A Prospective Controlled Trial of the Influence of a Geriatrics Home Visit Program on Medical Student Knowledge, Skills, and Attitudes Towards Care of the Elderly

Abstract

PURPOSE:To determine the impact of a geriatrics home visit program for third-year medical students on attitudes, skills, and knowledge.METHODS: Using a mixed methods, prospective, controlled trial, volunteer control group students (n=17) at two sites and intervention group students (n=16) at two different sites within the same internal medicine clerkship were given Internet and CDROM-based geriatric self-study materials. Intervention group students identified a geriatrics patient from their clinical experience, performed one "home" visit (home, nursing home, or rehabilitation facility) to practice geriatric assessment skills, wrote a structured, reflective paper, and presented their findings in small-group teaching settings. Papers were qualitatively analyzed using the constant comparative method for themes. All students took a pre-test and post-test to measure changes in geriatrics knowledge and attitudes.RESULTS: General attitudes towards caring for the elderly improved more in the intervention group than in the control group (9.8 vs 0.5%; p=0.04, effect size 0.78). Medical student attitudes towards their home care training in medical school (21.7 vs 3.2%; p=0.02, effect size 0.94) improved, as did attitudes towards time and reimbursement issues surrounding home visits (10.1 vs −0.2%; p = 0.02, effect size 0.89). Knowledge of geriatrics improved in both groups (13.4 vs 15.2% improvement; p=0.73). Students described performing a mean of seven separate geriatric assessments (range 4-13) during the home visit. Themes that emerged from the qualitative analysis of the reflective papers added depth and understanding to the quantitative data and supported results concerning attitudinal change.CONCLUSIONS: While all participants gained geriatrics knowledge during their internal medicine clerkship, students who performed a home visit had improved attitudes towards the elderly and described performing geriatric assessment skills. Requiring little faculty time, a geriatrics home visit program like this one may be a useful clerkship addition to foster medical students' professional growth.

Systematic Review: Helping the Young to Understand the Old. Teaching Interventions in Geriatrics to Improve the Knowledge, Skills, and Attitudes of Undergraduate Medical Students

“…Even interventions of relatively brief duration, for example, an electronic game, 38 a 1-week geriatrics course, 29 and a 3-hour falls and delirium prevention session with selfstudy, 39 demonstrated an immediate positive change in student knowledge. One study compared a didactic teaching intervention with a novel experiential teaching intervention; Locally developed Improvement in some aspects of attitude after intervention; better scores on some aspects of attitude in intervention than control Bernard et al 19 Cohort 294 1st-year students, United States Senior mentor program Intermittent over 2 years ASD Attitudes improved in both cohorts but more so in the intervention group Denton et al 26 Before-and-after intervention with control cohort 33 3rd-year student, United States…”

Geriatric assessment in undergraduate geriatric education – a structured interpretation guide improves the quantity and accuracy of the results: a cohort comparison

“…For instance, Medina-Walpole et al found that respective experiences successfully enhanced the geriatric curricular content and positively affected students’ attitudes towards chronically ill and homebound elderly persons [23]. Furthermore, Denton et al described a positive effect, especially with regard to attitudes [24]. Our results indicate that undergraduate medical students need a structuring tool serving as interpretation aid to handle the complexity of a CGA.…”

When Contact Is Not Enough: Affecting First Year Medical Students’ Image towards Older Persons

“…If the quality of contact is high i.e. in-depth, then this may lead to improved attitudes, as shown by a trial among students visiting geriatric patients at home[36]. Furthermore, more long-term and frequent high quality contact seems to reduce prejudice[35].…”