones and preferred to communicate through the Belmont Village community director who then relayed any messages to the program facilitators.\u003c/p\u003e\n\u003cp\u003eIn regard to program length, while 90% of medical students felt the 8-week program was “just right,” older adults had more varied views, with 18% reporting it was “too long,” 27% “just right,” and 36% “too short.” This finding highlights a divergence in perceptions of program length between medical students and older adults. A strong majority of medical students found the 8-week duration appropriate, suggesting that the program was well-aligned with their schedules, learning expectations, and engagement levels. In contrast, older adults exhibited a broader range of opinions suggesting the older adults may have more diverse needs or expectations regarding pacing and content delivery. The contrast points to the importance of tailoring program duration or offering flexible formats to better accommodate different participant groups.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eQuantitative Survey Data - Nonsignificant Findings\u0026nbsp;\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eWhile there was no statistically significant difference after the program in medical student nor older adult responses to the Brief Resilience Scale or Mental Health Continuum Short Form questionnaires, it is important to note that countless factors can influence resilience and mental well-being. Whether it is balancing the demands of medical school or doctors’ appointments, or navigating life events and relationships, it is understandable that an 8-week intergenerational program that meets weekly may not significantly impact one’s overall sense of resilience or mental well-being. Qualitatively, however, many medical student participants noted getting a fresh life perspective from their older adult partners, which helped them reflect on their own life in a way that helped them feel less stressed. Some older adult participants shared feeling more connected with their greater community and looking forward to their weekly meetings with students. This positive feedback from participants is promising. In addition, there is literature to suggest the relationship between social connectedness, resilience, and mental well-being (7,8). Given the statistically significant increase we found in the MS-Intervention cohort’s subjective sense of community connectedness as measured by the IOS Scale, there is room for further studies to explore impacts of intergenerational initiatives on resilience and mental well-being.\u003c/p\u003e\n\u003cp\u003eAlthough there was no statistically significant change in responses to Age-Related Attitudes Questions 2–5 among either medical students or older adults following the program, we believe this result—particularly for the MS-Intervention group—may have been influenced by their high baseline scores. Additionally, the limited range of the 5-point Likert scale may have constrained the potential for upward movement, especially for participants who already held positive attitudes at baseline. We suspect that the self-enrollment process of the program, at least partially, explains the high pre-program scores of the participants in that the individuals who chose to take part in an intergenerational program are more likely to have a more positive outlook towards aging, value connecting with those of different generations, and for the MS-Intervention group, have a higher baseline interest in serving older adults or exploring geriatrics as a career.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eQualitative Survey Data\u0026nbsp;\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eWe sought and received constructive feedback for future efforts which can inform quality improvement for feasibility and sustainability of this program for our community partners.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMedical Students’ Feedback\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAs noted above, participating medical students valued their time with older adults in the community, highlighting the connection to their purpose in pursuing medicine. They appreciated hearing life stories, embraced the opportunity to reflect on any unconscious biases, and developed a more positive attitude towards older adults along with curiosity about geriatric medicine. Through the discussion board posts and post-program survey, the medical student participants commonly expressed how much they valued the opportunity to interact with the older adults in the community. Several students wrote about feeling isolated in the “medical school bubble” but felt the program provided them with an opportunity to expand upon their existing tight-knit community in a non-medical setting. Additionally, students felt that the emphasis of the elective on storytelling allowed them to interact with other members of the community without the pressure or agenda of a clinical setting which consequently fostered more authentic connections.\u003c/p\u003e\n\u003cp\u003eA significant amount of feedback from medical students included expressing gratitude for the opportunity to hear the older adults’ stories. Many medical students appreciated the narrative structure of the elective as a catalyst to build meaningful and compassionate connections with their partners. In the post session discussion boards, students summarized their conversations, often empathizing with their partners’ past struggles or celebrating their partners’ accomplishments. It was evident that all the students left the one-on-one sessions reflecting not only on their partners’ stories but also on their own life experiences. Frequently, students wrote about how something that came up in their conversation led them to think more deeply about their personal life, career goals, or in their future as a physician.\u003c/p\u003e\n\u003cp\u003eAnother commonly cited positive feedback was that interacting with the older community members actually challenged and reshaped many unconscious biases or preconceived notions about the geriatric population. Several medical students discussed how they initially saw aging in a negative light, but after talking with their partner, they realized many of the most exciting times and opportunities can come with older age and accumulated wisdom. Furthermore, numerous medical student posts emphasized how much they had in common with the Belmont Village residents. Lastly, others wrote about challenges often faced by the elderly and how we can make medicine, and society as a whole, more accessible to them.\u003c/p\u003e\n\u003cp\u003eFinally, medical students shared how interacting with the Belmont Village residents reminded them of why they decided to pursue a career in medicine and further built upon their initial motivations. The students in the program mentioned the similarities between medicine and storytelling emphasizing that medicine, at its core, is a career based on human connections.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFuture Adaptations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e1. Training and resources for students on geriatrics and common age-related challenges\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWhen asked about some challenges of the program, numerous students described wanting more formal guidance and tips on communicating with their partners who may be facing common age-related challenges, especially memory or cognitive decline. The difficulties they encountered are, more or less, typical changes related to aging. Students most often cited obstacles associated with declining hearing or memory. Consequently, several students suggested including an educational session prior to meeting with their partners so that they would be better informed of age-related changes and could strategize how to best accommodate their partners’ needs. Furthermore, other students highlighted that the program could benefit from additional resources on geriatric medicine which would not only help inform their interactions with their partners but would also be useful in their future training and careers working with older adults. Future adaptations of this program may include didactics featuring both the uplifting components of aging as well as common health challenges to provide a more holistic and realistic representation of the older demographic. Providing these ample resources throughout the program, from the pre-orientation session to process groups, could help medical students feel better supported.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOlder Adults’ Feedback\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOlder adult participants expressed overall appreciation for the intergenerational nature of the program and valued the time spent with their individual medical student partners during interview sessions. Many noted a desire for more bidirectional conversations and the opportunity to share their own medical experiences in addition to their life stories. Some participants reported a lack of clarity regarding the program’s objectives and expressed interest in a more thorough organizational overview, including its aims and expectations. Logistical concerns were also raised, particularly regarding the poor acoustics in the conference room used for group sessions at Belmont Village. Despite these challenges, participants reported a more positive attitude toward medical students and physicians as a result of their involvement in the program.\u003c/p\u003e\n\u003cp\u003eBringing older community members and medical students together presents a unique educational opportunity to dialogue and learn directly from each other about healthcare experiences and topics. For some older participants, the program’s aims and expectations were less clear when limiting the main one-on-one activity to biographical storytelling (e.g. \u003cem\u003e“I didn’t really understand the connection between hearing about my life and my physical health.”\u003c/em\u003e) Some expressed not grasping how this activity was useful to medical students’ training. When working with this specific cohort of future physicians, many older participants expressed wanting, and even expecting, to share their personal health conditions and experiences living with them. They wanted to discuss personal health challenges, experiences with aging, examples of positive and negative healthcare encounters, and end-of-life topics.\u003c/p\u003e\n\u003cp\u003eWhile the process of biographical life story interviewing itself yields many benefits, inviting older participants to share about both their wellness and illness experience, if they so choose, can provide medical students a valuable and balanced perspective on their partner’s aging experience. One’s medical conditions and experiences can be closely intertwined with their life stories, influencing their relationships, values, and perspectives. Speaking about their lives would naturally include telling stories about health and aging. These can add an extra layer to medical students’ training in empathy and compassion for their future patients, especially if students can appreciate diagnoses in context of a person’s larger life story.\u003c/p\u003e\n\u003cp\u003eLastly, many older adult participants voiced their desire for improved logistics and setting, specifically acoustics and lighting of the conference room where all group sessions took place. Participants with hearing challenges mentioned that the echoes in the room made it difficult to hear comments from others sitting across the room, thus negatively impacting their ability to fully engage in group conversations. During a few icebreaker activities where multiple conversations took place at once, it was often difficult to hear their partners’ voices despite sitting next to each other. In addition, the bright sunlight streaming in felt blinding for those with vision challenges. Collectively, this led to some dissatisfaction from some participants as it detracted from their experience and ability to stay fully engaged.\u003c/p\u003e\n\u003cp\u003eFrom this feedback, we learned that it is critical to design programs with accessibility to accommodate a wide range of health and ability statuses. This includes, but is not limited to, those with challenges regarding cognition, hearing, vision, immunocompromised health status, and technological literacy. Every program round would require flexibility and adjustments depending on the individual and overall needs of each cohort.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFuture Adaptations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e1. \u003cem\u003eIncorporate clear conversation prompts focused on medicine and aging.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eHowever, to ensure privacy of participants’ health information, this would not be a requirement, but simply an open invitation. Consent would be gathered and expectations for confidentiality would be made explicit in the program’s orientations.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2. Host a group orientation and create a syllabus for older participants to clarify program objectives and tasks.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDuring our pilot intervention, the orientation for older participants occurred via an individual phone call from one of the program’s directors. Initially, we felt this would be a personalized way to get to know each participant and address any questions, concerns, and accommodations. Additionally, as with any community-based initiative that requires adaptation, we were deciding between an in-person versus virtual orientation over Zoom. There was a range of participants’ preference and technological accessibility, therefore phone call orientations seemed most feasible. However, future program adaptations may include hosting an in-person group orientation that would serve the purpose of outlining the program’s purpose, objectives, and tasks. It would also allow dedicated time to discuss questions and concerns with the program team, helping them feel more heard and supported.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3. Logistics and setting could be improved and accommodated for older adults with common age-related challenges including hearing and vision difficulties. Identify any accommodations that would improve participant experience.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn this pilot round, accommodation needs were assessed through the initial individual phone calls with each older adult participant. Alternative methods can be through surveys and pre-program focus groups with program leaders where we could gather a better sense of cognitive challenges and other concerns that may require specific accommodations and guidance for medical students.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants’ Feedback on Specific Program Components\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIndividual Sessions\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBased on feedback from participants, older adults and medical students unanimously enjoyed the individual sessions with their respective partners. Participants valued having a clear goal or task to work towards in these sessions (e.g. life story interviewing, medical students working on interpersonal communication and history taking skills). Some medical students mentioned appreciating the structure and physical guides with suggested question prompts, while also having the freedom and flexibility to personalize conversations. Older adults valued the opportunity to actively reflect on their lives and growth from core memories. Some older adult participants expressed a desire for more bi-directional conversations with their partners, including learning more about the students’ lives. Overall, participants valued getting to build one deeper relationship or friendship with a consistent partner over the course of the program. Participants from both cohorts spoke positively about finding common humanity despite age and other differences. Medical students welcomed the individual sessions especially as an opportunity to actively reflect on unconscious biases regarding age, socioeconomic status, and other factors.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGroup Sessions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFeedback and satisfaction measures for the group discussions were more mixed. Some sessions emphasized more community building through icebreaker activities (e.g. sessions on identities, cultural and ethnic backgrounds, family history), while others were medicine-focused (e.g. discussing compassion in healthcare). The medical students unanimously enjoyed all group discussions, voicing appreciation for dedicated time in their curriculum to connect with a small cohort of their peers and the local community members in a non-clinical setting. They also appreciated the group discussions as opportunities to actively reflect on their unconscious biases regarding age, race, and other intersections of identity. Some constructive feedback included a desire for additional guidance in navigating communication with partners facing memory or cognitive challenges, as for some students, this was their first exposure to this.\u003c/p\u003e\n\u003cp\u003eFor the older adult participants, while many shared positive comments about the group sessions, constructive feedback was offered. A few mentioned a desire for less icebreaker activities and more discussions on medical topics. For example, they enjoyed the group discussion on the theme of “Compassion in Healthcare,” as the interaction between older participants and medical students had a more defined purpose beyond simply fostering community through conversation, which some felt was too broad. Suggested topics for future programming included aging, health challenges, personal healthcare experiences, and end-of-life topics that were relevant for those in their age group.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eResearch Limitations\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eWhile our pilot study yielded promising preliminary findings, there were many limitations to our research, a prominent one being the small sample size. Due to the recent opening of the Belmont Village La Jolla location, there were fewer older adults residing at the senior living community at the time available for recruitment. This also contributed to our decision to not recruit a control group for the older adults, further limiting our ability to determine if observed results were due to the intervention or other confounding factors. Regarding the medical student recruitment, the medical school has a wide selection of elective courses open to first- and second-year students, resulting in relatively low enrollment in any single course.\u003c/p\u003e\n\u003cp\u003eAnother limitation was the limited demographic diversity of both cohorts. The older adult participant population lacked racial and ethnic diversity, likely due to the socioeconomic and cultural factors associated with residing in a well-resourced senior living community. Among medical students in the intervention group, the self-identified gender was largely female — while reflective of the gender distribution at UCSD SOM — it limits the generalizability of the findings to the broader medical student population.\u003c/p\u003e\n\u003cp\u003eAnother limitation from a research perspective is that all six outcome measures were assessed using subjective, self-reported questionnaires. Although self-report measures are useful, they are limited by potential biases, including social desirability and fluctuations in emotional or situational context at the time of data collection. Future research could benefit from incorporating objective cognitive assessments or other mixed-methods approaches. In particular, the increase in self-reported wisdom among older adult participants could be further explored using validated cognitive or behavioral assessments. Wisdom is known to be associated with differential cognitive abilities across the lifespan (42), and further investigation is warranted to better understand this relationship in the context of intergenerational programming.\u003c/p\u003e\n\u003cp\u003eWhile promising patterns emerged, future studies with larger, more diverse samples, multi-site implementation, and randomized controlled designs would be necessary to strengthen the evidence base and assess replicability.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe creation and implementation of a pilot \u003cem\u003eIntergenerational Narratives\u003c/em\u003e program at a large medical school was positively received by both participating medical students and older adults. Preliminary results suggest that participation was associated with statistically significant changes in medical students\u0026rsquo; social connectedness, empathy, compassion, and feelings of being respected and valued by other generations. Older adult participants also reported increases in wisdom after engaging in \u003cem\u003eIntergenerational Narratives\u003c/em\u003e. These findings align with broader literature showing intergenerational programs improving empathy, attitudes toward aging, and social connection in both youth and older adults (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile two of the six outcome measures \u0026mdash; resilience and mental well-being \u0026mdash; did not show statistically significant changes in either cohort based on standardized questionnaires, many medical student participants described the program as a meaningful source of connection and purpose. In qualitative reflections, students shared how hearing stories of adversity and resilience from their older partners helped them to reframe their own challenges, particularly those related to medical school, within a broader life context. These recurring reflections suggest that the program may have fostered meaningful benefits not fully captured by the quantitative measures used. This highlights the importance of further exploring not only resilience and mental well-being, but also burnout as a distinct and relevant construct in future studies of intergenerational interventions in medical education. These themes are especially relevant given broader concerns about medical student and physician burnout, which continue to challenge the culture and sustainability of medical training.\u003c/p\u003e\u003cp\u003ePhysician burnout is a growing national health crisis, with prevalence estimates at around 50% among United States physicians (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Medical students, in particular, are at heightened risk (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), often navigating overwhelming academic pressures, emotional fatigue, and a sense of isolation. Evidence suggests that resilience, a strong sense of purpose, and social connection are key protective factors that can mitigate burnout, depression, and anxiety among medical trainees (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). While many wellness programs in medical school emphasize internal strategies such as mindfulness, self-compassion, reflective writing, or peer support (\u003cspan additionalcitationids=\"CR47 CR48 CR49\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e), intergenerational storytelling offers a relational and community-based approach. Storytelling provides a powerful medium for exchanging wisdom and life experiences across generations, allowing lessons in perseverance and adaptability to be shared in meaningful ways (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). For medical students, listening to and engaging in stories can be both healing and impactful, reinforcing the bio-psycho-social-cultural-spiritual dimensions of holistic care central to medical training. These narrative encounters also promote social integration, helping students feel more connected and supported (\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). When participants come from diverse backgrounds, storytelling further cultivates cultural humility and deepens awareness of health equity issues (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e) by fostering humility and urging medical students to confront their own biases and privilege. Through these pathways, intergenerational storytelling may offer a promising approach to supporting the emotional well-being and professional identity development of medical students.\u003c/p\u003e\u003cp\u003eBeyond supporting emotional well-being, intergenerational storytelling holds deep cultural significance, especially within traditions that honor the wisdom of elders. In many Indigenous cultures, elders are revered as knowledge-keepers and carriers of collective identity, with storytelling serving as a core mechanism for intergenerational learning, healing, and cultural continuity. Speech-based methods grounded in Indigenous epistemologies prioritize voice, oral tradition, and relational reciprocity (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). Incorporating this lens, our program sought not only to foster empathetic and compassionate communication skills, but also to elevate older adults as valued contributors to the professional development and humanistic growth of future physicians. In doing so, the program challenged ageist assumptions and affirmed the value of elder voices in shaping the next generation of physicians.\u003c/p\u003e\u003cp\u003eIn conclusion, amid an increasingly global aging population, there is a growing need to train community-oriented, compassionate physicians who develop and maintain positive attitudes towards older adults and aging (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Through our structured \u003cem\u003eIntergenerational Narratives\u003c/em\u003e program, medical students practiced compassionate communication skills in a setting that fostered both healthy aging and intergenerational connection. Older adult participants, in turn, experienced affirmation of their wisdom and sense of social purpose. While these findings are preliminary and exploratory as a pilot study, they point to the potential of such programs to foster humanism in medical education. Further research with larger, more diverse samples and longitudinal designs is needed to confirm and build upon these results. Drawing on traditions of storytelling and existing literature on intergenerational engagement, we sought to reignite the humanistic values and sense of purpose that often draw students to medicine. By inviting older adults to share their voices, experiences, and wisdom, we honored our diverse, multigenerational communities \u0026mdash; and the rich perspectives they offer to those poised to serve them.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBRS: Brief Resilience Scale\u003c/p\u003e\n\u003cp\u003eIOS: Inclusion of Other in the Self Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMHC-SF: Mental Health Continuum Short Form\u003c/p\u003e\n\u003cp\u003eMS-Control: Medical Students in Control Cohort\u003c/p\u003e\n\u003cp\u003eMS-Intervention: Medical Students in Intervention Cohort\u003c/p\u003e\n\u003cp\u003eOA: Older Adults\u003c/p\u003e\n\u003cp\u003eSD-WISE-28: 28-item San Diego Wisdom Scale also known as Jeste-Thomas Wisdom Index (JTWI)\u003c/p\u003e\n\u003cp\u003eTEQ: Toronto Empathy Questionnaire\u003c/p\u003e\n\u003cp\u003eUCSD SOM: University of California San Diego School of Medicine\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics Approval and Consent to Participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed by the University of California, San Diego Institutional Review Board (Protocol #805143) and deemed exempt from full IRB oversight under 45 CFR 46.104. Informed consent was obtained from all participants through exempt-abbreviated consent forms approved by the UC San Diego IRB. These forms were embedded at the beginning of the pre-program surveys administered via Qualtrics, and participants indicated their consent by agreeing to complete the survey. This process met the IRB-approved criteria for a waiver of signed consent. Participation in the survey was optional and not required to take part in the program; however, all medical students and older adults opted to complete the survey. This study adhered to the ethical principles outlined in the World Medical Association\u0026rsquo;s Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eClinical trial number:\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for Publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of Data and Materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe creation and implementation of this program and research study were made possible through the generous support of a grant awarded to Heidi Banh by the UC San Diego T. Denny Sanford Institute for Empathy and Compassion\u0026rsquo;s MedGap Scholars Program (2022-2023), under the valued mentorship of faculty Dr. Desiree Shapiro. Some additional funding was provided by the UC San Diego Child and Adolescent Psychiatry Inclusive Excellence (CAPIE) Program, funded by UnitedHealth Group and led by Dr. Shapiro.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eAuthors\u0026rsquo; Contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eH.B. and D.S. were responsible for the study concept and design and are guarantors of the integrity of the entire study. H.B. led the creation of the intergenerational program and research proposal, including course design, participant recruitment and support, and securing community partnerships and funding, with D.S. mentoring and collaborating in every step from its inception to implementation. A.R. contributed to program design and implementation and directed the research component of the study, overseeing its implementation, developing data collection surveys, and analysis. A.R. and J.O.Y. carried out data encoding, categorization, and analysis. J.O.Y. processed raw survey data, conducted statistical analyses, and created data visualizations. S.J. and J.M. supervised data analysis and provided interpretive guidance. H.B. and A.R. prepared the first and majority of the manuscript draft. D.S. contributed to manuscript editing and provided critical revisions throughout development. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank the members of NEATLabs at UC San Diego for their collaboration, particularly undergraduate students Sripad Karne and Niharika Malhotra, who contributed meaningfully to the initial data categorization. We are also grateful to Dr. Marc Marino from the UC San Diego Division of Biological Sciences for his thoughtful guidance during the data analysis process.\u003c/p\u003e\n\u003cp\u003eThis project was made possible through the collaboration with our community partners. We extend our sincere appreciation to the UC San Diego Stein Institute for Research on Aging and the Center for Healthy Aging\u0026mdash;especially Danielle Glorioso, Dr. Allison Moore, and Dr. Anthony Molina\u0026mdash;for facilitating our partnership with Belmont Village Senior Living and welcoming us into the community-engaged work of the Living Lab.\u003c/p\u003e\n\u003cp\u003eWe are deeply thankful to the community at Belmont Village Senior Living in La Jolla. We are inspired by the participants who generously shared their life stories, and we appreciate the support of liaisons Paula Lemkuil and Deborah Rose, whose dedication helped bring this program to life and ensured its success.\u003c/p\u003e\n\u003cp\u003eWe are also grateful to the medical student participants, whose openness, curiosity, and care were central to the spirit of this work.\u003c/p\u003e\n\u003cp\u003eFinally, we extend our heartfelt thanks to the UC San Diego Sanford Institute for Empathy and Compassion \u0026mdash; particularly Dr. Lisa Eyler, Dr. Federica Klaus, and Jenna Tutjer, and Angela Elo-Rivera \u0026mdash; for their generous support, collaboration, and ongoing partnership.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026rsquo; Information (optional)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSchool of Medicine, University of California, San Diego, CA, United States\u003c/p\u003e\n\u003cp\u003eAnastasia Ryhanych (ORCID: 0009-0006-1547-012X), Heidi Banh (ORCID: 0009-0000-3670-7559), Desiree Shapiro (ORCID: 0000-0002-1367-8713)\u003c/p\u003e\n\u003cp\u003ePsychiatry Residency Program, UC Los Angeles/Veterans Affairs, Los Angeles, CA, United States\u003c/p\u003e\n\u003cp\u003eHeidi Marie Banh\u003c/p\u003e\n\u003cp\u003eNEATLabs, University of California, San Diego, CA, United States\u003c/p\u003e\n\u003cp\u003eJessica Olivia Young (ORCID: 0000-0002-1220-3070), Satish Jaiswal (ORCID: 0000-0002-3617-1106), Jyoti Mishra (ORCID: 0000-0001-6612-4557)\u003c/p\u003e\n\u003cp\u003eDepartment of Psychiatry, University of California, San Diego, CA, United States\u003c/p\u003e\n\u003cp\u003eDesiree Shapiro, Jyoti Mishra\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAgeing and health [Internet]. 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Med Teach. 2018 Feb;40(2):146\u0026ndash;53.\u003c/li\u003e\n\u003cli\u003eAbrams MP, Salzman J, Espina Rey A, Daly K. Impact of Providing Peer Support on Medical Students\u0026rsquo; Empathy, Self-Efficacy, and Mental Health Stigma. Int J Environ Res Public Health. 2022 Apr 23;19(9):5135.\u003c/li\u003e\n\u003cli\u003eEast L, Jackson D, O\u0026rsquo;Brien L, Peters K. Storytelling: an approach that can help to develop resilience: Relating personal experiences can help participants to cope with their conditions and improve research, explain Leah East, Debra Jackson, Louise O\u0026rsquo;Brien and Kathleen Peters. Nurse Res. 2010 Apr;17(3):17\u0026ndash;25.\u003c/li\u003e\n\u003cli\u003eCaleb AM, Lafferty‐Danner K, Marroquin A. Cultivating narrative humility in medical education through community‐based narrative encounters. New Dir Teach Learn. 2024 June;2024(178):25\u0026ndash;33.\u003c/li\u003e\n\u003cli\u003eRieger KL, Horton M, Copenace S, Bennett M, Buss M, Chudyk AM, et al. Elevating the Uses of Storytelling Methods Within Indigenous Health Research: A Critical, Participatory Scoping Review. Int J Qual Methods. 2023 Oct;22:16094069231174764.\u003c/li\u003e\n\u003cli\u003eViscogliosi C, Asselin H, Basile S, Borwick K, Couturier Y, Drolet MJ, et al. Importance of Indigenous elders\u0026rsquo; contributions to individual and community wellness: results from a scoping review on social participation and intergenerational solidarity. Can J Public Health. 2020 Oct 1;111(5):667\u0026ndash;81.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 6","content":"\u003cp\u003eTable 6 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Medical Education, Intergenerational Programs, Narrative Medicine, Storytelling, Age-Inclusive Healthcare, Geriatrics","lastPublishedDoi":"10.21203/rs.3.rs-7255538/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7255538/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003e Intergenerational programs benefit participants across generations by reducing ageism and promoting empathy and resilience. Despite compelling evidence supporting their effectiveness, formal integration into medical education remains limited. This study evaluated the impact of a narrative-based intergenerational program on medical students and older adults.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eAn eight-week elective course paired medical students with residents at a local senior living community for interviews focused on life experiences and personal stories. Standardized pre- and post-program surveys were administered to participating medical students and older adults, as well as to a comparison group of medical students not enrolled in the program. Surveys measured empathy, compassion, social connectedness, resilience, mental well-being, and wisdom. Paired t-tests evaluated within-group changes between pre- and post-program responses. A Mann-Whitney U test was used to compare outcomes between enrolled and non-enrolled medical students. Qualitative feedback was analyzed thematically.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eStatistically significant improvements were observed in medical students\u0026rsquo; self-reported social connectedness (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.037), empathy (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034), compassion (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010), and age-related perceptions (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013), as well as in older adults\u0026rsquo; self-reported wisdom (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012) from pre- to post-program. Compared to non-enrolled peers, medical students in the program demonstrated significantly higher social connectedness (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), empathy (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009), compassion (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.046) and age-related perceptions (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004). Thematic analysis revealed that students valued opportunities to connect with community members in non-clinical settings, actively reflect on unconscious biases, and develop more positive attitudes toward older adults. Older adults provided constructive feedback on the program's logistics and noted the highlight of their experience as spending time with medical students in an individual setting.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThese findings highlight the potential of narrative-based intergenerational programming to enhance key competencies in medical trainees while promoting wisdom in older adults. Integration of such programs into medical curricula may promote more empathetic and compassionate, age-inclusive healthcare while strengthening meaningful cross-generational connections.\u003c/p\u003e","manuscriptTitle":"An Intergenerational Storytelling Program in Medical Education: A Mixed-Methods Evaluation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 18:50:04","doi":"10.21203/rs.3.rs-7255538/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-03T17:11:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261393920082229478622268220188491306700","date":"2025-09-17T15:40:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-16T16:35:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251121491762977384931779439138009260579","date":"2025-09-12T15:30:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169980824339719130034425794860472598756","date":"2025-09-12T15:01:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-10T14:19:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T07:51:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-11T06:08:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-10T15:44:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-08-10T15:40:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d6dc0274-ea00-4710-9ab5-63979cd97c19","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-17T18:50:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 18:50:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7255538","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7255538","identity":"rs-7255538","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}