An examination of students' perceptions of their interprofessional placements in residential aged care

Impact of allied health student placements for older clients' health and wellbeing in primary healthcare settings: a systematic integrative review

PURPOSE

Allied health student placements in healthcare settings are complex, constantly evolving, and tailored to real-life environments. The value of student placements in acute and primary healthcare settings is reflected in enhanced student learning, improved service delivery, and positive patient outcomes. This review aims to synthesise the effects of allied health student placements in primary healthcare settings, particularly focusing on older clients' health outcomes and satisfaction with care.

MATERIALS AND METHODS

A systematic integrative review was conducted. The five-step integrative review approach, established by Whittemore and Knafl was used to allow the inclusion of diverse research methodologies. Five major databases, i.e., Medline-EBSCO, PubMed, PROQUEST, CINAHL, and SCOPUS were searched. The CLUSTER model was used to track additional references. Data were extracted as suggested by Whittemore and Knafl and then thematically synthesised.

RESULTS

Eleven papers were reviewed. Despite a lack of rigorous methodologies, five mixed-methods studies, four quantitative studies, one qualitative study, and one cost-benefit analysis were identified exploring the possible effects of allied health student placements for older clients. From these papers, four main themes were identified: student integration in service delivery, older clients' health outcomes, satisfaction with care, and insights into mechanisms to achieving health and well-being outcomes.

CONCLUSION

This review suggests that integration of allied health students into service delivery can provide additional healthcare support for older clients, but further high-quality research is needed to confirm.

"Elderly care through new eyes: Insights from Spain's future nurses" A phenomenological study

This study explores nursing students' perceptions of institutionalized elderly care, aiming to identify attitudes and biases that influence their academic and professional development in gerontological nursing. Conducted with 128 students across two campuses, this qualitative study utilized 15 focus groups for data collection. Five primary themes emerged through thematic and inductive analysis: Institutionalized Living, Stereotypes, Improvement Proposals, Exemplary Practices and Positive Observations and Educational Strategies and Person-centered Care Integration. Findings underscore the multifaceted nature of elderly long-term care settings, highlighting the prevalence of loneliness. Despite institutionalization's intent to mitigate loneliness, results suggest its effectiveness is variable, with a deficiency in social interaction opportunities. This underscores the imperative for comprehensive socialization programs. Additionally, integrating students into professional teams has been shown to foster positive interpersonal relationships significantly. Recommendations for enhancing care quality include personalizing living spaces, strengthening bonds between staff and residents, and enriching the nursing curriculum with advanced professional training.

Program evaluation of a new interprofessional geriatrics curriculum for advanced practice nursing and master of social work learners

The Indiana Geriatrics Workforce Enhancement Program (GWEP) implemented a new longitudinal geriatrics curriculum for advanced practice registered nurse (APRN) and master of social work (MSW) learners to prepare them for interprofessional collaborative practice in the care of older adults. This paper reports program outcomes of a novel longitudinal interprofessional geriatrics curriculum involving immersive learning for these learners. Outcomes are described in terms of learner reaction, modification of attitudes/perceptions, acquisition of knowledge/skills, behavior change, impact on the organization, and impact on the patient or client using the Freeth/Kirkpatrick evaluation model. Program participation influenced graduates' knowledge of and their perceived ability to participate in team care and job selection in geriatric-focused positions.

Knowledge and Perceptions of Speech-Language Pathology Students Participating in a Feeding Training Program: A Pilot Study

This study examined the knowledge and perceptions of speech-language pathology students working with older adults before and after their participation in a feeding training program. A secondary objective evaluated the feeding training program in terms of improving students' knowledge and skills. A repeated measures design was used to assess changes in perceptions and knowledge over time of students participating in a feeding training program assisting older adults at a skilled nursing facility. Twenty-four students in the communication sciences and disorders department from a university were recruited. Data were collected on the perceptions of working with older adults, knowledge of feeding and swallowing, and the evaluation of the program. Participants reported feeling less fearful of assisting older adults with feeding issues and appeared to acquire a higher level of knowledge in certain areas post-training. Analysis of the evaluation forms revealed that students were positive about their experience. The findings provide additional support that perceptions become more favorable following early exposure to older adults through participation in service-learning experiences. This study supplements the literature about the knowledge and perceptions of speech-language pathology students working with older adults. This information may be used to improve the quality of care for older adults in various settings.

Pharmacy and medical student interprofessional education placement week

BACKGROUND

Developing collaborative practice through interprofessional education (IPE) activities in undergraduate healthcare curricula is advocated by the World Health Organisation and the regulatory bodies for Medicine and Pharmacy within the UK.

APPROACH

Our local faculty, comprising educators from within the Highland Pharmacy Education and Research Centre (HPERC) and Highland Medical Education Centre (HMEC), developed a 5-day IPE placement for pharmacy and medical students on clinical placement within NHS Highland.

EVALUATION

We collected qualitative evaluation data using face-to-face focus group discussions with five pharmacy and four medical students (January 2020 cohort). Three key categories and multiple themes within each category were identified from participant narratives: Category 1, overall perception of experience-(themes: better than previous IPE experience; greater exposure to clinical pharmacy); Category 2, student interactions-(themes: learning with a buddy; understanding of interprofessional roles); Category 3, suggestions for improvement-(themes: choice of relevant clinical rotation and content; increase learning from clinical pharmacists; better orientation to placement). Overall, students valued their participation during this week and reported many benefits of learning with students from another profession. Students also highlighted suggestions to improve their learning experience.

IMPLICATIONS

This evaluation has indicated students' support for embedding interprofessional placements into their curricula. Clinical educators should consider designing similar placements, while further work should focus on inclusion of higher student numbers and look to include a range of professions and practice settings.

Preparing advanced learners for geriatric team care: A short-term curricular model that works

Health outcomes for complex older adults are enhanced by interprofessional collaboration. Funded by a Geriatrics Workforce Enhancement Program (GWEP), an interprofessional team of educators developed a short-term geriatrics experience, including four hours of pre-clinical education and 12-20 hours of immersion in team-based care for advanced learners in nursing (n = 70 APN), social work (n = 48 MSW), and medicine (n = 122 medical students). Content focused on five areas: medication management, dementia, depression, falls, and myths about aging. Learners completed pre/post surveys measuring knowledge of geriatrics, attitudes toward geriatric patients and team care, and post-surveys regarding perceptions of the overall clinical experience. Results showed significant improvement in knowledge and attitudes toward older adults and interprofessional (IP) team practice. Qualitative comments reflected increased empathy toward and enthusiasm for working with older adults, valuing IP teams, and a desire for geriatrics content earlier in their respective curricula.

Attitudes towards older adults (80 years and older): A measurement with the ageing semantic differential - A cross-sectional study of Austrian students

INTRODUCTION

The aims of the study were to investigate the four-factor structure of the German version of the Aging Semantic Differential (ASD) and to gain initial insights into the attitudes of nursing, medical and humanities students towards older people in Austria.

METHOD

A cross-sectional study design with a convenience sample was chosen.

RESULTS

The ASD was completed by 255 Austrian nursing, medicine, and humanities students, who described their attitudes towards persons who are 80 years of age and older. The applicability of the four-factor structure (instrumentality, autonomy, acceptability and integrity) of the German version was confirmed by performing a confirmatory factor analysis. The mean age of students in our sample was 23.6 years; 79% of these were female. The sample displayed negative attitudes regarding the factors of autonomy and instrumentality, but more positive attitudes regarding the factors integrity and acceptability. The attitudes of the students in the three study programmes differed, with the medical students displaying the most negative attitudes. Students who displayed positive attitudes had statistically significantly higher levels of knowledge about ageism and better possibilities to hold personal conversations with older people (80+) in the family or circle of friends.

CONCLUSION

We conclude that having more knowledge about ageism and close personal contacts to older persons can support positive attitudes towards older individuals.

Development and Evaluation of an Inter-professional Education Course at a Medical School in Korea

BACKGROUND

Interprofessional collaborative practice (IPCP) is emphasized in medical care for patient safety. As patient care is provided by teams, interprofessional competence is required to ensure the quality and safety of care and should be taught as early as possible. In this study, we introduced a 2-week interprofessional education (IPE) curriculum and attempted to describe and evaluate its effectiveness among medical students.

METHODS

We developed a 2-week IPE course and gave it to third- or fourth-year medical students (n = 166) from 2018 to 2019. The curriculum was composed of interactive lectures, discussions, small-group discussions, and simulation and was given to diverse medical students. Students were asked to report their satisfaction with the IPE program, write a reflection paper, and complete readiness for interprofessional learning scale (RIPLS) questionnaires before, immediately after, and 4 months after the curriculum. We also obtained 360° evaluations of the students by other health professionals 1 year after the training.

RESULTS

The IPE program changed students' attitudes about interprofessional learning, from less favorable to more favorable. The 360° evaluation by nurses revealed that students became more favored as teammates (overall satisfaction with them as teammates increased from 3.1/5 to 3.4/5) compared to medical interns before IPE training, and complaints from nurses about medical interns were significantly less frequent 1 year after the training.

CONCLUSION

The IPE program was effective in preparing medical students for team based collaborative practice even though it was short and exposed once in the curriculum. Further extension to other medical schools is recommended.

Student contributions in residential aged care

BACKGROUND

Health care professional students can develop knowledge and skills to care for elderly patients during placements in residential aged care facilities (RACF). Enabling student contribution during clinical placements can enhance student learning and quality of care. Our medical student RACF placement includes a learning task where students recommend improvements to resident care. This study aimed to identify these recommendations and measure how many were adopted.

METHODS

Students completed a medical assessment of a resident during their RACF placement, summarising their recommendations in a letter to the resident's general practitioner (GP). Recommendations were categorised for quantification and audit. Three months after the time of recommendation residents' files were audited. Definitions and descriptive statistics of the types of recommendations, and whether they had been implemented, are reported.

RESULTS

Forty residents and 43 students participated in the study. In total, 391 recommendations were made. Medication recommendations were most common (47%), followed by allied health referrals (12%), lifestyle changes (10%) and GP review (10%). Smaller numbers of recommendations for nursing care, investigations, specialist review and patient education were made. Seventy-seven recommendations were adopted.

DISCUSSION

Student learning is enhanced when contributing to resident care, and educators can structure clinical placements to support this. Using an existing student learning task to feed into genuine quality improvements for care is one example of how this might be implemented. This study gives insight into types of recommendations students make, suggesting further research to explore barriers and enablers to maximise the benefits of student contributions.

Stereotypes of Older Adults: Development and Evaluation of an Updated Stereotype Content and Strength Survey

BACKGROUND AND OBJECTIVES

Stereotypes are beliefs about a particular group often adopted to bypass complex information processing. Like racism and other forms of discrimination, ageism affects individuals and society as a whole. The purpose of the study was to analyze the Stereotype Content and Strength Survey (SCSS) designed to update assessment tools commonly used to measure stereotypes of older adults.

RESEARCH DESIGN AND METHODS

An updated survey was developed including aging-related descriptive items from previously published studies. Students enrolled at two Midwestern universities (n = 491) were directed to think about their perceptions of "older adults" and select the proportion they believed could be described by the items used in the tool. Response categories for each descriptive item were dichotomized and operationalized to be a strong stereotype if the collapsed response percentage was significantly ≥80%.

RESULTS

A Principal Axis Factor analysis and Direct Oblim rotation was computed on 117 descriptive items representing positive, negative, and physical characteristics, resulting in a 3-factor model with acceptable psychometric properties. Cronbach alpha analyses revealed reliable scales for negative (α = .92), positive (α = .88), and physical (α = .81) stereotypes. Of 117 descriptive items, 33 emerged as strong stereotypes including 30 positive, 2 physical, and 1 negative item.

DISCUSSION AND IMPLICATIONS

This updated assessment has the potential to contribute to an understanding of the existence of age-related stereotypes as well as the strength, or the proportion of older adults who could be described by each of the items used in the SCSS.

The Effect of Educational Interventions on Willingness to Work with Older Adults: A Comparison of Students of Social Work and Health Professions

The study examined the effect of an educational intervention on the willingness of Israeli social work students to work with older adults, comparing them to students of nursing, speech therapy, and physiotherapy. A sample of 187 first-year students were divided into two groups: a research group (n=83) exposed to an educational intervention on ageing, and a control group (n=104) that received no intervention of any kind. Following the intervention, ageism among social work students in the research group decreased and positive behavior toward older adults increased. No significant differences were found among students of the health professions following the intervention. In addition, ageism mediated between knowledge of ageing and willingness to work with older adults.Furthermore, the higher the students assessed the contribution of the intervention, the lower their level of ageism, the more positive their behavior toward older adults, and the more willing they were to consider a career in geriatrics. The results suggest that introducing into the curriculum a variety of learning methods aimed at increasing knowledge of ageing and familiarity with the world of older adults is likely to encourage more students of social work and other therapeutic professions to work with the older population.

Test/Re-Test reliability of the readiness for interprofessional education learning scale and interdisciplinary education perception scale in health science students

This study aimed to establish the test/re-test reliability of two common interprofessional education (IPE) instruments, the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IEPS), and to compare results based on previous IPE experience. The RIPLS and the IEPS were distributed to 251 students within five academic health science programs at one university. Both instruments were distributed at a second session 10-14 days later. Weighted Kappa, intraclass correlation coefficients (ICC), standard error of measurement, and minimal detectable change were calculated for each instrument's composite scores and subscales. Assessments occurred for all subjects and between students with and without previous IPE experience. Overall and between-group composite score reliability for the RIPLS and IEPS were excellent (ICC≥0.81). RIPLS subscale ICCs were variable per previous IPE experience, ranging from fair-excellent (ICC = 0.56-0.86). IEPS subscale ICCs were excellent for students with previous IPE experience (ICC≥0.76), and fair-excellent for students without previous experience (ICC = 0.64-0.84). Students with previous IPE experience had significantly higher scores within and between sessions for the RIPLS (p ≤ 0.031) but not the IEPS. Both instruments have acceptable measurement consistency; however, the RIPLS varied in repeatability compared to the IEPS. Previous IPE experience should be accounted for when distributing/interpreting the results.

Benefit-cost analysis of an interprofessional education program within a residential aged care facility in Western Australia

Interprofessional education (IPE) programs in residential aged care facilities (RACF) contributes to the care of older adults whilst providing an environment for students to learn and practise in an interprofessional manner. Clinical placements are provided by RACF through funding and support from universities in collaboration with the RACF. Conducting a benefit-cost analysis (BCA) can determine the sustainability of a clinical placement program such as an IPE program but there is limited research reporting the economic aspects of clinical placements even though it is a university and government priority. This study provides a benefit-cost analysis of an interprofessional education program offered by a residential aged care provider in Western Australia. Analysis using a BCA methodology was conducted to provide information about the level and distribution of the costs and benefits from different analytical perspectives over the three-year period of the IPE program. The analysis showed that the program was highly beneficial from an economic efficiency viewpoint, even though it did not present a financial gain for the aged care provider. The benefits accrued mainly to students in terms of increased education and skill, and to residents in terms of health outcomes and quality of life, while the cost was mostly incurred by the care provider. An IPE program in a RACF is a valuable educational learning experience for students and is also socially beneficial for residents and the broader health sector. For IPE programs in aged care to be sustainable, they require the development of collaborative partnerships with external funding.

Medical student attitudes towards older people: a critical review of quantitative measures

OBJECTIVES

Further research into medical student attitudes towards older people is important, and requires accurate and detailed evaluative methodology. The two objectives for this paper are: (1) From the literature, to critically review instruments of measure for medical student attitudes towards older people, and (2) To recommend the most appropriate quantitative instrument for future research into medical student attitudes towards older people.

RESULTS

A SCOPUS and Ovid cross search was performed using the keywords Attitude and medical student and aged or older or elderly. This search was supplemented by manual searching, guided by citations in articles identified by the initial literature search, using the SCOPUS and PubMed databases. International studies quantifying medical student attitudes have demonstrated neutral to positive attitudes towards older people, using various instruments. The most commonly used instruments are the Ageing Semantic Differential (ASD) and the University of California Los Angeles Geriatric Attitudes Scale, with several other measures occasionally used. All instruments used to date have inherent weaknesses. A reliable and valid instrument with which to quantify modern medical student attitudes towards older people has not yet been developed. Adaptation of the ASD for contemporary usage is recommended.

Understanding Australian medical student attitudes towards older people

OBJECTIVE

The aim of this article was to review the literature around Australian medical student attitudes towards older people.

METHODS

An Ovid cross-search and SCOPUS search were performed using keywords such as 'Attitude', 'Medical Student' and 'Aged or Older or Elderly'.

RESULTS

Several recent studies have investigated the attitudes of Australian medical students towards older people. Baseline attitudes at two medical schools were positive. Three studies quantified attitude improvement after curriculum intervention. All the studies used US-developed instruments, which have not been validated in Australia. Qualitative studies have described mixed attitudes towards older people: negative themes included nihilism, paternalism, communication issues, greater morbidity and reduced quality of life. Positively, students placed value on clinical decision-making and critical reflection during residential aged care placements.

CONCLUSION

Australian medical students' attitudes towards older people are mixed and not well understood based on quantitative measures developed for use in the US and on qualitative evidence. Future research in this area requires a reliable and locally-validated instrument.