The Hidden Curriculum of the Medical Care for Elderly Patients in Medical Education: A Qualitative Study

Abstract

Despite more attention being given to geriatrics in medical curricula, few new physicians are seeking training in this field. So far, there has been no exploration of factors in the hidden curriculum that could potentially influence the persisting lack of interest in this field of medicine. To study this hidden curriculum in medical education in relation to medical care of elderly patients, the authors used a qualitative research design including participant observations on two internal medicine wards in a teaching hospital and semistructured interviews. The results showed that elderly patients with multiple problems are seen as frustrating and not interesting. Medical students were not stimulated to go into the totality of medical problems of elderly patients. They picked up a lot of disparaging remarks about these patients. The mainly negative attitudes demonstrated by role models, in particular the residents, may potentially influence the development of future doctors and their choice of career.

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

“…The data show that less than 20 % of students were satisfied with the prospect of an aged care placement, and one in three expected to enjoy working with older adults. These findings are consistent with critiques of medical education that report a lack of interface between aged and acute care [ 10 ] and negative attitudes among medical students towards the care of older people and geriatric specialisations [ 18 , 31 , 44 , 45 ]. Such evidence suggests that negative sentiment is widespread among medical undergraduates and not unique to the cohort of students involved in this study.…”

“…Although negative student attitudes are well documented [ 18 , 31 , 44 , 45 ], few researchers have offered evidence to explain why such attitudes persist among medical undergraduates. Survey data from the current study concerning negative pre-placement sentiments were supported by focus-group results.…”

“…The response to this situation among students who lack such skills may be, as reported in the results, to conclude that either assessment is futile in the face of seemingly irresolvable communication challenges or to infer that the resident is clinically stable thereby apparently contradicting the appropriateness of conducting an assessment. Researchers have previously reported that medical students are not adequately prepared by their curricula for communication challenges encountered with cognitively impaired patients [ 17 – 47 ] and that they hold perceptions of older people’s health problems as frustrating and of little clinical interest [ 18 , 19 ]. Despite these sentiments, there is evidence to suggest that residents of aged care facilities do not always receive optimal health care [ 48 – 50 ] and can benefit from additional assessment and more targeted management, even when this is provided by students [ 33 ].…”

“…Compounding curricular shortcomings are the mixed attitudes held by medical students towards care of older people [ 18 – 22 ], including what Higashi et al [ 19 ] describe as persistent and implicitly negative attitudes. Persistent negative student attitudes towards aged care and older adults may be due to an educational culture that reinforces negative stereotypes about older adults [ 18 ], communication challenges that limit reciprocal and effective patient-centred relations [ 23 ], social distance between learners and RACF residents that reduces empathy [ 24 ], low levels of health literacy and compliance [ 24 ], or stark differences from the hospital training environment [ 25 ].…”

Preferences of nursing and medical students for working with older adults and people with dementia: a systematic review

“…One explanation is that education has a role in shaping perceptions of the field as low status with an emphasis on technical specialities; this socialisation process is seen as a deterrent for aged care [11,80]. This has been referred to as a 'hidden curriculum' [81]. Key impactful areas during education are clinical placements and educational interventions.…”