Transforming undergraduate education in geriatric medicine: an innovative curriculum at Bristol Medical School

Abstract

The World Health Organization (WHO) advocates investment in high-quality undergraduate education in geriatric medicine as a means of meeting the future needs of the aging population. However, there is a lack of evidence for the optimal delivery of training in this area. Rigorous pedagogical research is required to determine the most effective way to equip tomorrow’s doctors with the skills and knowledge to care for older adults with complex health and social care needs. The transition between two undergraduate medical curricula meant that Bristol Medical School (BMS) was uniquely positioned to innovate and evaluate undergraduate education in geriatric medicine. This transition marked BMS’ departure from a ‘traditional’ curriculum to case-based learning. The outgoing curriculum included a 4-week unit in geriatrics, whilst the new programme includes an 18-week clerkship titled ‘Complex Medicine in Older People’ (CMOP). CMOP is a clinical clerkship with 18 cases at its core, covering the fundamental aspects of geriatric medicine. The core cases and clinical learning are enhanced with five expert lectures, six tutorials and three journal clubs. Reflective practice is modelled and promoted with Balint groups and a book club. Consolidative workplace-based assessments and clinical portfolio mirror those used in postgraduate training, preparing students for professional practice. CMOP is iteratively improved in real-time using staff and student feedback. This marked shift in mode and duration of teaching affords the opportunity to evaluate the impact of differing education in geriatrics, providing an evidence-based model for teaching on aging.

Literacy for Frailty among Undergraduate Medical Education: An Under-Recognized Opportunity to Improve Geriatric Care

“…Although several major geriatric societies support the inclusion of frailty in medical education, arguments have been raised regarding how best to implement programs aiming to enhance frailty awareness in undergraduate medication [ 25 ]. Misidentification and terminology confusion, uncertainty surrounding the care of frail older adults, and clinical decisions altered by the recognition of frailty, have all been implicated as potential factors responsible for the observed difficulty in formulating a formal targeted curriculum [ 22 ].…”

Exploring the Challenges of Frailty in Medical Education

“…Furthermore, seeing people with frailty over time enables medical students to view frailty as a spectrum that is dynamic in nature, which can help to reframe unhelpful 'snap shot' perceptions of older people with frailty (21). Longitudinal clerkships have been trailed with success across geriatric medicine and dementia (3,22), and are recommended by the British Geriatrics Society (5). The community has been found to be a particularly rich environment for learning about and with patients with frailty (20).…”

“…For example, following a patient from primary care to secondary care, seeing a patient in their own environment, visits to nursing homes (3,19).…”

“…eople living with frailty account for 20% of hospital inpatients in the UK (1). Medical students will encounter patients with frailty, across a breadth of clinical conditions and specialities (2,3). There is a plethora of literature that highlights the need to develop undergraduate curricula to bridge a mismatch between the proportion of undergraduate medical education (UGME) currently provided and the demographic trends of the population (3,4).…”

“…Medical students will encounter patients with frailty, across a breadth of clinical conditions and specialities (2,3). There is a plethora of literature that highlights the need to develop undergraduate curricula to bridge a mismatch between the proportion of undergraduate medical education (UGME) currently provided and the demographic trends of the population (3,4). National geriatric societies across the globe include frailty as a learning outcome in their recommended undergraduate curricula, in 2023 the British Geriatrics Society has updated theirs to embrace frailty across multiple learning domains (5).…”