Preparing medical graduates to care for older adults.
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Date
2020
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Abstract
Background: Social accountability in medical training requires medical schools in South Africa to respond
to the health needs of the country’s rapidly increasing number of older adults. Reports, however, indicate
that elderly patients in South Africa receive poor quality of care from health professionals. Reports also
indicate that students’ empathy towards older adults declines as they progress through their studies. These
disparities necessitate greater awareness of the health needs and expectations of older adults and an inquiry
into the geriatric care training of medical professionals.
Aim: This 360-degree study investigated the geriatric medical curriculum at one institution from the
perspectives of geriatric patients, learners and health professions educators to make recommendations for
improvement, and to develop policy guidelines for the enhancement of undergraduate medical education in
geriatric care.
Methodology: A sequential mixed methods approach was adopted for this study. Four focus group
discussions were conducted with patients aged 60 years and older from primary care facilities served by
graduates of the medical institution (n=28). Data that emerged from this phase regarding patients’
expectations of quality geriatric healthcare were triangulated with a review of curriculum documents, semistructured
interviews with health professions educators (n=5) and an evaluation of the levels of knowledge
and attitudes of final year medical students regarding the care of older adults.
Results: The key principles for quality healthcare of older adults that were elicited from patients were
respectful communication, compassion, appropriate prescribing, patient-centredness and coordinated care.
However, professional attributes such as compassion and patient-centered care that were valued by geriatric
patients are not explicitly taught or assessed in the curriculum. The current curriculum includes a wide
variety of topics relevant to the care of older adults. Teaching and assessment relevant to geriatric care were
further integrated into other modules, but no minimum standards are applied in assessment of the geriatric
component. Students lacked exposure to older adults in ambulatory settings and received little teaching on
health promotion or rehabilitative services relevant to the care of older adults. Despite the opportunities
afforded by the problem-based learning approach in the curriculum for team-based learning and
collaboration, interprofessional education was absent in teaching and learning relevant to older adults.
Overall, final year medical students possessed minimal levels of geriatric knowledge despite their
perceptions of having had adequate exposure to geriatrics in the current curriculum. The majority of
students had positive attitudes towards working with elderly patients. In particular, older students and those
with a prior higher education qualification had significantly higher levels of knowledge and attitudes towards caring for older adults. Of note, there was no association between geriatric knowledge and attitudes.
Medical students also reported challenges in communicating with older adults and believed that their
training had not prepared them adequately for this aspect.
Conclusion: The findings of the study affirmed the need to enhance the geriatric curriculum for
undergraduate medical students, and to develop and implement minimum core competencies in geriatric
care. Curriculum planners should consider greater attention to patient-centred care, communication skills
training with older adults and interprofessional education, as well as broader community engagement.
Policy guidelines based on the findings of this study were developed and recommended to the
Undergraduate Committee for Teaching and Learning to improve the preparedness of medical graduates to
care for older adults.
Description
Doctoral Degree. University of KwaZulu-Natal, Durban.