Encountering aged care: a mixed methods investigation of medical students’ clinical placement experiences

Abstract

BackgroundResidential aged care is an increasingly important health setting due to population ageing and the increase in age-related conditions, such as dementia. However, medical education has limited engagement with this fast-growing sector and undergraduate training remains primarily focussed on acute presentations in hospital settings. Additionally, concerns have been raised about the adequacy of dementia-related content in undergraduate medical curricula, while research has found mixed attitudes among students towards the care of older people. This study explores how medical students engage with the learning experiences accessible in clinical placements in residential aged care facilities (RACFs), particularly exposure to multiple comorbidity, cognitive impairment, and palliative care.MethodsFifth-year medical students (N = 61) completed five-day clinical placements at two Australian aged care facilities in 2013 and 2014. The placements were supported by an iterative yet structured program and academic teaching staff to ensure appropriate educational experiences and oversight. Mixed methods data were collected before and after the clinical placement. Quantitative data included surveys of dementia knowledge and questions about attitudes to the aged care sector and working with older adults. Qualitative data were collected from focus group discussions concerning medical student expectations, learning opportunities, and challenges to engagement.ResultsPre-placement surveys identified good dementia knowledge, but poor attitudes towards aged care and older adults. Negative placement experiences were associated with a struggle to discern case complexity and a perception of an aged care placement as an opportunity cost associated with reduced hospital training time. Irrespective of negative sentiment, post-placement survey data showed significant improvements in attitudes to working with older people and dementia knowledge. Positive student experiences were explained by in-depth engagement with clinically challenging cases and opportunities to practice independent clinical decision making and contribute to resident care.ConclusionsAged care placements can improve medical student attitudes to working with older people and dementia knowledge. Clinical placements in RACFs challenge students to become more resourceful and independent in their clinical assessment and decision-making with vulnerable older adults. This suggests that aged care facilities offer considerable opportunity to enhance undergraduate medical education. However, more work is required to engender cultural change across medical curricula to embed issues around ageing, multiple comorbidity, and dementia.

Key stakeholders’ views on the quality of care and services available to frail seniors in Canada

“…HCP training might be challenging as residents and newly graduated family physicians report little interest in caring for seniors afflicted with complex or chronic diseases, especially in home care settings [28]. New training models, such as clinical placements in long-term care settings [29], and interprofessional faculty development programs in geriatrics [30, 31] show promise to improve the autonomy of HCP in their clinical assessment and decision-making with vulnerable older adults.…”

Evaluation of the geriatric curriculum implemented at Shiraz University of Medical Sciences, Iran, since 2017: A qualitative study

“…One of the issues that the medical profession has to face is prioritizing elderly care, as the number of older people suffering chronic illness and multiple comorbidities is on the rise 1 . For example, in Ireland research shows that individuals aged 65 years and over make up 11.6% of the population in 2011, which is believed to reach 22% by 2041 2 , while in Australia, it is predicted that the number of individuals aged 65 years and over will increase from 13% in 2007 to 23% in 2061 1 . Aging population is on increase both in developed and developing countries 3 .…”

“…Following the rise in life expectancy and medical advances, multi-morbidity and poly-pharmacy has increased recently; this trend has been very significant in the elderly 6 . Hence, the medical profession needs to handle these patients effectively 1,7,8 . However, research conducted in the UK shows that medical undergraduate students have not been trained for treatment of these patients sufficiently, and it was also reported that less than two weeks of a five-year educational program had been dedicated to elderly health care 1,9 .…”

“…Hence, the medical profession needs to handle these patients effectively 1,7,8 . However, research conducted in the UK shows that medical undergraduate students have not been trained for treatment of these patients sufficiently, and it was also reported that less than two weeks of a five-year educational program had been dedicated to elderly health care 1,9 . In Australia, medical students spend 78% of their clinical placement time in hospitals; however, only 0.5% this time is dedicated to residential aged care facilities 1 .…”

“…However, research conducted in the UK shows that medical undergraduate students have not been trained for treatment of these patients sufficiently, and it was also reported that less than two weeks of a five-year educational program had been dedicated to elderly health care 1,9 . In Australia, medical students spend 78% of their clinical placement time in hospitals; however, only 0.5% this time is dedicated to residential aged care facilities 1 . The number of geriatric fellowship-trained physicians (geriatricians), who provide appropriate care for older adults, is not expected to meet the needs of a growing aging population.…”