1
|
Zisberg A, Shulyaev K, Van Son C. Assessing attitudes and intention to work with older adults by American and Israeli nursing students: Adapting and testing a measure. NURSE EDUCATION TODAY 2021; 98:104735. [PMID: 33453557 DOI: 10.1016/j.nedt.2020.104735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/08/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Finding workers to care for older adults in healthcare settings has become a priority, and research identifying factors influencing a nursing student's intention to make geriatrics a career choice is needed. This calls for the development of a reliable measure of students' perceptions and attitudes. OBJECTIVES To determine the adaptability of Carolina Opinions on Care of Older Adults (COCOA) to assess nursing students' attitudes to older adults and their intentions to work with them in two countries. DESIGN Cross-sectional survey. SETTINGS Nursing students enrolled in an introduction to gerontological nursing course in the United States and Israel. PARTICIPANTS A convenience sample of 231 undergraduates pursuing a Bachelor of Science in nursing in the United States (N=122) and Israel (N=109). METHODS Students completed the COCOA instrument and basic demographics using an electronic platform. RESULTS Exploratory Factor Analysis (EFA) produced five factors explaining 59% of the variation, with the majority of the items (17, 71%) loading above 0.40 on subscales from the instrument's original structure. EFA led to the elimination of one subscale (Value of Older Adults) and the creation of a new subscale (Older versus Younger Adults) with three items. The reliability scores were good to acceptable for all subscales in both Israeli and American samples (α-Cronbach 0.80 to 0.60). Confirmatory FA supported the data's fit to the 21 items of the modified COCOA instrument (CMIN/DF=1.55, CFI=0.93, IFI=0.93, RMSEA=0.05). The analysis of model equivalence for American and Israeli samples revealed significant differences only on the Experience in Caring for Older Adults subscale. CONCLUSIONS The modified COCOA demonstrated good construct validity and reliability and can serve as estimation of nursing students' attitudes to older adults and their intention to make geriatrics a career choice. Future studies should further evaluate its predictive validity.
Collapse
Affiliation(s)
- Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel 31905, Israel.
| | - Ksenya Shulyaev
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, University of Haifa, Mount Carmel 31905, Israel.
| | - Catherine Van Son
- Washington State University College of Nursing - Vancouver, 14204 NE Salmon Creek Avenue, Vancouver, WA 98686-9600, United States of America.
| |
Collapse
|
2
|
Shaw L, Kiegaldie D, Farlie MK. Education interventions for health professionals on falls prevention in health care settings: a 10-year scoping review. BMC Geriatr 2020; 20:460. [PMID: 33167884 PMCID: PMC7653707 DOI: 10.1186/s12877-020-01819-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023] Open
Abstract
Background Falls in hospitals are a major risk to patient safety. Health professional education has the potential to be an important aspect of falls prevention interventions. This scoping review was designed to investigate the extent of falls prevention education interventions available for health professionals, and to determine the quality of reporting. Method A five stage scoping review process was followed based on Arksey and O’Malley’s framework and refined by the Joanna Briggs Institute Methodology for JBI Scoping Reviews. Five online databases identified papers published from January 2008 until May 2019. Papers were independently screened by two reviewers, and data extracted and analysed using a quality reporting framework. Results Thirty-nine publications were included. Interventions included formal methods of educational delivery (for example, didactic lectures, video presentations), interactive learning activities, experiential learning, supported learning such as coaching, and written learning material. Few studies employed comprehensive education design principles. None used a reporting framework to plan, evaluate, and document the outcomes of educational interventions. Conclusions Although health professional education is recognised as important for falls prevention, no uniform education design principles have been utilised in research published to date, despite commonly reported program objectives. Standardised reporting of education programs has the potential to improve the quality of clinical practice and allow studies to be compared and evaluated for effectiveness across healthcare settings.
Collapse
Affiliation(s)
- L Shaw
- Faculty of Health Science, Youth and Community Studies, Holmesglen Institute, 488 South Road, Moorabbin, VIC, 3189, Australia. .,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, 3086, Australia.
| | - D Kiegaldie
- Faculty of Health Science, Youth and Community Studies and Healthscope Hospitals, Holmesglen Institute, 488 South Road, Moorabbin, VIC, 3189, Australia.,Eastern Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - M K Farlie
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC, 3199, Australia
| |
Collapse
|
3
|
Jirau-Rosaly W, Brown SP, Wood EA, Rockich-Winston N. Integrating an Interprofessional Geriatric Active Learning Workshop Into Undergraduate Medical Curriculum. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520923680. [PMID: 32548306 PMCID: PMC7271265 DOI: 10.1177/2382120520923680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The aging population in the United States poses a substantial challenge to our health care system, and particularly affects the training of physicians in geriatric care. To introduce undergraduate medical students to a variety of clinical skills and concepts emphasized in geriatrics, we created an interprofessional geriatric workshop and examined changes in student perceptions of working in interprofessional teams, knowledge regarding geriatric concepts, perceptions of the pre-work material, and suggestions for curricular improvement to enhance the workshop for future students. METHODS Second-year medical students participated in a 4-hour workshop with tasks that emphasized activities of daily living, geriatric physical assessment, end-of-life discussions, Beers Criteria, and a home health assessment. Pre- and post-surveys were administered including the Students Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) survey and a knowledge assessment. Student perceptions of pre-work and overall program assessment were captured after the workshop. Descriptive statistics and paired t tests assessed for significant differences. Emerging themes were analyzed using the Glaser constant comparative method. RESULTS Of the 186 medical student participants, 178 students completed the SPICE-R survey, demonstrating significant increases in students' perceptions of the value of interprofessional education (P < .001). In addition, 111 students completed the pre- and post-test for the knowledge assessment, demonstrating significant gains in geriatric concepts (P < .001). Overall, most students perceived the pre-work as useful and felt prepared to evaluate geriatric patients. Open-ended question analysis supported results, in which 34 students indicated that they felt most comfortable performing a home health assessment and emphasized the usage of the home health simulation. CONCLUSIONS Introducing medical students to a variety of geriatric assessments and concepts in an interprofessional environment early in their career positively influences their perceptions of working as an interprofessional team member to deliver comprehensive care to older adults.
Collapse
Affiliation(s)
- Wanda Jirau-Rosaly
- Department of Medicine, Medical College
of Georgia, Augusta University, Augusta, GA, USA
| | - Shilpa P Brown
- Department of Medicine, Medical College
of Georgia, Augusta University, Augusta, GA, USA
| | - Elena A Wood
- Department of Medicine, Medical College
of Georgia, Augusta University, Augusta, GA, USA
- Educational Innovation Institute,
Augusta University, Augusta, GA, USA
| | - Nicole Rockich-Winston
- Department of Pharmacology and
Toxicology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| |
Collapse
|
4
|
Hyer K, Jester DJ, Badana ANS, D'Aoust R, Robinson BE, Guerra L, Michael M, Molinari V, Schwartz A, Schocken D, Wills T, Wilson C, Andel R. Medical Faculty Beliefs: Self-Rated Importance and Confidence in Teaching Geriatrics Primary Care. J Am Geriatr Soc 2019; 67:576-580. [PMID: 30839109 DOI: 10.1111/jgs.15759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate and contrast 25 content areas essential to the primary care of older adults by medical faculty, thus identifying faculty beliefs and areas of possible improvement. DESIGN Using measures from the Healthcare Effectiveness Data and Information Set, the Consumer Assessment of Healthcare Providers and Systems, and Healthy People 2020, nine practicing clinical faculty identified 25 content areas essential to the primary care of older adults. SETTING A large academic health center in southeastern United States. PARTICIPANTS Eighty-two university medical faculty. MEASUREMENTS Faculty rated importance, knowledge, and confidence in teaching the 25 content areas on a scale from 1 (low) to 10 (high). Gap scores reflecting the difference in ratings for importance and confidence in teaching were calculated and assessed. The survey had high internal consistency within each of the three domains-Cronbach's α > .94. RESULTS The most important content areas were being able to explain details about patient's condition and taking medication clearly, followed by taking age-appropriate history. The three largest gaps were: "evaluating sensory impairment," "identifying and counseling at-risk drivers," and "evaluating cognition." The three smallest gaps were: "explaining prescribed medications," "explaining health conditions in easy-to-understand language," and "taking an age-appropriate patient history and performing a physical assessment." CONCLUSION Medical faculty were comfortable with topics reflecting primary care expertise but expressed less confidence with more specialized topics, such as sensory or cognitive impairment and driving. This may represent key areas for geriatrics training applicable to all those involved in education and training of future healthcare professionals. Integration of specialists (eg, neurologists, psychiatrists) may improve the geriatrics curricula. J Am Geriatr Soc 67:576-580, 2019.
Collapse
Affiliation(s)
- Kathryn Hyer
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, Florida
| | - Dylan J Jester
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, Florida
| | - Adrian N S Badana
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, Florida
| | - Rita D'Aoust
- Department of Acute and Chronic Care, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Bruce E Robinson
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, Florida.,Department of Geriatrics, Sarasota Memorial Hospital, Sarasota, Florida
| | - Lucy Guerra
- College of Medicine, University of South Florida, Tampa, Florida
| | - Melanie Michael
- College of Nursing, University of South Florida, Tampa, Florida
| | - Victor Molinari
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, Florida
| | - Amy Schwartz
- College of Pharmacy, University of South Florida, Tampa, Florida
| | - Dawn Schocken
- College of Medicine, University of South Florida, Tampa, Florida
| | - Todd Wills
- College of Medicine, University of South Florida, Tampa, Florida
| | - Cheryl Wilson
- College of Nursing, University of South Florida, Tampa, Florida
| | - Ross Andel
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, Florida
| |
Collapse
|
5
|
Yanamadala M, Kaprielian VS, O'Connor Grochowski C, Reed T, Heflin MT. A problem-based learning curriculum in geriatrics for medical students. GERONTOLOGY & GERIATRICS EDUCATION 2018; 39:122-131. [PMID: 26909895 DOI: 10.1080/02701960.2016.1152268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A geriatrics curriculum delivered to medical students was evaluated in this study. Students were instructed to review real patient cases, interview patients and caregivers, identify community resources to address problems, and present a final care plan. Authors evaluated the course feedback and final care plans submitted by students for evidence of learning in geriatric competencies. Students rated the efficacy of the course on a 5-point Likert scale as 3.70 for developing clinical reasoning skills and 3.69 for interdisciplinary teamwork skills. Assessment of an older adult with medical illness was rated as 3.87 and ability to perform mobility and functional assessment as 3.85. Reviews of written final care plans provided evidence of student learning across several different geriatric competencies such as falls, medication management, cognitive and behavior disorders, and self-care capacity. Assessment of the curriculum demonstrated that medical students achieved in-depth learning across multiple geriatric competencies through contact with real cases.
Collapse
Affiliation(s)
- Mamata Yanamadala
- a Department of Medicine , Duke University School of Medicine , Durham , North Carolina , USA
| | - Victoria S Kaprielian
- b Family Medicine and Faculty Development and Medical Education , Campbell University School of Osteopathic Medicine , Buies Creek , North Carolina , USA
| | | | - Tiffany Reed
- d Piedmont Senior Care , Cone Health Medical Group , Greensboro , North Carolina , USA
| | - Mitchell Tod Heflin
- e Department of Medicine , Duke University School of Medicine , Durham , North Carolina , USA
| |
Collapse
|
6
|
Jeste DV, Avanzino J, Depp CA, Gawronska M, Tu X, Sewell DD, Huege SF. Effect of short-term research training programs on medical students' attitudes toward aging. GERONTOLOGY & GERIATRICS EDUCATION 2018; 39:214-222. [PMID: 28614041 PMCID: PMC6095204 DOI: 10.1080/02701960.2017.1340884] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Strategies to build a larger workforce of physicians dedicated to research on aging are needed. One method to address this shortage of physician scientists in geriatrics is short-term training in aging research for early-stage medical students. The authors examined the effects of two summer research training programs, funded by the National Institutes of Health, on medical students' attitudes toward aging, using the Carolina Opinions on Care of Older Adults (COCOA). The programs combined mentored research, didactics, and some clinical exposure. In a sample of 134 participants, COCOA scores improved significantly after completion of the research training program. There was a significant interaction of gender, such that female students had higher baseline scores than males, but this gender difference in COCOA scores was attenuated following the program. Four of the six COCOA subscales showed significant improvement from baseline: early interest in geriatrics, empathy/compassion, attitudes toward geriatrics careers, and ageism.
Collapse
Affiliation(s)
- Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego
| | - Julie Avanzino
- Department of Psychiatry, University of California, San Diego
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego
- VA San Diego Healthcare System, San Diego
| | - Maja Gawronska
- Department of Psychiatry, University of California, San Diego
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego
| | - Xin Tu
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego
- Department of Family Medicine and Public Health, University of California, San Diego
| | | | - Steven F. Huege
- Department of Psychiatry, University of California, San Diego
| |
Collapse
|
7
|
van de Pol MHJ, Lagro J, Koopman EL, Olde Rikkert MGM, Fluit CRMG, Lagro-Janssen ALM. Lessons learned from narrative feedback of students on a geriatric training program. GERONTOLOGY & GERIATRICS EDUCATION 2018; 39:21-34. [PMID: 26886481 DOI: 10.1080/02701960.2015.1127810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Geriatrics continues to draw insufficient numbers of medical students today. Currently, little is known regarding how education can motivate students to choose geriatrics. The authors' aim was to examine geriatrics from the students' perspective to identify elements that can be useful in education and improving attitudes toward, interest in, and knowledge about geriatrics. The authors analyzed narrative reflection essays of 36 students and clarified the themes from the essays during focus group sessions. Four overarching themes that influenced students' perspective on geriatrics were identified: professional identity, perception of geriatrics, geriatric-specific problems, and learning environment. Students have an inaccurate image of clinical practice and the medical professional identity, which has a negative impact on their attitude toward, interest in, and knowledge of geriatrics. Furthermore, this study yielded the important role of the hidden curriculum on professional identity, the novelty of geriatric-specific problems to students, and the importance of educational approach and good role models.
Collapse
Affiliation(s)
- Marjolein H J van de Pol
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Joep Lagro
- b Department of Internal Medicine , Haga Teaching Hospital , The Hague , The Netherlands
| | - Elise L Koopman
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | | | - Cornelia R M G Fluit
- d Academic Educational Institute , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Antoine L M Lagro-Janssen
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| |
Collapse
|
8
|
van de Pol MHJ, Fluit CRMG, Lagro J, Slaats Y, Olde Rikkert MGM, Lagro-Janssen ALM. Shared decision making with frail older patients: Proposed teaching framework and practice recommendations. GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:482-495. [PMID: 28027017 DOI: 10.1080/02701960.2016.1276014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study has two aims: The first aim is to identify core competencies for shared decision making (SDM) with frail older persons, and the second is to determine key elements of a teaching framework, based on the authors' recently developed model for SDM with older patients who are frail. To this end the authors conducted a qualitative inquiry among health professionals (n = 53) and older patients who are frail (n = 16). Participants formulated core competencies and educational needs for SDM with older patients who are frail, which were further explored in the literature. This resulted in practice recommendations and a teaching framework with the following key elements: create a knowledge base for all health professionals, offer practical training, facilitate communication, identify discussion partners, engage patients, and collaborate. The authors' teaching framework for SDM with older patients who are frail may be useful for clinicians, educators, and researchers who aim to promote SDM with older patients who are frail.
Collapse
Affiliation(s)
- Marjolein H J van de Pol
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Cornelia R M G Fluit
- b Learning Research and Education , Radboudumc Health Academy Nijmegen , Nijmegen , The Netherlands
| | - Joep Lagro
- c Department of Internal Medicine , Haga Teaching Hospital , The Hague , The Netherlands
| | - Yvonne Slaats
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | | | - Antoine L M Lagro-Janssen
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| |
Collapse
|
9
|
Omlor RL, Watkins FS, Lawlor JS, Lovato JF, Fino NF, Atkinson HH. Intern Boot Camp: Feasibility and impact of a 1-hour session to ensure graduating medical student competency in falls risk assessment. GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:346-353. [PMID: 26885576 DOI: 10.1080/02701960.2015.1115982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The authors evaluated the feasibility of a 1-hour session to ensure competency in gait and falls risk assessment for medical students at their institution. The session included a history and exam with faculty and staff as standardized patients, gait recognition videos, and case evaluation for falls risk assessment and prevention. Student perceptions were evaluated using a retrospective pre-post survey, scored on a 5-point Likert-type scale. Wilcoxon signed-rank tests were used to assess change and Kruskal-Wallis tests were used to analyze differences by residency choice. A range of five to 11 faculty and staff certified 238 medical students during eight 1-hour sessions. Overall self-perception of competence in falls risk assessment and prevention improved (p ≤ .001), and did not differ by residency choice, both before and after the training program (p = .73 and p = .25). Feedback was positive. This session is a feasible way to teach and assess the competency for falls risk assessment with modest time commitment.
Collapse
Affiliation(s)
- Rebecca L Omlor
- a Internal Medicine Residency Program, Department of Internal Medicine , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
| | - Franklin S Watkins
- b Section on Gerontology and Geriatric Medicine, Department of Internal Medicine , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
| | - Janice S Lawlor
- b Section on Gerontology and Geriatric Medicine, Department of Internal Medicine , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
- c Department of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
| | - James F Lovato
- c Department of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
| | - Nora F Fino
- d Department of Biostatistical Science , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
| | - Hal H Atkinson
- a Internal Medicine Residency Program, Department of Internal Medicine , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
- b Section on Gerontology and Geriatric Medicine, Department of Internal Medicine , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
| |
Collapse
|
10
|
Annear MJ, Lea E, Lo A, Tierney L, Robinson A. Encountering aged care: a mixed methods investigation of medical students' clinical placement experiences. BMC Geriatr 2016; 16:38. [PMID: 26846779 PMCID: PMC4743178 DOI: 10.1186/s12877-016-0211-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/28/2016] [Indexed: 12/30/2022] Open
Abstract
Background Residential aged care is an increasingly important health setting due to population ageing and the increase in age-related conditions, such as dementia. However, medical education has limited engagement with this fast-growing sector and undergraduate training remains primarily focussed on acute presentations in hospital settings. Additionally, concerns have been raised about the adequacy of dementia-related content in undergraduate medical curricula, while research has found mixed attitudes among students towards the care of older people. This study explores how medical students engage with the learning experiences accessible in clinical placements in residential aged care facilities (RACFs), particularly exposure to multiple comorbidity, cognitive impairment, and palliative care. Methods Fifth-year medical students (N = 61) completed five-day clinical placements at two Australian aged care facilities in 2013 and 2014. The placements were supported by an iterative yet structured program and academic teaching staff to ensure appropriate educational experiences and oversight. Mixed methods data were collected before and after the clinical placement. Quantitative data included surveys of dementia knowledge and questions about attitudes to the aged care sector and working with older adults. Qualitative data were collected from focus group discussions concerning medical student expectations, learning opportunities, and challenges to engagement. Results Pre-placement surveys identified good dementia knowledge, but poor attitudes towards aged care and older adults. Negative placement experiences were associated with a struggle to discern case complexity and a perception of an aged care placement as an opportunity cost associated with reduced hospital training time. Irrespective of negative sentiment, post-placement survey data showed significant improvements in attitudes to working with older people and dementia knowledge. Positive student experiences were explained by in-depth engagement with clinically challenging cases and opportunities to practice independent clinical decision making and contribute to resident care. Conclusions Aged care placements can improve medical student attitudes to working with older people and dementia knowledge. Clinical placements in RACFs challenge students to become more resourceful and independent in their clinical assessment and decision-making with vulnerable older adults. This suggests that aged care facilities offer considerable opportunity to enhance undergraduate medical education. However, more work is required to engender cultural change across medical curricula to embed issues around ageing, multiple comorbidity, and dementia.
Collapse
Affiliation(s)
- Michael J Annear
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia.
| | - Emma Lea
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia.
| | - Amanda Lo
- School of Medicine, Faculty of Health, University of Tasmania, Private Bag 34, Hobart, TAS, 7001, Australia.
| | - Laura Tierney
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia.
| | - Andrew Robinson
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Private Bag 143, Hobart, TAS, 7001, Australia. .,School of Health Sciences, Faculty of Health, University of Tasmania, Private Bag 135, Hobart, TAS, 7001, Australia.
| |
Collapse
|
11
|
Laks J, Wilson LA, Khandelwal C, Footman E, Jamison M, Roberts E. Service-Learning in Communities of Elders (SLICE): Development and Evaluation of an Introductory Geriatrics Course for Medical Students. TEACHING AND LEARNING IN MEDICINE 2016; 28:210-8. [PMID: 27064723 DOI: 10.1080/10401334.2016.1146602] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PROBLEM Medical students have limited exposure to Geriatrics in their traditional training. Service-learning offers students the opportunity to engage with older adult communities and become more comfortable interacting with this population. INTERVENTION A preclinical elective course was developed to expand medical students' experiences in Geriatrics through service-learning. In this course, students conducted needs assessments in diverse older adult communities, created health education projects to address community-identified needs, and reflected on their experiences through written assignments and presentations. The course instructor presented lectures on special topics in Geriatrics, including ageism and health literacy. The curriculum aimed to familiarize students with older adults' needs in a variety of settings. CONTEXT Over 3 years, 74 students participated in the service-learning course. Students were assigned to older adult community sites, where they conducted needs assessments and designed and implemented original educational projects targeting community concerns. Program evaluation methods included a validated survey assessing students' attitudes toward older adults, course evaluations, review of student assignments and projects, and feedback from older adult participants and site coordinators. OUTCOME Students gained hands-on experience working with older adults and designing appropriate health education projects. Analysis of attitude surveys demonstrated students' increased interest in Geriatrics as a career. Both students and older adult participants described enjoyable, valuable experiences gained from service-learning activities. LESSONS LEARNED Students appreciated the combination of community and classroom learning about Geriatrics. Service-learning was most constructive at sites with responsive coordinators, engaged older adults, and a need for health education resources. The course challenged students to assess health needs in communities that included cognitively impaired elders and to design educational projects tailored to older adults.
Collapse
Affiliation(s)
- Jordana Laks
- a University of North Carolina School of Medicine , Chapel Hill , North Carolina , USA
| | - Lindsay A Wilson
- b Division of Geriatric Medicine , University of North Carolina School of Medicine , Chapel Hill , North Carolina , USA
| | | | - Eleni Footman
- d Department of Internal Medicine , Fairfax Hospital , Fairfax , Virginia , USA
| | - Margaret Jamison
- e Centers of Disease Control and Prevention , National Center for Health Statistics , Research Triangle Park , North Carolina , USA
| | - Ellen Roberts
- b Division of Geriatric Medicine , University of North Carolina School of Medicine , Chapel Hill , North Carolina , USA
| |
Collapse
|
12
|
Koh GCH, Ling CLH, Ma BHM, Chen C, Lim WS, Scherer SC, Amin Z, Merchant RA. Effect of a new longitudinal interprofessional geriatric medicine educational track on knowledge and attitude of medical students: a controlled cohort study. J Am Geriatr Soc 2015; 63:558-64. [PMID: 25732398 DOI: 10.1111/jgs.13295] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A new interprofessional geriatric medicine curriculum was recently introduced at a large undergraduate Asian medical school. A longitudinal controlled interventional cohort study was conducted to evaluate the effect of the new curriculum on the knowledge and attitudes of medical students. The medical students under the new curriculum formed the intervention cohort, and those under the former curriculum formed the control cohort. To test knowledge, the University of California at Los Angeles (UCLA) geriatrics knowledge test (GKT) was used in Year 2 and the University of Michigan GKT in Year 5. Geriatrics attitudes were evaluated using the UCLA geriatrics attitudes test in Years 2 and 5. Not surprisingly, geriatrics knowledge at the end of Year 5 of medical school was enhanced to a greater degree in the intervention cohort than the control cohort, although improvements in geriatrics attitudes in each cohort were of similar magnitude by the end of Year 5, suggesting that factors other than a formal geriatrics curriculum influenced the improvements in geriatrics attitudes. This article is one of few published on the effectiveness of geriatrics curricular innovations using validated knowledge and attitude outcomes in a longitudinal controlled study design and will be useful to other medical institutions seeking to improve the geriatrics knowledge and attitudes of their students.
Collapse
Affiliation(s)
- Gerald C H Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | | | | | | | | | | | | | | |
Collapse
|
13
|
van de Pol MHJ, Lagro J, Fluit LRMG, Lagro-Janssen TLM, Olde Rikkert MGM. Teaching geriatrics using an innovative, individual-centered educational game: students and educators win. A proof-of-concept study. J Am Geriatr Soc 2014; 62:1943-9. [PMID: 25283695 DOI: 10.1111/jgs.13024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Given the increasingly aging population, nearly every doctor will encounter elderly adults who present with multiple complex comorbidities that can challenge even experienced physicians. This may explain why many medical students do not have a positive attitude toward elderly adults and find the complexity of their problems overwhelming. It was hypothesized that a recently developed medical school geriatrics course, based on the game GeriatriX and designed specifically to address the complexities associated with decision-making in geriatrics, can have a positive effect on attitudes toward geriatrics and on perceived knowledge of geriatrics. The effects of this game-based course were evaluated as a proof of concept. The assessment was based on the Aging Semantic Differential (ASD) and a validated self-perceived knowledge scale of geriatric topics. The usability of (and satisfaction with) GeriatriX was also assessed using a 5-point Likert scale. After completion of the course, the ASD changed significantly in the geriatrics course group (n = 29; P = .02) but not in a control group that took a neuroscience course (n = 24; P = .30). Moreover, the geriatrics course group had a significant increase in self-perceived knowledge for 12 of the 18 topics (P = .002), whereas in the control group self-perceived knowledge increased significantly for one topic only (sensory impairment) (P = .04). Finally, the geriatrics students reported enjoying GeriatriX. This proof-of-concept study clearly supports the hypothesis that a 4-week course using a modern educational approach such as GeriatriX can improve students' self-perceived knowledge of geriatrics and their attitudes toward elderly adults.
Collapse
Affiliation(s)
- Marjolein H J van de Pol
- Department of Primary and Community Care, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | | | | | | | | |
Collapse
|
14
|
Siegler EL, Jalali C, Finkelstein E, Ramsaroop S, Ouchida K, Carmen TD, Logio L. Assessing Effectiveness of a Geriatrics Rotation for Second-Year Internal Medicine Residents. J Grad Med Educ 2014; 6:521-5. [PMID: 26279779 PMCID: PMC4535218 DOI: 10.4300/jgme-d-13-00344.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/09/2013] [Accepted: 01/06/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residents need to acquire an understanding of the biopsychosocial aspects of caring for older adults with chronic illness, along with effective use of interdisciplinary services inside and outside of the hospital. OBJECTIVE We expanded the geriatric medicine experience for second-year internal medicine residents and present the results of the first year's experience. METHODS We paired a mandatory rotation for postgraduate year-2 internal medicine residents (2 weeks of day and 1 week of night inpatient experience in the Acute Care for Elders Unit), and a 1-week outpatient systems-based practice experience with online modules and readings. Evaluation included a case presentation, an oral examination, a written questionnaire for all residents, and a global assessment of the residents' performance on the geriatrics portion of the 2012 In-Training Examination (ITE). RESULTS All residents passed their oral examination; there was little difference between classes in systems-based practice knowledge. More than 90% (21 of 23) of the residents who took the rotation reported that it left a lasting impression on how they would care for their patients. Mean ITE scores in geriatrics for all residents increased from 53% (versus 61% overall) in 2010 to 87% (versus 81%) in 2012, although they dropped to 69% (versus 82%) in 2013. CONCLUSIONS A rotation in geriatrics that is highly rated and covers both acute care and systems-based practice concepts is feasible for internal medicine residents. Residents did not learn detailed knowledge about specific programs for older adults, but clinical geriatrics knowledge improved.
Collapse
|
15
|
Atkinson HH, Tan ZS, Brennan M, Granville L. A collaborative national model to assess competencies for medical students, residents, and other healthcare practitioners in gait and falls risk evaluation. J Am Geriatr Soc 2014; 62:1155-60. [PMID: 24617296 DOI: 10.1111/jgs.12732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To ensure that the healthcare workforce is adequately prepared to care for the growing population of older adults, minimum competencies in geriatrics have been published for medical students and primary care residents. Approaches to teaching and assessing these competencies are needed to guide medical schools, residencies, and continuing medical education programs. With sponsorship by the Education Committee and Teachers Section of the American Geriatrics Society (AGS), geriatrics educators from multiple institutions collaborated to develop a model to teach and assess a major domain of student and resident competency: Gait and Falls Risk Evaluation. The model was introduced as a workshop at annual meetings of the AGS and the American College of Physicians in 2011 and 2012. Participants included medical students, residents, geriatrics fellows, practicing physicians, and midlevel practitioners. At both national meetings, participants rated the experience highly and reported statistically significant gains in overall competence in gait and falls risk evaluation. The largest gains were observed for medical students, residents, and practicing physicians (P < .001 for all); geriatrics fellows reported a higher level of baseline competence and therefore had a lower magnitude of improvement, albeit still significant (P = .02). Finally, the majority of participants reported intent to disseminate the model in their institutions. This article describes the design, implementation, and evaluation of this collaborative national model. A number of institutions have used the model, and the goal of this article is to aid in further dissemination of this successful approach to teaching and assessing geriatrics competencies.
Collapse
Affiliation(s)
- Hal H Atkinson
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | | |
Collapse
|