Why do medical students not have a geriatrics textbook?

To study the opinions of medical students on textbooks of geriatrics, we made a questionnaire for 5th-year medical students. All students had their own textbook (s) of internal medicine, and nearly half of the students had textbook (s) of physical examination. However, only 3.6% of students had their own textbook of geriatrics. The reasons for not having a textbook of geriatrics were as follows: 1) no understanding which textbook is better (59.1%), 2) no need to have a textbook (15.5%), 3) no appropriate textbooks (4.1%), and 4) others (17.6%). The most important point for choosing a textbook was as follows: 1) information from friends or seniors (38.9%), 2) looking by oneself (47.7%), 3) recommendation of a teacher (9.8%), and 4) others (3.6%).     

Geriatric education. Part I: Efficacy of a mandatory clinical rotation for fourth year medical students.

OBJECTIVES: To describe the curriculum of a mandatory, fourth-year geriatrics clerkship and assess its impact on medical students' knowledge of geriatric medicine and attitudes toward the elderly. DESIGN: One group, before/after trial. SETTING: Mount Sinai School of Medicine of the City University of New York. PARTICIPANTS: Entire fourth year class of medical students (n = 127). INTERVENTION: Four-week-long clinical geriatrics clerkship. MEASUREMENTS: Pre- and post-rotation: test of knowledge; Aging Semantic Differential (ASD) attitude scale; Modified Maxwell-Sullivan attitude scale; questionnaire. MAIN RESULTS: Seventy percent of students found the rotation to be educationally valuable; however, only one-third of students would have taken the clerkship had it not been required. Mean geriatric knowledge score increased by 18.7% (P less than 0.001). Mean ASD attitude score did not change significantly (130.5 +/- 19.2 pre-rotation versus 126.6 +/- 18.8 post-rotation, P = 0.15), but students started the rotation with a neutral attitude. Over 90% of students agreed they would welcome elderly into their future practice. CONCLUSION: If a national curricular goal is to improve medical students' knowledge of geriatric medicine, required rather than elective rotations may be in order.     

Medical School and VA Cooperation in Gerontology/Geriatrics Education

The School of Medicine at Wright State University developed with support from the VA Medical School Assistance and Health Manpower Act of 1972 (PL 92-541). This laid the foundation for collaborative efforts between WSU SOM and DVAMC in the development of educational programs for medical students, residents, faculty, and staff from both facilities. The major emphasis of these joint programs is in the area of geriatric medicine. This paper discusses the formulation of these programs, the results of their efforts, as well as plans for the future.     

Effect of a 1-week clinical rotation in palliative medicine on medical school graduates' knowledge of and preparedness in caring for seriously ill patients

OBJECTIVES: To assess the effect of a required 1‐week clinical rotation in palliative medicine during a 12‐week internal medicine–geriatrics clerkship on graduating medical students' knowledge and self‐assessed preparedness in caring for seriously ill patients. DESIGN: Historical control trial. SETTING: Mount Sinai School of Medicine (MSSM), New York, New York. PARTICIPANTS: Students from the MSSM classes of 2007 (MS07) and 2008 (MS08). INTERVENTION: MS08 was the first class to complete the required clinical rotation in palliative medicine. MS07 served as a historical control, having received only didactics in palliative care but no clinical rotation. MEASUREMENTS: Both classes were invited to complete an anonymous online survey designed to assess experiences and preparedness in caring for seriously ill patients and a 30‐question multiple choice knowledge examination. RESULTS: Fifty‐eight (55%) students from MS07 and 59 (51%) students from MS08 completed the survey. Students from MS08 rated their skill level in several areas of pain management and communication more favorably than did students from MS07. Mean scores on the knowledge portion of the survey were not significantly different between the two classes. CONCLUSION: Graduating medical students who had a 1‐week clinical rotation in palliative medicine had higher self‐assessed skills in pain management and communication than students who received no clinical exposure. A brief clinical experience in palliative care should be considered for integration into the curriculum at all medical schools.     

The Johns Hopkins Geriatric Summer Scholars Program: a model to increase diversity in geriatric medicine

The Division of Geriatric Medicine and Gerontology at the Johns Hopkins University strives to create a workforce that represents the racial, ethnic, and sex diversity of U.S. society. To that end, the division has developed a summer program for underrepresented minority first-year medical students to expose them to geriatric medicine and research. The ultimate aim of this initiative is to recruit students to academic medicine, specifically geriatric medicine, where they are drastically underrepresented. Nineteen students participated in the program from the summer of 2002 to the summer of 2004. The participants have continued on to win seven other research fellowships, participate in the National Institute on Aging Technical Assistance Workshop, and present at four national conferences, including the American Geriatrics Society conference and the Gerontological Society of America meeting. One of the students, who is completing medical school in May 2005, is returning to begin the internal medicine residency program at Johns Hopkins Bayview, where the majority of the geriatric faculty practice medicine. Another student who is also graduating is obtaining her Masters in Public Health with a concentration in epidemiology from the Johns Hopkins Bloomberg School of Public Health before starting residency. This article describes the outcomes of the first 3 years of the program, with an emphasis on curriculum development and the recruitment and retention of underrepresented minority medical students.     

A case-oriented web-based curriculum in geriatrics for third-year medical students

OBJECTIVES: This paper describes the development, implementation, and evaluation of a case-oriented, web-based curriculum in geriatric medicine for third-year medical students. DESIGN: Single cohort, pre/post trial. SETTING: University of Kansas School of Medicine, Kansas City, Kansas. PARTICIPANTS: Third-year medical students (n = 130). INTERVENTION: A web-based curriculum, offered during a clinical geriatrics clerkship, is composed of 13 case-oriented, web-based modules spanning key topics in geriatric medicine. Each module topic is also reviewed in a post-module, faculty-led discussion session. MEASUREMENTS: A pre-and post-rotation test of knowledge was completed. Student feedback about the curriculum was collected through web-based and written evaluation. MAIN RESULTS: Pre-and post-rotation comparison of examination scores demonstrated an average increase of 13 correct items on a 40-item exam. Seventy-five percent of students rated each module favorably at the time of completion (range 53-89%). Most modules (10/13) were rated as excellent or good after all modules had been completed. CONCLUSIONS: A case-oriented web-based curriculum in geriatrics was rated favorably by third-year medical students. Students' knowledge increased in key geriatric topics. Student feedback allows for continuous improvement of the curriculum. This model of curricular innovation may be useful for other institutions seeking to develop or enhance geriatric medicine content in the medical school curriculum.     

The effect of geriatric and palliative medicine education on the knowledge and attitudes of internal medicine residents

A recent Institute of Medicine report on geriatric work force issues recommends training residents in settings with geriatric patients and increasing certification requirements to include competence in the care of older adults. Although the number of internal medicine programs with a geriatric curriculum has increased, the scope and effectiveness of these programs vary. The purpose of this study was to evaluate the effect of a new academic geriatric and palliative medicine curriculum on the knowledge and attitudes of third-year internal medicine and fourth-year medicine and pediatrics residents. The study was conducted at The University of Texas Medical School at Houston. A new Division of Geriatric and Palliative medicine was created that offered inpatient, consultation, ambulatory, and home visit experiences in addition to didactic lectures. The University of Michigan Geriatrics Clinical Decision Making Assessment and the University of California at Los Angeles Geriatric Attitude Test was used to evaluate pre- and post-rotation knowledge and attitudes. Residents' knowledge improved after completing the rotation, as shown by a 6.9-point increase in posttest scores (P<.001). There was also a 10-point improvement in pretest scores over the course of the year (P=.03). Fifty-seven percent of residents had an improvement in attitude. This study shows that an increase in geriatric and palliative teaching opportunities provided by the establishment of a geriatric and palliative medicine division improves residents' knowledge significantly.     

The Attitudes of Medical Students Towards Careers in Geriatric Medicine

When designing a geriatric medical curriculum, it is important to understand the attitudes that medical students have towards the elderly and careers in geriatric medicine. Therefore, attitudes of senior medical students at the University of Queensland towards a career with the elderly were assessed using a questionnaire. Very few students were considering pursuing a career in geriatric medicine and most students excluded the elderly from the age groups that they would prefer to treat This appeared to be secondary to a perception that geriatric medicine is a ‘low tech’ specialty concerned with psychosocial and placement issues and rarely with cure.     

… But Does It Stick? Evaluating the Durability of Improved Knowledge Following an Undergraduate Experiential Geriatrics Learning Session

Canada's aging population, fewer medical students training in geriatric medicine, and inadequate geriatric curricula require that medical schools immediately address how future physicians will be able to care for older people effectively. The medical literature suggests that experiential learning strategies improve undergraduate medical students' knowledge of and interest in less-popular subjects, but the durability of improvements resulting from these resource-intensive learning approaches remains unclear. In October 2001, a convenience sample of all University of Western Ontario medical students attending the geriatric component of their first year was randomized to attend one 3-hour didactic lecture or 3-hour experiential learning session. Approximately 1 year later, students completed a follow-up knowledge and attitudes survey that was matched to their first-year surveys using date-of-birth data. Of 100 completed follow-up surveys, 42 were used in formal analysis. Although initially the experiential group demonstrated a better knowledge score, at 1-year follow-up, there was no significant difference in knowledge, attitudes toward older people, or interest in geriatric medicine between the didactic (n=17) and experiential (n=25) groups. Nevertheless, these students (n=42) demonstrated better attitude scores than those (n=22) who had not attended either educational intervention. This study challenges the belief that an experiential approach is a superior training method to a didactic approach. One year after an educational intervention, there was no difference in geriatric knowledge, attitude scores, or interest in geriatric medicine between students who underwent a didactic lecture or a participatory, experiential learning session.     

An analysis of questionnaires about geriatric medicine/medical education sent to members of the Japanese Society of General Medicine]

Geriatric medical care can be viewed as general medical care for the elderly. We conducted a survey of members of the Japanese Society of General Medicine who belong to a university hospital, on their views of geriatric medicine/medical education. The questionnaires consisted of six categories of items about: (1) the physician's career; (2) whether the physician performs geriatric research in his/her laboratory; (3) whether the physician has an interest in geriatric medicine or medical education; (4) the physician's views on geriatric medicine or medical education; (5) of what pre- and post-graduate medical education on geriatric medicine should consist, from the physician's point of view: and (6) the physician's ideas about geriatric medicine/medical education in view of general medicine. Out of the 181 questionnaires sent, 96 (53%) people replied, of whom 51 (53.1%) were members of a Department of General Medicine, 57 (60%) were teaching staff, 46 (48.4%) had experience in home medical care such as home visits, and 17 (18.1%) belonged to the Japanese Society of Geriatric Medicine. Seventy-six respondents (85.4%) had an interest in geriatric medicine/medical education. Of the respondents, 96.8% recognized the need for pre- and post-graduate medical education concerning geriatrics. Some members of the Japanese Society of General Medicine who answered the questionnaire see geriatric medicine as entirely general medicine, and also that geriatric medicine is important, necessary and special. In addition, they see that the field of geriatric medicine is not yet developed in regard to geriatric medical care and education. Most respondents could not specify which section in a medical university is responsible for teaching the fields of basic and social medicine. This result shows that it may be difficult to incorporate pre-graduate geriatric medical education into the curriculum. As part of the pre-graduate curriculum of medical education on geriatrics, a practical exercise such as inspection of a geriatric hospital and geriatric home was considered most desirable by the respondents. Out of nine items, the top three most important aspects of post-graduate medical education on geriatrics for clinical and social medicine, were (1) studying the medical care and welfare of the elderly, (2) assessing the impaired life function of the elderly, and (3) studying pharmaco- therapy. Out of 6 items, the top three most important aspects of a practical exercise in post-graduate medical education in geriatrics were (1) providing general care to the elderly, (2) giving rehabilitation guidance and (3) providing psychological support for the elderly. Furthermore, 20 of the respondents (22.5%) have performed geriatric medical research on either the activities of daily life of the elderly or living wills, both of which seem to reflect the health and life of elderly people.     

Does performance on the NBME part II medicine examination when used as a clerkship examination reflect knowledge acquired during the medicine clerkship?

Objective:The purpose of this study was to examine whether the National Board of Medical Examiners (NBME) Medicine Examination provides a reasonable assessment tool for testing students’ knowledge acquired during a medicine clerkship. Design:Comparison of the performances of two classes of medical students on the NBME Part II Medicine Examination on the first and last days of 12-week medicine clerkships in a two-year period (1985–87). Participants:176 medical students in two consecutive classes at the Oregon Health Sciences University. Measurements and results:There was no significant difference in students’ performances on the NBME Part II Medicine Examination on the first day of the medicine clerkship, regardless of the quarter in which they took the clerkship. Prior clerkship experiences did not appear to influence the baseline pre-clerkship internal medicine knowledge base as defined by NBME Part II Medicine Examination performances. Students in the second half of the year, however, demonstrated greater gains in post-clerkship NBME Part II Medicine Examination performances than did their counterparts from the first half of the year, despite similar pre-clerkship testing performances. Received from the Division of General Internal Medicine, Oregon Health Sciences University, Portland VA Medical Center, Portland, Oregon. Presented in part at the January 1990 Northwest Regional Meeting of the Society of General Internal Medicine, Seattle, Washington.     

Effect of a mandatory geriatric medicine clerkship on third-year students

A nationwide push has increased geriatric medicine instruction within medical school curricula. Some institutions have proceeded with an integrated 4-year curriculum while others have constructed discrete courses in the third or fourth year of medical school. This paper describes the impact of a new mandatory 4-week geriatric medicine clerkship on third-year students developed by the Donald W. Reynolds Department of Geriatric Medicine at the University of Oklahoma Health Sciences Center. In the first year of implementation, 135 students took the course on both the Oklahoma City and Tulsa campuses. Clinical sites included inpatient, VA extended care unit, outpatient clinics, dementia clinics, home care, long-term care settings, and hospice. Didactic instruction used formal lectures and problem-based learning. The impact of the clerkship on students was assessed in three areas: knowledge, skills, and attitude using a pre- and postknowledge test, student satisfaction survey, and written comments. This article discusses how the clerkship resulted in increased knowledge of geriatric medicine. Student self-report indicates that the clerkship enhanced clinical evaluation and patient assessment skills. Students indicated that the experience was positive and recognized the importance of geriatric medicine in their development as doctors.     

Early clinical exposure to geriatric medicine in second-year medical school students--the McGill experience

This study examined the effect of a curriculum change on early clinical exposure to geriatrics for second-year medical students at McGill University and its effects on learning and students' appreciation of geriatrics as a subspecialty. Second-year medical students (N = 200) were exposed to a change in the curriculum involving the integration of 10 weekly sessions into one integrated week in geriatric medicine. Students participating in 10 weekly sessions were Group 1 and students participating in one integrated week were Group 2. Students rated their rotation using two different scales. The students completed 12-item questionnaires during their feedback sessions at the end of the 10-week session experience or the integrated week. The first six items assessed the students' appreciation of their improvement of knowledge in the subject of geriatrics and aging. The second and third part of the survey (questions 7 and 8) included the students' opinions about the quality of the instruction (teaching feedback) and evaluation. Students in Group 2 found their rotation more effective as a learning experience and expressed greater satisfaction with interaction with the tutors, community settings, and multidisciplinary team sessions. Grades obtained on final examinations showed a better and more-effective acquisition of knowledge by Group 2. The integrated week is a more-effective learning tool in the early clinical experience for medical students in geriatric medicine than 10 weekly sessions as the first introductory experience to the field of geriatric medicine.     

Social Learning: Medical Student Perceptions of Geriatric House Calls

Bandura's social learning theory provides a useful conceptual framework to understand medical students' perceptions of a house calls experience at Virginia Commonwealth University School of Medicine. Social learning and role modeling reflect Liaison Committee on Medical Education guidelines for “Medical schools (to) ensure that the learning environment for medical students promotes the development of explicit and appropriate professional attributes (attitudes, behaviors, and identity) in their medical students.” This qualitative study reports findings from open-ended survey questions from 123 medical students who observed a preceptor during house calls to elderly homebound patients. Their comments included reflections on the medical treatment as well as interactions with family and professional care providers. Student insights about the social learning process they experienced during house calls to geriatric patients characterized physician role models as dedicated, compassionate, and communicative. They also described patient care in the home environment as comprehensive, personalized, more relaxed, and comfortable. Student perceptions reflect an appreciation of the richness and complexity of details learned from home visits and social interaction with patients, families, and caregivers.     

A case of interstitial pneumonia caused by gosha-jinki-gan

A 74-year-old woman was admitted to the hospital of Ehime University School of Medicine because of slight fever, dry cough and dyspnea on exertion. Chest X-ray films on admission showed diffuse infiltrations in both lungs. Drug-induced pneumonia due to the herbal medicine Gosha-jinki-gan was suspected, as Gosha-jinki-gan had been administered for 5 months for the treatment of a right knee pain. Her symptoms and the X-ray abnormality improved after cessation of administration. The lymphocyte stimulation test against Gosha-jinki-gan was positive. To the best of our knowledge, this is the first case of interstitial pneumonia caused by Gosha-jinki-gan.     

A Multimodal Aging and Dying Course for First-Year Medical Students Improves Knowledge and Attitudes

When medical schools change their curricula, this opens up opportunities for the development of new material and often eliminates previously designed courses. Emory University's School of Medicine revised its curriculum in 2007, combining clinical medicine and basic sciences in the first 18 months. As part of its first section on "The Healthy Human," it included a weeklong module on aging. The main objective of this study was to evaluate attitudes and knowledge about aging issues before and after the course. The course included 5 days of sessions on topics ranging from molecular biology to societal aspects of aging. Students completed a survey including demographics, the University of California at Los Angeles Geriatrics Attitudes Scale (UCLA-GAS), and the Facts on Aging Quiz-1 (FAQ1) before and after the course. The UCLA-GAS measures attitudes toward geriatric patients on a 5-point Likert scale, and the FAQ1 is a 25-item true–false test on knowledge of aging. All 130 first-year students completed the precourse survey, and 129 completed the postcourse survey. Four students said they planned to pursue specialty training in geriatrics before the module, and 10 planned to do so after the course ( P =.28 using Fisher exact test). Mean UCLA-GAS score was 3.7±0.4 before the class and 3.8±0.4 after ( P <.001 using paired t -test). Mean of correct answers on FAQ1 was 16.1±2.4 before the class and 17.5±2.3 after ( P <.001 using paired t -test). This weeklong course on aging for first-year medical students at Emory improved their attitudes toward elderly people and their knowledge base on aging.     

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.     

A vertically integrated geriatric curriculum improves medical student knowledge and clinical skills

The objective of this study was to determine the effect of a vertically integrated curriculum intervention on the geriatric knowledge and performance in clinical skills of third-year medical students. This observational cohort study conducted at the University of Michigan Medical School evaluates the performance of 622 third-year medical students from the graduating class years of 2004 through 2007. An integrated curriculum intervention was developed and implemented for the class of 2006. Its elements included identification and tracking of geriatric learning outcomes in an individualized Web-based student portfolio, integration of geriatric content into preclinical courses, development of a geriatric functional assessment standardized patient instructor, and an experience in a geriatrics clinic during the ambulatory component of the third-year internal medicine clerkship. Medical student performance was assessed on a geriatric knowledge test and during a geriatric functional assessment station administered during an Observed Structured Clinical Examination (OSCE) at the beginning of the fourth year. Student performance on the geriatric functional assessment OSCE station progressively improved from pre-intervention performance (mean performance+/-standard deviation 43+/-15% class of 2005, 62 + 15% class of 2006, 78+/-10% class of 2007; analysis of variance, P<.001). Similarly, student performance on the geriatric knowledge test was significantly better for the classes of 2006 and 2007 than for the class of 2005 (model F ratio=4.72; P<.001). In conclusion, an integrated approach to incorporating new educational geriatric objectives into the medical school curriculum leads to significant improvements in medical student knowledge and in important clinical skills in the functional assessment of older patients.     

The Impact of Role Models on Medical Students

OBJECTIVE: To explore the relationship between exposure to clinical role models during medical school and the students' choice of clinical field for residency training, and to estimate the strength of this association. DESIGN: Cross-section study. SETTING: McGill University School of Medicine, Montreal, Canada. PARTICIPANTS: Of the 146 graduating medical students in the class of 1995, 136 participated. MEASUREMENTS AND MAIN RESULTS: Clinical field chosen by students for residency training and the students' assessment of their exposure to and interaction with physician role models were the main measurements. Ninety percent of graduating students had identified a role model or models during medical school. Personality, clinical skills and competence, and teaching ability were most important in the selection of a role model, while research achievements and academic position were least important. Odds ratios between interacting with "sufficient" role models in a given clinical field and choosing that same clinical field for residency were 12.8 for pediatrics, 5.1 for family medicine, 4.7 for internal medicine, and 3.6 for surgery. Most students (63%) received career counseling and advice from their role models. CONCLUSIONS: Exposure to role models in a particular clinical field is strongly associated with medical students' choice of clinical field for residency training. Knowing which characteristics students look for in their role models should help identify the physicians who may be most influential in medical students' career choice.     

Lernzielkatalog für die studentische Lehre im Fachbereich „Geriatrie“ an Fakultäten für Humanmedizin

Sound knowledge in the care and management of geriatric patients is essential for doctors in almost all medical subspecialties. Therefore, it is important that pregraduate medical education adequately covers the field of geriatric medicine. However, in most medical faculties in Europe today, learning objectives in geriatric medicine are often substandard or not even explicitly addressed. As a first step to encourage undergraduate teaching in geriatric medicine, the European Union of Medical Specialists -Geriatric Medicine Section (UEMS-GMS) recently developed a catalogue of learning goals using a modified Delphi technique in order to encourage education in this field. This catalogue of learning objectives for geriatric medicine focuses on the minimum requirements with specific learning goals in knowledge, skills and attitudes that medical students should have acquired by the end of their studies. In order to ease the implementation of this new, competence-based curriculum among the medical faculties in universities teaching in the German language, the authors translated the published English language curriculum into German and adapted it according to medical language and terms used at German-speaking medical faculties and universities of Austria, Germany and Switzerland. This article contains the final German translation of the curriculum. The Geriatric Medicine Societies of Germany, Austria, and Switzerland formally endorse the present curriculum and recommend that medical faculties adapt their curricula for undergraduate teaching based on this catalogue.