Student attitudes about surgery in older patients before and after the surgical clerkship

Development of a Measure of Attitude toward Pulmonary Disease Prevention

This developmental study aimed to produce a measure of attitude toward pulmonary disease prevention that yields reliable data from health professionals and students. Systematic scale development procedures, reliability analyses on three samples of 2,852 medical students, and factor analysis were used to develop and refine the attitude scale. Internal consistency (a = .83) and test-retest (r = .57) reliabilities are high. These and otheranalyses indicate that the scale is unidimensional. The resulting Pulmonary Disease Prevention Survey (PDPS) holds promise in educational and health services research as an outcome measure or as a mediating variable that may correlate with preventive behavior

Relating Medical Students' Knowledge, Attitudes, and Experience to an Interest in Geriatric Medicine

PURPOSE

This study examined medical students' interest in geriatrics: Are knowledge, positive attitudes, and prior experience with older adults associated with an interest in geriatric medicine?

DESIGN AND METHODS

Entering University of Michigan medical students completed three surveys: the Revised Facts on Aging Quiz, the University of California at Los Angeles Geriatric Attitudes Scale, and the Maxwell-Sullivan Attitudes Scale. The students were also asked questions about their prior experience with older adults and their interest in geriatric medicine.

RESULTS

The results indicate that incoming medical students have minimal knowledge about aging, moderately positive attitudes toward older adults, and low interest in geriatric medicine. Having more positive attitudes toward older adults (ss =.28) and having cared for older persons prior to medical school (ss =.14) were associated with greater interest in geriatric medicine.

IMPLICATIONS

These findings suggest that interventions to increase the number of geriatric-oriented physicians should focus on influencing learners' attitudes through experiences in the care of older adults.

Development of a measure of attitude toward nutrition in patient care

BACKGROUND

Development of reliable measures of medical student and resident attitudes about nutrition in patient care is needed before the effects of educational interventions or clinical experience can be gauged. This report describes the systematic development of a measure of attitude toward nutrition in patient care. It presents evidence about scale reliability and the absence of response bias that endorses the trustworthiness of data from the measure.

METHODS

An eight-step attitude scale development procedure was used to create the Nutrition In Patient care Survey (NIPS). Data from five samples of first- and second-year medical students and first-year medical residents were subjected to factor analysis (PA2, varimax rotation), reliability analyses, and statistical analyses to test for demographic bias in the attitude data.

RESULTS

A 45-item attitude measure was developed that contains five subscales derived from the factor analysis: (1) nutrition in routine care (NRC, 8 items); (2) clinical behavior (CB, 20 items); (3) physician-patient relationship (PPR, 8 items); (4) patient behavior/motivation (PBM, 3 items); and (5) physician efficacy (PE, 6 items). Each subscale yields reliable data in terms of internal consistency (alpha coefficients) and stability (test-retest reliability). Medical student and resident demographic variables have negligible influence on attitude scores.

DISCUSSION

The NIPS subscales yield reliable data that can be used to assess outcomes in evaluation research on educational or clinical interventions or to predict patient care practices. Systematic attitude scale development increases the likelihood that the resulting measures will produce useful, trustworthy data.

Geriatric clinical training in medical schools

The primary purpose of geriatric training in medical school is to improve the care of the elderly by practitioners in every specialty, by increasing their knowledge base and fostering interest in older patients. A secondary goal is to interest some students in geriatrics as a career. For > 10 years, leaders in medicine and medical education have strongly recommended clinical geriatric training for medical students, but only a few programs have been implemented. Geriatrics educational experiences must be required; otherwise, not enough medical students will elect to take these courses. Although we still do not know which model best provides this experience, evaluations of existing programs suggest that geriatrics can be taught in both long-term care and acute settings, involving well-designed curriculum and interested faculty. More studies are needed, but exposure to well elderly and community-based programs may also improve attitudes toward the elderly and thereby further improve their medical care.

Medical students' experiences with and perceptions of chronic illness prior to medical school

Concerns have been expressed about the failure of the medical curriculum to address the health-care needs of the chronically ill. It has been shown in the literature that medical students develop cynicism and negative feelings towards chronic illness as they progress through their training, perhaps as a result of the attitudes and frustrations of their teachers. What has been inadequately addressed are the experiences with and perceptions about chronic illness that medical students have before entering medical school. Some recommendations are made for curriculum changes based on the findings reported.

Attitudes of medical students to old people: a cross-national comparative study

Medical students' attitudes to the elderly were compared at the start and finish of a 5-week clinical attachment in health care of the elderly at the Christchurch School of Medicine. The study investigated students in their first clinical year (fourth year of their medical course) over five terms using a questionnaire employing a Rosencranz-McNevin semantic differential scale to measure general attitudes to old age and a Likert scale to measure attitudes to medical care. A question was also asked about career preferences. There was significant improvement in attitudes measured by both scales (Rosencranz-McNevin P less than 0.001, Likert P less than 0.001). Students also showed an increase in interest in health care of the elderly as a career choice. When compared with two cohorts of students from Nottingham Medical School, attitudes were significantly better in the Christchurch group at the commencement of the run. Students at both schools showed an improvement in knowledge but this was more marked for Christchurch students.

Treating Older Patients: Who Treats and Why?

A la lumière de la proportion croissante de personnes âgées recourant aux services de médecins, cette recherche tente de déterminer dans quelle mesure les médecins qui traitent les personnes âgées sont différents de leurs collègues qui ne le font pas. Des études précédentes ont porté sur certaines facettes de cette problématique, notamment en ce qui concerne les caractéristiques des médecins, leurs comportements dans la pratique, leurs attitudes et leurs convictions générales. Cette étude examine à nouveau et de façon systématique ces différentes catégories, à partir d'un groupe de médecins, en utilisant une procédure de régression multiple. Les résultats laissent entendre que les médecins qui suivent des patients âgés dans les domaines de la chirurgie orthopédique, de la chirurgie générale et de l'ophthalmologie, ne sont pas vraiment différents de leurs collègues qui traitent des patients plusjeunes. On explore également dans cette étude d'autres explications concernant le choix des patients âgés. On se demande aussi quelles seraient les implications pour les patients âgés de choisir un médecin doté d'une expertise dans les soins gériatriques.

Effects of age and nutritional status on surgical outcomes in head and neck cancer

Older and younger malnourished and well-nourished head and neck cancer patients scheduled for surgery were studied. More of the young (75%) compared with the old (58%) underwent curative surgery, and only the old with lower clinical states of cancer were selected. When data on those undergoing surgery were analyzed in regard to older and younger malnourished and well-nourished men, the malnourished old had the poorest surgical outcomes of any group, with significantly more complications and morbidity rates. The well-nourished old had outcomes that did not differ from younger patients. On further examination, 60% of the young malnourished and only 20% of the old malnourished received preoperative enteral or parenteral nutritional support. Findings suggest that more attention to the needs of the older malnourished patients could improve surgical outcomes.