An exploration of medical student attitudes towards older persons and frailty during undergraduate training
Tóm tắt
To investigate medical student attitudes towards older persons and frailty over an
entire medical student cohort. Global student attitudes towards older persons are positive, but decline with
regard to functionality. Negative, often stereotypical perceptions of frailty persist
despite high regard for older persons. Medical student attitudes towards older persons and frailty are generally
positive, but appear most negative with the introduction of clinical placement, which
may provide opportunity for targeted educational intervention. Older persons and patients with frailty constitute an ever increasing proportion of hospital patients. Improving student attitudes towards both groups is important in preparing future doctors for this demographic shift. We aimed to investigate medical student attitudes towards older persons and frailty over an entire medical school cohort. All current Brighton and Sussex Medical School students were invited to complete an online questionnaire consisting: (i) the Australian Ageing Semantic Differential (AASD), (ii) the Medical Condition Regard Scale (MCRS) with regards to frailty, (iii) a qualitative question asking participants to record three words regarding both a person over 70 years and frailty. 187 students participated (66% female, 25.2% response rate). Participants reported positive attitudes with mean scores of 73.45/114 on the AASD and 52.4/66 on the MCRS. The most positive attitudes towards both older persons and frailty were held by year 1 students, and most negative by year 3 and year 4 students for older persons and frailty, respectively. Examining AASD subgroups, students held negative attitudes towards the instrumentality (function) of older persons (mean score: 17.6/36) with significant variation across year groups (p < 0.05), with the most negative attitudes expressed in year 3. Word clouds of qualitative responses showed that medical students consider the two concepts differently with frailty attracting more negative associations. Generally medical student attitudes were positive towards older persons and frailty. However, these declined when focusing on the functionality, with word cloud analysis of attitudes revealing a dichotomy between the quantitative and qualitative data surrounding frailty.
Tài liệu tham khảo
National Statistics (2018) Hospital admitted patient care activity, 2017–18—NHS Digital [Internet]. NHS Digital. 2018 [cited 2 November 2019]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity/2017-18#resources
Oakley R, Pattinson J, Goldberg S et al (2014) Equipping tomorrow’s doctors for the patients of today. Age Ageing 43(4):442–447
British Geriatric Society (2019) Fit for frailty—consensus best practice guidance for the care of older people living in community and outpatient settings [Internet]. 2017 [cited 15 November 2019]. Available from: https://www.bgs.org.uk/sites/default/files/content/resources/files/2018-05-23/fff_full.pdf
Bergman H, Ferrucci L, Guralnik J et al (2007) Frailty: an emerging research and clinical paradigm–issues and controversies. J Gerontol A Biol Sci Med Sci 62(7):731–737
Junius-Walker U, Onder G, Soleymani D et al (2018) The essence of frailty: a systematic review and qualitative synthesis on frailty concepts and definitions. Eur J Intern Med 56:3–10
Tullo E, Khoo T, Teodorczuk A (2015) Preparing to meet the needs of an ageing population—a challenge to medical educators globally. Med Teach 37(2):105–107
General Medical Council (GMC) (2020) Outcomes for graduates [Internet]. 2018 [cited 10 February 2020]. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates
De Biasio J, Parkas V, Soriano R (2016) Longitudinal assessment of medical student attitudes toward older people. Med Teach 38(8):823–828
Wilson M, Tran Y, Wilson I, Kurrle S (2019) Development of the Australian ageing semantic differential, a new instrument for measuring Australian medical student attitudes towards older people. Aust J Ageing. https://doi.org/10.1111/ajag.12627
Fisher J, Tullo E, Stewart J (2018) Pejorative phrases or innocent idioms? Exploring terms used by tomorrow’s doctors in relation to older people. Educ Gerontol 44(9):551–561
Nimmons D, Pattison T, O’Neill P (2017) Medical student attitudes and concepts of frailty and delirium. Eur Geri Med 9(1):45–50
Christison G, Haviland M, Riggs M (2002) The medical condition regard scale: measuring reactions to diagnoses. Acad Med 77(3):257–262
Word Cloud Art Creator [Internet] (2020) Wordart.com. 2020 [cited 13 January 2020]. Available from: https://wordart.com/
Ahearn L (2014) Detecting research patterns and paratextual features in AE word clouds, keywords, and titles. Am Ethnol 41(1):17–30
Bletzer K (2015) Visualizing the qualitative: making sense of written comments from an evaluative satisfaction survey. J Educ Eval Health Prof. https://doi.org/10.3352/jeehp.2015.12.12
Liu Y, While A, Norman I, Ye W (2012) Health professionals’ attitudes toward older people and older patients: a systematic review. J Interprof Care 26(5):397–409
Wilson M, Kurrle S, Wilson I (2018) Medical student attitudes towards older people: a critical review of quantitative measures. BMC Res Notes. https://doi.org/10.1186/s13104-018-3186-z
Rosencranz H, McNevin T (1969) A factor analysis of attitudes toward the aged. Gerontologist 9(1):55–59
Samra R, Cox T, Gordon A, Conroy S, Lucassen M, Griffiths A (2017) Factors related to medical students’ and doctors’ attitudes towards older patients: a systematic review. Age Ageing 46(6):911–919
Clegg A, Young J, Iliffe S, Rikkert M, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762
Manthorpe J, Iliffe S (2015) Frailty—from bedside to buzzword? J Integr Care 23(3):120–128
Meiboom A. The future is almost there: attitudes of medical students towards medicine for older people and their motives for future career choice [PhD]. Vrije Universiteit Amsterdam; 2018.
Archibald M, Lawless M, Gill T, Chehade M (2020) Orthopaedic surgeons’ perceptions of frailty and frailty screening. BMC Geriatr. https://doi.org/10.1186/s12877-019-1404-8
Ambagtsheer R, Archibald M, Lawless M, Mills D, Yu S, Bielby J (2019) General practitioners’ perceptions, attitudes and experiences of frailty and frailty screening. Aust J Gen Pract 48(7):426–433
Arakawa Martins B, Jadczak A, Dollard J, Barrie H, Mahajan N, Tam K et al (2020) Fifth-year medical students’ perceptions of the importance of frailty and competence in assessing, diagnosing and managing frailty before and after a geriatric medicine course. Aust J Ageing 39(3):472–477
Hughes N, Soiza R, Chua M et al (2008) Medical student attitudes toward older people and willingness to consider a career in geriatric medicine. J Am Geriatr Soc 56(2):334–338
Robbins T, Crocker-Buque T, Forrester-Paton C, Cantlay A, Gladman J, Gordon A (2011) Geriatrics is rewarding but lacks earning potential and prestige: responses from the national medical student survey of attitudes to and perceptions of geriatric medicine. Age Ageing 40(3):405–408
Samra R, Griffiths A, Cox T, Conroy S, Knight A (2013) Changes in medical student and doctor attitudes toward older adults after an intervention: a systematic review. J Am Geriatr Soc 61(7):1188–1196
Ridgway V, Mason-Whitehead E, McIntosh-Scott A (2018) Visual perceptions of ageing: a longitudinal mixed methods study of UK undergraduate student nurses’ attitudes and perceptions towards older people. Nurse Educ Pract 33:63–69
Hovey S, Dyck M, Reese C, Kim M (2017) Nursing students’ attitudes toward persons who are aged: an integrative review. Nurse Educ Today 49:145–152
King B, Roberts T, Bowers B (2013) nursing student attitudes toward and preferences for working with older adults. Gerontol Geriatr Educ 34(3):272–291
Ridgway V (2019) Social work students’ perceptions of ageing. Practice. 31(2):117–134
Booth L, Kada S, Satinovic M, Phillips P, Miller P (2017) Student radiographers’ attitudes towards the older patient: a longitudinal study. Radiography 23:229–234