Preparing medical graduates to care for older adults.

Abstract

Background: Social accountability in medical training requires medical schools in South Africa to respond to the health needs of the country’s rapidly increasing number of older adults. Reports, however, indicate that elderly patients in South Africa receive poor quality of care from health professionals. Reports also indicate that students’ empathy towards older adults declines as they progress through their studies. These disparities necessitate greater awareness of the health needs and expectations of older adults and an inquiry into the geriatric care training of medical professionals. Aim: This 360-degree study investigated the geriatric medical curriculum at one institution from the perspectives of geriatric patients, learners and health professions educators to make recommendations for improvement, and to develop policy guidelines for the enhancement of undergraduate medical education in geriatric care. Methodology: A sequential mixed methods approach was adopted for this study. Four focus group discussions were conducted with patients aged 60 years and older from primary care facilities served by graduates of the medical institution (n=28). Data that emerged from this phase regarding patients’ expectations of quality geriatric healthcare were triangulated with a review of curriculum documents, semistructured interviews with health professions educators (n=5) and an evaluation of the levels of knowledge and attitudes of final year medical students regarding the care of older adults. Results: The key principles for quality healthcare of older adults that were elicited from patients were respectful communication, compassion, appropriate prescribing, patient-centredness and coordinated care. However, professional attributes such as compassion and patient-centered care that were valued by geriatric patients are not explicitly taught or assessed in the curriculum. The current curriculum includes a wide variety of topics relevant to the care of older adults. Teaching and assessment relevant to geriatric care were further integrated into other modules, but no minimum standards are applied in assessment of the geriatric component. Students lacked exposure to older adults in ambulatory settings and received little teaching on health promotion or rehabilitative services relevant to the care of older adults. Despite the opportunities afforded by the problem-based learning approach in the curriculum for team-based learning and collaboration, interprofessional education was absent in teaching and learning relevant to older adults. Overall, final year medical students possessed minimal levels of geriatric knowledge despite their perceptions of having had adequate exposure to geriatrics in the current curriculum. The majority of students had positive attitudes towards working with elderly patients. In particular, older students and those with a prior higher education qualification had significantly higher levels of knowledge and attitudes towards caring for older adults. Of note, there was no association between geriatric knowledge and attitudes. Medical students also reported challenges in communicating with older adults and believed that their training had not prepared them adequately for this aspect. Conclusion: The findings of the study affirmed the need to enhance the geriatric curriculum for undergraduate medical students, and to develop and implement minimum core competencies in geriatric care. Curriculum planners should consider greater attention to patient-centred care, communication skills training with older adults and interprofessional education, as well as broader community engagement. Policy guidelines based on the findings of this study were developed and recommended to the Undergraduate Committee for Teaching and Learning to improve the preparedness of medical graduates to care for older adults.