Predicting Third Year Medical Students' Attitudes Toward the Elderly and Treating the Old

Third year medical students (N=179) were tested on attitudes about the elderly and treating the old. Other variables such as age, sex, career preference of the students, knowledge about aging in the curriculum, experience with the elderly, and age definition of old were used to predict attitudes about the elderly and about their care. The best predictor of both attitudes was a more favorable view of geriatrics as a profession. Attitudes toward pediatrics was also a predictor. Those who selected family medicine as a career preference had more favorable attitudes about the elderly. Greater knowledge about aging was a predictor of positive attitudes toward the elderly and their care. Increasing knowledge about aging may be a practical way to shape more positive attitudes in medical students. The best way to increase knowledge may be through exposing of students to healthy elderly or those with short-term health problems rather than long-term care only. Attitudes about geriatrics also could be influenced by faculty role models who have positive attitudes about treatment of the elderly.     

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 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.     

Attitudes, experiences, and interest in geriatrics of first-year allopathic and osteopathic medical students

A cross-sectional survey was designed to assess interest in geriatric medicine of allopathic and osteopathic medical students and to determine whether their career interests were related to past experiences with and current attitudes toward older adults. The study was conducted at an allopathic and osteopathic medical school with 231 first-year medical students. Experiences with elderly people were measured using survey questions assessing amount and quality of experiences with grandparents, as well as experiences caring for, volunteering with, or having a paid position working with older adults. Attitudes were measured using the University of California at Los Angeles Geriatric Attitudes Scale, revised for applicability to medical students. Interest in geriatrics was measured using a 4-point scale. Overall, students expressed positive attitudes toward older adults. Past experiences, including positive relationships with older relatives ( P <.001) and experiences providing care for older adults ( P <.001), were related to more-positive attitude scores toward elderly people. Students had low interest in geriatric medicine, but those with more-positive attitudes were more likely to consider geriatrics as a career (odds ratio=8.18, P <.001). Furthermore, having prior experience caring for older persons increased interest in the field ( P =.001). No significant differences were found between allopathic and osteopathic student interest in geriatrics or attitudes toward older adults. Efforts toward increasing the pool of future geriatricians and increasing positive attitudes toward older patients could be improved by providing quality experiences caring for and interacting with older adults before medical school training.     

An evaluation of a low-intensity intervention to introduce medical students to healthy older people

This is a report of a controlled, prospective, longitudinal trial of an intervention to affect medical students' attitudes toward aging. Members of the Class of 2002 at the University of Oklahoma College of Medicine were assigned a senior mentor (a community-dwelling older person) upon matriculation into medical school. Students were required to perform a structured interview with the mentor once per semester for the first 2 preclinical years and to discuss these interviews in small groups mediated by geriatrics faculty. Members of the Class of 2001 were controls. Attitudes toward aging were determined using the Aging Semantic Differential (ASD) attitude scale in August 1998 and again at the end of the second year of medical school. Initial mean ASD scores were not significantly different for the two groups. Although both classes experienced improvements in their ASD scores from Time 0 to Time 1, the improvement for the class of 2002 was significantly greater than that for the class of 2001 (2001 class mean = 0.17, 2002 class mean = 0.40, t = -3.09, degrees of freedom (df) = 219, P =.002). This difference held up under controls for sex, age, prior visits to a nursing home, prior work/volunteering in an old-age environment, and a prior course on aging (Model F = 3.00, df = 6/214, P =.008; class F = 9.70, df = 1, P =.002). It was concluded that a low-intensity intervention to introduce entering medical students to healthy older people might have a positive effect on attitudes toward aging.     

Teaching Geriatrics Using an Innovative,Individual‐Centered Educational Game: Students and Educators Win. A Proof‐of‐Concept Study

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.     

Knowledge and attitudes about geriatrics of medical students, internal medicine residents, and geriatric medicine fellows

OBJECTIVES: To evaluate the attitudes and knowledge of medical students (MS1-3), internal medicine residents (postgraduate years 1 to 3 (PGY1-3)), and geriatric medicine fellows about elderly patients before implementation of a new geriatrics curriculum. DESIGN: Cross-sectional study. SETTING: An academic medical center. PARTICIPANTS: Two hundred eleven people participated: 54 MS1, 52 MS2, 50 MS3, 20 PGY1, 12 PGY2, 12 PGY3, and 11 geriatric medicine fellows. MEASUREMENTS: Each participant completed a questionnaire, including a 16-item geriatrics attitude scale, and a 23-item knowledge test (both revised versions of the University of California at Los Angeles (UCLA) Geriatrics Survey). Pearson correlation coefficients and t tests were used for statistical analyses. RESULTS: Both surveys demonstrated high internal consistency (alpha=0.70 and 0.71, respectively). Knowledge test scores increased with advancing level of training. MS1 and MS2 scored significantly lower and fellows scored significantly higher than others. PGY3 scored significantly higher than PGY1 on the knowledge test. All groups demonstrated positive attitudes toward geriatric patients (score>3.5). MS1 and fellows had significantly more favorable attitudes scores than more advanced students and residents. CONCLUSION: The results suggest that the UCLA Attitudes Scale and Knowledge Test can be used reliably to assess attitudes and knowledge level across all levels of medical education and training. The information from this study will be used to implement a more structured and comprehensive geriatrics curriculum across all trainee levels to improve attitudes and knowledge in the care of the geriatric patient.     

HIV/AIDS stigma and knowledge among predominantly middle-class high school students in New Delhi, India

This study examined stigmatizing attitudes toward HIV/AIDS among predominantly middle-class adolescents in New Delhi high schools. This study was specifically designed to: 1) assess stigmatizing attitudes toward HIV/AIDS and sexuality; HIV/AIDS knowledge, and awareness of HIV-related health resources; and 2) examine whether HIV-related stigma and knowledge are related to one another and to gender, parents' education, and exposure to HIV/AIDS education. In four high schools in New Delhi, 186 students completed a questionnaire assessing stigmatization of HIV/AIDS, stigmatization of sexuality, knowledge of HIV/AIDS, HIV/AIDS education and resources, and demographic characteristics. Adolescents varied in how much they stigmatized persons with HIV/AIDS. They generally lacked accurate knowledge about the disease and of related health resources. However, those with greater exposure to HIV/AIDS education demonstrated significantly greater HIV/AIDS knowledge. Female adolescents demonstrated significantly less knowledge about HIV/AIDS compared with male adolescents, while the males reported significantly greater exposure to HIV/AIDS education compared with the females. These results suggest a need for greater HIV/AIDS education and awareness of health resources, especially among female adolescents. Education must directly address stigmatizing attitudes about HIV/AIDS, gaps in HIV/AIDS knowledge and awareness of HIV-related health resources.     

Prevalence,Formation, Maintenance,and Evaluation of Interdisciplinary Student Aging Interest Groups

The authors describe the prevalence, formation, maintenance, and evaluation of student aging interest groups. They conducted a cross-sectional electronic survey of the 46 academic medical centers funded by the Donald W. Reynolds Foundation. To evaluate their group of approximately 50 students, the authors conducted an electronic pretest and posttest of attitudes toward interdisciplinary education and knowledge about aging. Twenty-nine of 32 responding institutions funded by the Reynolds Foundation conducted a group; only medical students participated in one half of these groups. Panel presentations were the most prevalent group activity. Evaluation of their group revealed that an interprofessional service learning experience had the greatest impact on student perceptions of the educational preparation and competency of other disciplines. At posttest, medical students in their group had significantly less positive perceptions of actual cooperation between disciplines than did physical therapy or pharmacy students. Aging interest groups conducted by institutions funded by the Reynolds Foundation did not have a high level of interdisciplinary participation. Intermittent exposure to other disciplines during a small number of group activities may be insufficient to overcome “disciplinary split” and achieve interprofessional team orientation without changes in the structure of medical education.     

Gerontological education: Course and experiential differences across academic colleges

A knowledgeable workforce is key to meeting the demands of an aging population that is expected to nearly triple by 2030 and their attitudes influence propensity to seek aging-related careers. Postsecondary education offers an opportunity to increase aging-related knowledge and facilitates intergenerational experiential-learning opportunities; however, research is lacking regarding attitudes toward aging and experiences among an academically diverse sample. To address this gap, the aims of this study were to (1) examine differences in students’ attitudes toward older adults by academic college, (2) assess differences in aging-related coursework and course experiences by academic college, and (3) explore key factors associated with students’ attitudes toward older adults. Online survey methodology was used with a sample of 816 undergraduate students from a single university who represented all academic colleges offering undergraduate degrees. Significant differences among students’ attitudes toward older adults by academic college were noted: those enrolled in the College of Human Sciences reported better stereotype, separation, and affective attitudes. Furthermore, factors associated with students’ aging-related attitudes were sex, affiliation with academic college, perception of “old,” contact frequency, and desire to learn aging-related content. The authors suggest interdisciplinary and disciplinary-specific educational recommendations to improve students’ attitudes toward older adults.     

Medical student attitudes toward older people and willingness to consider a career in geriatric medicine

OBJECTIVES: To evaluate the attitudes of first- and fourth-year medical students toward older people and the relationship between these attitudes and possible career choice. To examine the effects of an intensive geriatric medicine (GM) teaching program on these attitudes and career aspirations.
DESIGN: Observational study.
SETTING: University of Aberdeen.
PARTICIPANTS: Medical students.
MEASUREMENTS: In September 2005, first-year students (n=163) at the start of their undergraduate training completed a questionnaire based on the University of California at Los Angeles Geriatrics Attitudes Scale. Students were asked how likely they were to consider a career in GM in the future on a 5-point Likert scale. From the beginning of the academic year 2005/06, fourth-year students completed the same questionnaire before and after an intensive 8-day GM teaching program.
RESULTS: First-year medical students had a mean attitude score±standard deviation of 3.69±0.39. A more-positive attitude increased the likelihood of considering a career in GM ( P <.001). Fourth-year students had better attitude scores than first-year students (3.86±0.36, P =.002). The GM teaching program did not significantly affect attitude scores but significantly increased the willingness to consider a career in GM by a mean 0.52 points (95% confidence interval=0.35–0.70, P <.001).
CONCLUSION: Attitudes toward older people were better in fourth-year than first-year medical students. A more-positive attitude toward older people increased the likelihood of considering a career in GM. An intensive 8-day course in GM had no significant effect on attitudes but increased the likelihood of fourth-year students considering a career in GM.     

Effect of service-learning on knowledge about older people and faculty teaching evaluations in a physical therapy class

The major purpose of this study was to identify the knowledge, misconceptions, and bias regarding aging among graduate physical therapy students and to determine whether service-learning modified any of these variables. A cohort of 40 students in a graduate physical therapy program was randomly divided into an experimental (service-learning) or control (no service-learning) group. General knowledge and attitudes about aging were measured by Palmore's Facts on Aging Quiz I. The Wilson Student Evaluation of Faculty tool measured student evaluations of a faculty member at the end of the semester. Two-way analyses of variance with repeated measures revealed that all students increased their knowledge about aging, p < .05. However, students who initially had negative attitudes toward older adults significantly improved their attitudes only after the service-learning experience, p < .05. A t-test revealed that teaching evaluation scores were significantly lower in the service-learning course, p < .05. The results suggest that service-learning effectively enhanced both the knowledge and attitudes of physical therapy students toward the older adult. Although service-learning imparted better learning for the student, there was some risk to the faculty member as evidenced by lower teaching evaluations.     

Doctoral Clinical Geropsychology Training in a Primary Care Setting

Abstract

Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica, to clinical psychology doctoral students within a large urban professional psychology program. In an innovative effort to provide the most disadvantaged elderly with comprehensive mental health treatment and maximize trainee exposure to an interdisciplinary treatment model, the program also pairs selected doctoral psychology trainees with medical residents to optimize integrated mental health service delivery for primary care elderly. The program has the following core objectives: (1) Infuse the mental health and aging knowledge base into the regular graduate curriculum; (2) Provide interdisciplinary training in geropsychological diagnostic and consultative services within an urban primary care setting; (3) Provide interdisciplinary training in the practice of psychological and neuropsychological evaluation of elderly; (4) Provide training in geropsychological psychotherapeutic intervention, including individual, couples/family, and brief/psycho-educational therapies with outpatient older adults. These objectives are achieved by pooling the resources of a graduate school of psychology, a local public hospital, and an academic medical center to achieve educational and clinical service goals.     

Doctoral clinical geropsychology training in a primary care setting

Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica, to clinical psychology doctoral students within a large urban professional psychology program. In an innovative effort to provide the most disadvantaged elderly with comprehensive mental health treatment and maximize trainee exposure to an interdisciplinary treatment model, the program also pairs selected doctoral psychology trainees with medical residents to optimize integrated mental health service delivery for primary care elderly. The program has the following core objectives: (1) Infuse the mental health and aging knowledge base into the regular graduate curriculum; (2) Provide interdisciplinary training in geropsychological diagnostic and consultative services within an urban primary care setting; (3) Provide interdisciplinary training in the practice of psychological and neuropsychological evaluation of elderly; (4) Provide training in geropsychological psychotherapeutic intervention, including individual, couples/family, and brief/psycho-educational therapies with outpatient older adults. These objectives are achieved by pooling the resources of a graduate school of psychology, a local public hospital, and an academic medical center to achieve educational and clinical service goals.     

Evaluation of geriatrics education at a Chinese University: A survey of attitudes and knowledge among undergraduate medical students

ABSTRACT

Despite widespread reforms in medical education across China, nationally there has been no mandate or movement toward systemically incorporating geriatrics into curricula. To what degree medical students are trained and have exposure to geriatric topics remains unclear. We surveyed 190 medical students during their final year of medical school at a Chinese medical university, graduating from reformed and also traditional curricula. The survey was comprised of a subjective assessment of attitudes and reported knowledge, as well as an objective assessment of knowledge via a multiple choice test. Student attitudes were favorable toward geriatrics, with 91% supporting the addition of specialized clinical experiences to the curriculum. Students generally reported low exposure to geriatrics, with no statistically significant differences between reform and traditional curricula. There was a statistically significant difference in performance on the multiple choice test between curricula but at a degree unlikely to be practically significant. Students had very favorable attitudes toward geriatrics as a field and specialty; however scored poorly on competency exams, with the lowest performance around diagnosis and treatment of specific geriatric conditions. Our results suggest that there is a need and desire for increased geriatric-oriented learning at Chinese medical schools.     

When I’m 64: Effects of an interdisciplinary gerontology course on first-year undergraduates’ perceptions of aging

One challenge for gerontology is getting more students interested in aging at an earlier point in their academic career. This study evaluated the impact of an interdisciplinary course on aging designed for first-year undergraduate students. The course aimed to expand students’ appreciation of the personal and professional relevance of aging issues, with the goal of expanding their aging-related curricular and career interests. Main outcome variables of the study included knowledge of older adults and aging, attitudes toward older adults, and anxiety about personal aging. Participants included an intervention group enrolled in the course and a control group not enrolled in the course. Compared to baseline, at the end of the semester students in the class had more knowledge about aging and more positive explicit attitudes toward older adults, but their implicit attitudes toward older adults and anxiety about aging did not change. Control students showed no changes. These findings suggest that objective knowledge of aging and explicit attitudes improve with curricular intervention, but implicit attitudes and anxiety might be more difficult to change. Gerontology education is a complex undertaking whose diverse goals must be clearly articulated in order to guide curricular interventions and incite curiosity among young undergraduate students.     

Not quite color blind: ethnic and gender differences in attitudes toward older people among college students

Attitudes toward older people can influence how they are treated and their cognitive and physical health. The populations of the United States and many other countries have become more ethnically diverse, and are aging. Yet little research examines how ethnic diversity affects attitudes toward older people. Our study addresses this research gap. Using the Aging Semantic Differential, 592 university students expressed their attitudes toward older African-American, Hispanic, and White women and men. Repeated measures analysis of variance examined attitude differences by participant ethnicity and gender, and by the ethnicity and gender of evaluated individuals. Both African-American and White students had more positive attitudes toward older women and men of their own ethnic group. Participants had more positive attitudes toward older women than they did toward older men. Findings suggest in-group favoritism, and the usefulness of training those in service industries and public service to treat older individuals equitably.     

Effect of short-term research training programs on medical students’ attitudes toward aging

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.     

Medical Students' Attitudes:

Although education in the care of the elderly is widely recommended for all medical students, the specifics of this aspect of pressional education are widely variable and their effects unclear. This study evaluated the effects of a short-term interdisciplinary clinical rotation in geriatrics on medical student attitudes toward elderly patients, as well as attitudes toward non-physician health professionals. We also evaluated whether assignment to long-term care facilities as geriatrics clinical sites had a deleterious effect on attitudes of medical students taking this rotation. Our analysis demonstrated no measurable beneficial effects of the week-long geriatrics rotation on medical student attitudes toward elderly patients. The brief rotation did improve student attitudes toward the importance of non-physician health professionals in patient care; at the end of the course the students had more positive attitudes toward social workers, psychologists, and occupational therapists. Assignment to long-term care clinical sites during this geriatric curriculum had no negative effect on student attitudes toward elderly patients. This study suggets that clinical geriatrics education in long-term care settings need not adversly affect medical students' attitudes toward the elderly. Furthermore, medical students' attitudes toward health professionals caring for the elderly may be positively influenced by even a short didactic and clinical experience in geriatrics which emphasizes the interdisciplinary approach.