September 8, 2026
Teaching More Than Medicine: The Hidden Curriculum of PALTC
By Shauna Assadzandi, MD
Ask most health-care professionals what learners gain from a rotation in post-acute and long-term care (PALTC), and the answers are predictable: dementia, falls, polypharmacy, wound care, and delirium. While these are foundational topics, they are only part of what makes PALTC such a powerful learning environment.
Every day, learners experience interdisciplinary teamwork, longitudinal relationships, complex decision-making, and truly person-centered care in ways that are difficult to replicate elsewhere. These experiences not only shape more thoughtful clinicians but also have the power to inspire the next generation of health-care professionals to see PALTC as a rewarding and meaningful career.
From Diagnosis to Goals
Throughout health-care education, learners are taught to identify the correct diagnosis and select the appropriate treatment. In PALTC, however, the question often becomes, "What matters most to this person?" Sometimes the best treatment is not the guideline-directed medication or the next specialty referral. Instead, it is the intervention that best aligns with an individual's goals as outlined in the Institute for Healthcare Improvement Age-Friendly framework.1 That goal may be staying out of the hospital, maintaining independence, or remaining awake and engaged long enough to attend a grandchild's wedding. Learning to provide goal-concordant care is one of PALTC's greatest educational strengths, reminding learners that the best clinical decision is not always the most aggressive one.
From Independence to Teamwork
One of the first things I tell learners is that no single person is the most important member of the team. They are often surprised to hear that. While many health-care settings naturally place one discipline at the center of care, PALTC shifts the spotlight depending on the patient's needs. Rehabilitation therapists, nurses, advanced practice providers, physicians, social workers, pharmacists, dietitians, and activities staff each bring expertise that is essential to the patient's success. Learners quickly recognize that exceptional care is not delivered by one profession; rather, it is built through collaboration. In PALTC, teamwork is not simply encouraged; it is indispensable.
From Certainty to Comfort with Uncertainty
Acute care settings often provide rapid answers. Laboratory testing, advanced imaging, and specialist consultations are readily available, allowing clinicians to make decisions with a high degree of certainty. PALTC is different. Learners frequently encounter situations in which decisions must be made without immediate diagnostic information, balancing clinical judgment with an individual's goals, prognosis, and available resources while optimizing medication, mobility, and mentation.1 This uncertainty can feel uncomfortable at first. Over time, however, learners discover that uncertainty is not a weakness of health care; it is an inevitable part of caring for older adults living with multiple chronic conditions. Learning to navigate uncertainty thoughtfully prepares clinicians for the complexity they will encounter throughout their careers.
From Encounters to Relationships
Perhaps my favorite part of teaching in PALTC is watching learners develop meaningful relationships with the people they care for. Unlike many acute care rotations, where encounters may last only minutes or days, PALTC allows learners to witness recovery, celebrate successful discharges to home, navigate setbacks, and support individuals and families through decline and end-of-life care. These longitudinal relationships deepen empathy, strengthen communication, and fundamentally change how learners approach care. Health care becomes less about treating illnesses and more about caring for people.
From Clinician to Leader
Leadership is another lesson that often develops quietly. Learners participate in interdisciplinary meetings, observe leaders from different professions solving problems together, and contribute to quality improvement initiatives, whether focused on reducing falls, improving antipsychotic stewardship, or enhancing transitions of care. They begin to appreciate that leadership is not simply directing others; it's listening, building consensus, advocating for patients, and improving systems of care. Whether or not they ultimately practice in PALTC, these experiences prepare learners to lead teams and improve care wherever their careers take them.
Conclusion
PALTC has never been simply a place to learn about the care of older adults. It is a place where learners develop judgment, humility, collaboration, and leadership; qualities that define exceptional health-care professionals across every discipline. Looking back, many of us remember far more than medication adjustments or regulatory requirements. We remember the people who trusted us, the families who invited us into life's most difficult moments, and the interdisciplinary teams that demonstrated what exceptional care truly looks like.
Those are the lessons of PALTC's hidden curriculum. They may never appear in a syllabus or competency checklist, but they are among the most enduring lessons we teach. As educators, preceptors, and mentors, we should not underestimate the influence of these everyday teaching moments. Every learner who joins us in PALTC leaves with more than clinical knowledge. They leave with a deeper understanding of person-centered care, teamwork, and leadership. Those lessons will shape their careers, whether they remain in PALTC or carry them into another corner of health care. And for some, they will be the very reason they choose to come back.
Dr. Assadzandi is a geriatrician at the University of Pittsburgh Medical Center, and the program director for their geriatric medicine fellowship. She’s the chair of the PALTmed Education Committee.
1. Institute for Healthcare Improvement. Age-Friendly Health Systems. Available at: https://www.ihi.org/partner/initiatives/age-friendly-health-systems