A systematic review of surveys on undergraduate teaching of Geriatrics in medical schools in the XXI century

Knowledge of aging, attitudes toward older people and willingness to engage in geriatric rehabilitation among rehabilitation students in southwestern China: a cross-sectional study

BACKGROUND

As the global elderly population rises, providing quality care for older adults is increasingly challenging. Rehabilitation technicians are crucial in this effort. Their knowledge and attitudes significantly impact care quality and their willingness to work with the elderly. While many studies have examined healthcare professionals' attitudes toward older adults, few focus on rehabilitation students. This study assesses Chinese rehabilitation students' knowledge of aging, attitudes toward older individuals, willingness to care for them, and the factors influencing these aspects.

METHODS

A sample of 890 rehabilitation students from three colleges and universities in southwestern China was investigated with a self-administered questionnaire, which included socio-demographic information, the Palmore Facts on Aging Quiz, the Kogan's Attitude towards Older People Scale and the Chinese Version of the Interpersonal Reactivity Index. Data analyses were conducted using SPSS version 25.0. Descriptive statistics were used to illustrate the demographic characteristics of the respondents. The frequency and percentage of responses was calculated. Means and standard deviations were computed for general knowledge of aging, attitudes toward older people, and empathy. Independent t-tests and one-way ANOVA assessed differences in FAQ, KAOP, and IRI-C scores between groups. Pearson's correlation examined correlations among general knowledge of aging, attitudes toward older people and empathy ability. Chi-square or Fisher's exact tests compared willingness to engage in geriatric rehabilitation across different respondent characteristics. Hierarchical multiple regression analysis explored the independent effect of different variables on attitudes toward older people.

RESULTS

The Chinese rehabilitation students from three colleges and universities in southwestern China displayed a relatively low level of knowledge about aging, but a generally positive attitude towards older people. Females had significantly more positive attitudes toward older people than males(p<0.01). The students who had previous experience of being cared for by (maternal) grandparents, living with the elderly, and taking care of the elderly showed significantly more positive attitudes toward older people (p = 0.001, 0.007 and 0.007, respectively) and a significantly stronger willingness to engage in geriatric rehabilitation(p = 0.013, <0.01 and <0.01, respectively) than those who had not had these experiences. Students with good relationships with older people had more positive attitudes toward the elderly (p < 0.01) and greater willingness to engage in geriatric rehabilitation (p < 0.01). Those with frequent contact with the elderly also showed more positive attitudes (p < 0.01) and a stronger willingness to engage in geriatric rehabilitation (p = 0.002) compared to those with less contact. Knowledge of aging and empathy ability were both significantly positively related to attitudes toward older people and both independent predictors of attitudes toward older people(r = 0.143, p<0.01 and r = 0.337, p<0.01).

CONCLUSIONS

It is crucial to prepare rehabilitation students with adequate knowledge and positive attitudes to ensure the quality of rehabilitation and care provided to older people. Educators should adopt effective strategies to promote rehabilitation students' geriatric rehabilitation knowledge and increase their positive attitudes toward older people.

A narrative overview of undergraduate geriatric medicine education worldwide

There is a mismatch between the healthcare needs of the ageing population worldwide and the amount of education medical students receive in geriatric medicine. In 2014, Mateos-Nozal et al. published a systematic review of all undergraduate education surveys in geriatric medicine-a decade on, it is timely for an up-to-date overview of the state of undergraduate geriatric medicine education globally. In this review, we outline the international evidence in the field, exploring the results of national and multi-national teaching surveys, and discussing the relative strengths and weaknesses of nationally recommended curricula. We set these findings in the context of ageing population demographics, concluding with recommendations for the future of education and educational research in geriatric medicine, that aims to build capacity in the healthcare workforce and improve quality of care for older people.

Aging populations and perspectives of geriatric medicine in Japan

It is well known that Japan's population is aging, and the number of people older than 75 years is increasing significantly. Since older people, especially old individuals, are often multimorbid and cannot be always successfully treated and cared for by individual organ-specific treatment, it is essential to utilize knowledge of geriatrics when treating such older patients. Therefore, it is indisputable that education on geriatric medicine is extremely important in Japan, which is the country with the largest aging population. However, the number of universities in Japan that offer geriatrics courses is decreasing. This means that many medical students become doctors without learning the essential characteristics of medical care for older patients despite the need for prompt treatment of older patients in clinical practice in Japan, which is a major obstacle to the development of geriatric medicine in Japan. Here, we review the current status of geriatrics in Japan and overseas and consider the future of geriatrics education to provide holistic and cost-effective medical care for older patients and improve their quality of life and well-being.

Pitfalls in Oncogeriatrics

An oncogeriatric interdisciplinary activity exists only in a minority of high-income countries, and it is almost absent in those with lower incomes. Considering topics, sessions, and tracks in the main meetings and conferences of the major Oncological Societies in Europe and worldwide, the USA excluded, little attention has thus far been paid to the problem of cancer in the elderly. Again, with the exception of the USA, the major cooperative groups, for example, the EORTC in Europe, have only dedicated marginal attention to the research of cancer in the elderly. Despite major shortcomings, professionals interested in geriatric oncology have taken a number of important initiatives to highlight the benefits of this particular activity, including the organization of an international society (Société Internationale de Oncogeriatrie, or SIOG). In spite of these efforts, the authors believe that the management of cancer in the older population is still encountering several important and generalized pitfalls. The main obstacle is the grossly inadequate number of geriatricians and clinical oncologists necessary to an integrated care of the ever-expanding aging population, but other hurdles have been reported. Additionally, the prejudice of ageism can lead to missing potential resources for the development of a generalized oncogeriatric approach.

Geriatric medicine learning objectives and entrustable professional activities in undergraduate medical curricula: a scoping review

Background

entrustable professional activities (EPAs) have become an important component of competency-based medical education. The aim of this study is to evaluate how geriatric medicine learning objectives are addressed by undergraduate medical curricula including EPAs.

Methods

we performed a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines to identify undergraduate medical curricula that include EPAs. A content analysis was conducted to examine how these curricula address the care of older individuals. In addition, we mapped the curricula to 19 geriatric medicine learning objectives identified from the European curriculum of undergraduate medical education.

Results

we found nine curricula, each containing between 4 and 16 core EPAs. In the sections describing the EPAs, three of the nine curricula specify that all core EPAs apply to all age groups including older patients, whereas the remaining six curricula either only refer to older patients in selected EPAs or not at all. Mapping revealed that some geriatric medicine learning objectives are covered by most curricula (e.g. medication use, multidisciplinary team work), whereas others are lacking in the majority (e.g. normal ageing, geriatric assessment, cognitive assessment, nutrition assessment, decision-making capacity assessment, long-term care). Three curricula cover most geriatric learning objectives by using a matrix aligning EPAs with geriatric competencies.

Conclusions

geriatric learning objectives continue to be missing from undergraduate medical curricula, also from those adopting the novel approach of EPAs. However, this review also identified some curricula that might serve as models for how geriatric learning objectives can be successfully covered within future EPA frameworks.

A scoping review of the changing landscape of geriatric medicine in undergraduate medical education: curricula, topics and teaching methods

PURPOSE

The world's population is ageing. Therefore, every doctor should receive geriatric medicine training during their undergraduate education. This review aims to summarise recent developments in geriatric medicine that will potentially inform developments and updating of undergraduate medical curricula for geriatric content.

METHODS

We systematically searched the electronic databases Ovid Medline, Ovid Embase and Pubmed, from 1st January 2009 to 18th May 2021. We included studies related to (1) undergraduate medical students and (2) geriatric medicine or ageing or older adults and (3) curriculum or curriculum topics or learning objectives or competencies or teaching methods or students' attitudes and (4) published in a scientific journal. No language restrictions were applied.

RESULTS

We identified 2503 records and assessed the full texts of 393 records for eligibility with 367 records included in the thematic analysis. Six major themes emerged: curriculum, topics, teaching methods, teaching settings, medical students' skills and medical students' attitudes. New curricula focussed on minimum Geriatrics Competencies, Geriatric Psychiatry and Comprehensive Geriatric Assessment; vertical integration of Geriatric Medicine into the curriculum has been advocated. Emerging or evolving topics included delirium, pharmacotherapeutics, healthy ageing and health promotion, and Telemedicine. Teaching methods emphasised interprofessional education, senior mentor programmes and intergenerational contact, student journaling and reflective writing, simulation, clinical placements and e-learning. Nursing homes featured among new teaching settings. Communication skills, empathy and professionalism were highlighted as essential skills for interacting with older adults.

CONCLUSION

We recommend that future undergraduate medical curricula in Geriatric Medicine should take into account recent developments described in this paper. In addition to including newly emerged topics and advances in existing topics, different teaching settings and methods should also be considered. Employing vertical integration throughout the undergraduate course can usefully supplement learning achieved in a dedicated Geriatric Medicine undergraduate course. Interprofessional education can improve understanding of the roles of other professionals and improve team-working skills. A focus on improving communication skills and empathy should particularly enable better interaction with older patients. Embedding expected levels of Geriatric competencies should ensure that medical students have acquired the skills necessary to effectively treat older patients.

[Survey on innovation in the teaching of Geriatrics at the Spanish Medical Schools]

OBJECTIVE

To identify the innovations in teaching of Geriatrics at the Spanish Medical Schools.

METHODOLOGY

Interviews with those responsible for Geriatrics teaching at the Spanish Medical Schools through a short online survey. Existing Geriatrics curricula and responsible professors were identified by reviewing the curricula of the different Medical Schools.

RESULTS

35 of the 42 Medical Schools incorporated teaching in Geriatrics in 2019 with an answer rate of 94.3%. Regarding Geriatrics training it stand out classic methods (master classes, clinical rotations, and theoretical seminars), followed by innovation of teaching programs (clinical simulation and use of new technologies). While OSCE and portfolio stand out among the innovative evaluation tools of Geriatrics teaching. Of the 33 Medical Schools with Geriatrics teaching surveyed, 60.6% of them included the use of at least one innovative teaching or evaluation methodology.

CONCLUSIONS

Although the classical model predominates as a teaching methodology in Geriatrics, different innovations are also used in the undergraduate teaching in Spain. It is necessary to continue working in this area that may help a better level of skills in Geriatrics for our students.

[Undergraduate geriatric education in foreign countries]

In Japan, which has become a super-aged society, medical care for the elderly is more important than ever before. Geriatric education for medical students and young doctors is essential to ensure the best medical care possible for the elderly. In this paper, the Working Group for Education of the Japan Geriatrics Society collected and analyzed data and information on undergraduate education in the fields of geriatrics and gerontology at medical schools in various countries through the Internet, comparing the findings with those in Japan. Of the countries surveyed, 62% had undergraduate education in geriatrics and gerontology as mandatory subjects in medical school. Countries with advanced welfare programs, such as the United Kingdom, Germany, Austria, Denmark, Finland, Sweden, the Netherlands, Spain, Canada and New Zealand, performed substantial undergraduate education in geriatrics and gerontology. A lack of available staff and time for education was cited as a hurdle in many countries. The importance of education in geriatrics and gerontology is being emphasized in many countries, but few programs are satisfactory at present. The "struggle" to improve undergraduate education in geriatrics and gerontology therefore continues. We should endeavor to improve education in the fields of geriatrics and gerontology by working hand in hand with geriatricians and gerontologists around the world.

[Ten recommendations to improve undergraduate training in Geriatric Medicine]

INTRODUCTION

Population ageing and scientific progress have made specific training in Geriatrics essential for any medical students. There are different international recommendations on the teaching of Geriatric Medicine at undergraduate level, but they are still far from being offered systematically. The aim of this work was to develop a National list of recommendations in order to improve training in Geriatric Medicine at the undergraduate level.

MATERIAL AND METHODS

A list of 10 recommendations was produced by reflecting on the Geriatric training situation in Spain in 2016/2017 and international recommendations. Consensus was reached among the members of the Spanish Society of Geriatrics and Gerontology (SEGG) working group on «Geriatric training at undergraduate level» through 2meetings and online discussions.

RESULTS

A list of 10 of recommendations on Geriatric training in Spanish Medical Schools is proposed, including areas such as, the status of the discipline in the curriculum, length, contents, practical training, lecturers, teaching methods, and innovation.

CONCLUSIONS

These recommendations are intended to improve Geriatrics training. They can be used by different Medical Schools either to adapt their programs or to start training in Geriatric Medicine.

The practice of care in long-term care facilities for the elderly: a challenge for the training of professionals

Abstract Objective: to analyze how care is performed, understand the contributions of previous experience to professional practice in Long-Term Care Facilities for the Elderly (LTCFs), and recognize the challenges and propositions for professional training and the delivery of care in LTCFs. Method: an exploratory qualitative study was carried out in two stages with 33 professionals and managers of a long-term care facility in a municipality in the state of São Paulo. Analysis was performed using Collective Subject Discourse and Thematic Content Analysis (first and second stage, respectively). Results: It was found that, in the views of health professionals and managers, the quality of care is linked to basic needs and the training of professionals does not consider the specificities of gerontological care. They therefore reproduce a fragmented and mechanical work process. Conclusion: The results highlight the need to revisit courses in the area of health in order to understand their approach to training in elderly care.

Measuring medical students' attitudes and knowledge about geriatrics and gerontology in Brazilian medical students: A comparison of instruments

OBJECTIVE

To compare instruments available for evaluating attitudes and knowledge about geriatrics and gerontology.

METHODS

This cross-sectional study investigated 83 third-year Brazilian medical students (with exposure to geriatrics and gerontology) and 75 incoming students (with no exposure to this content). We used the University of California at Los Angeles Geriatrics Attitudes Scale, Palmore's Facts on Aging Quiz, modified Maxwell-Sullivan Attitude Survey, Aging Semantic Differential Scale and an instrument assessing their cognitive knowledge in geriatrics.

RESULTS

The instruments investigated had moderate-to-high correlations when evaluating similar constructs, had satisfactory or borderline internal consistency for the most part (Cronbach's α: 0.62-0.94) and were capable of discriminating between students exposed or not to practical and theoretical content.

CONCLUSION

Our findings reinforce previous studies that these scales are capable of differentiating students who have or have not had exposure/intervention and, in general, seem to be assessing different constructs.

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.

[Geriatric teaching at undergraduate level: are Spanish Medical Schools following European recommendations?]

OBJECTIVES

To compare the learning objectives proposed by the European Union of Medical Specialists Geriatric section (UEMS-GS) with those approved in Spain for undergraduate teaching.

MATERIAL AND METHODS

Learning objectives included in the European Undergraduate Curriculum in Geriatric Medicine developed by the UEMS-GS in 2013 were compared with those listed in different Spanish official documents: Boletín Oficial del Estado (BOE, Spanish State Gazette), white book on Medicine of the Spanish Accreditation Agency (ANECA), and list of learning objectives of Spanish Medical Schools.

RESULTS

the European curriculum recommends to teach 42 competencies divided in 10 sections, while the BOE mentions 37 general competencies and some other specific competencies, and the ANECA mentions 23 generic and 34 specific competencies (similar to the 37 of the BOE), and a list of common contents in which Geriatrics is included. The BOE includes 38% of the European competencies (range 17-100% of competencies in different sections), while the ANECA includes 52% of them (range 17-100%).

CONCLUSIONS

Spanish regulations include from one third to half of the European recommendations for Geriatrics teaching at undergraduate level. In the future, it seems advisable that official requirements in Spain should converge with European recommendations. This task should also be performed by Spanish Medical Schools.