For many medical students, the earliest years of training submerge them in textbooks and include little contact with sick or injured people. In their subsequent years of study, thousands of these students meet patients in hospitals, and some get to see them in health fund clinics.
Traditional, short-term educational efforts have a limited effect: Sustained, relationship-based programs hold promise but remain understudied. Students report anxiety about aging and death, as well as discomfort with the ambiguity and complexity of geriatric care.
Ageism is prejudice, stereotypes, or discrimination directed toward someone based on their age, particularly older people, and it persists among clinicians and medical students, undermining empathy and care quality.
But now a Jerusalem study has found that when first-year students meet patients in their homes over the course of a year, they develop stronger communication skills, rethink assumptions about aging, and understand patient care beyond the clinic.
Just published in Medical Education Online under the title “Beyond the classroom: a qualitative study of voluntary home visits to older adults as a tool for empathy and professional growth in medical students,” the study examines a 10-year Service-Learning Initiative in which first-year students visit older adults in the community throughout an academic year. The program gives them the chance to build sustained relationships and engage with aging, health, and vulnerability in a setting far removed from clinical routine.
The study was led by Dr. Adi Finkelstein of the Jerusalem College of Technology, Dr. Tali Sahar, and Prof. Naama Constantini of Hebrew University. Constantini, who is also director of the Heidi Rothberg Sports Medicine Center and the Eisenberg R&D Authority at Sha’are Zedek Medical Center, initiated the program together with Dr. Ohad Avny of HUJI’s family medicine department, in partnership with Randy Gerber of the Joint.
Constantini told The Jerusalem Post that the effort was one of the most important in her career, having initiated the idea a decade ago with 30 students. In the last 10 years, at least 800 male and female students have participated in the project. They met patients at their homes, including 400 elderly Israelis referred by GPs and nurses. They showed them how to exercise, exercised with them, and explained how to follow a healthy lifestyle.
Some 313 students who volunteered in recent years visited older adults in pairs, conducting about 10 visits over the course of the year. Lasting between an hour and 90 minutes, each visit focused on gentle, individualized physical activity alongside open conversation: about everyday challenges, health concerns, and what it means to age. The program included an introductory workshop and ongoing mentoring from volunteer physicians, including Constantini, and physiotherapists.
Constantini noted that as populations age, medical education continues to grapple with age-related stereotypes. “Relationship-based service learning early in training can help medical students develop stronger empathy, reduce ageist attitudes, and approach patients with a more human, patient-centered mindset,” she said. Not only can medical students benefit, but so can those studying nursing, physiotherapy, occupational therapy, and related fields who are in direct contact with patients.
Participants described significant shifts in their perspectives on aging, care relationships, and their professional identities – changes that persisted throughout their pre-clinical training. The study showed that early and sustained engagement with older adults in their homes through a structured service-learning project enhanced medical students’ professional development, empathy, and attitudes toward aging.
Building trust through attentive listening, consistent presence
Through interviews, focus groups, and reflective writing, the researchers found that the experience influenced the students in ways that extended far beyond the visits themselves. The organizers followed up with students who had graduated and worked as physicians to determine how the experience affected the way they work.
Many of those interviewed described learning how to build trust through attentive listening and consistent presence; communicate with sensitivity and respect, especially around autonomy; cope with uncertainty and complexity rather than rushing to “fix” problems; understand health in a broader context that includes loneliness, disability, and social support; and confront difficult topics. Many also declared that their encounters helped them reflect on what kind of physicians they hope to become.
“When I was able to create a real connection with an older person, I understood that treatment has meaning far beyond providing medicine – it is about seeing the whole person,” said one student. “I learned that sometimes, the most important thing is simply to listen,” another said. “Our mere presence in the room made an impact and gave the patient a sense of value.”
Another student said that, “The relationship with ‘my senior’ reminded me that behind every ID card and every age, there is a past; there are stories and dreams.”
Finally, some students described the challenge of dealing with death. Several students expressed appreciation for the support they received from their project mentors and through peer-partnerships; however, some suggested that, in the future, participating students should be better prepared to encounter death.
Three major themes and seven sub-themes emerged during the year:
• Building trusting patient-physician relationships, characterized by empathy, trust, and effective communication, alongside a balance between physician responsibility and patient autonomy;
• Embracing uncertainty and holistic care, which involved navigating medical ambiguity and integrating psychosocial dimensions into clinical reasoning; and
• Reflecting on vulnerability, aging, and mortality, encompassing the emotional impact of disability and decline, reframing aging positively, and processing experiences of death and loss.
The team recommended the inclusion of similar programs in medical-school curricula. Future research, they concluded, should assess long-term impacts on career choices and care quality.