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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 16  |  Issue : 3  |  Page : 107-110

Do medical interns have adequate training in geriatric medicine? A study on the knowledge and attitudes of interns toward older patients at a medical college in Kerala, South India


1 Department of Geriatric Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
2 Department of Anatomy and Department of Medical Education and Technology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India

Date of Submission20-Jun-2020
Date of Decision07-Aug-2020
Date of Acceptance30-Aug-2020
Date of Web Publication23-Feb-2021

Correspondence Address:
Dr. Steve Paul Manjaly
Department of Geriatric Medicine, Jubilee Mission Medical College and Research Institute, Thrissur - 680 005, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiag.jiag_4_20

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  Abstract 


Introduction: With the exponential increase in India's elderly population, the medical students of today need to be well prepared for the demographic changes of tomorrow. Training and attitude of future physicians in elderly care should develop concurrently with the rise in qualifying medical graduates. Objectives: The aim of this study is to determine the knowledge and attitudes of medical students entering internships, toward older people at a teaching hospital in Thrissur, Kerala. Methodology: Medical students of a medical college in Kerala, who were to enter the residency program were enrolled in the study. Sixty-nine students, who voluntarily participated, were asked to complete two questionnaires, the Revised Facts on Aging Quiz, a 25-item multiple-choice test on aging, and the University of California at Los Angeles (UCLA) Geriatric Attitudes Scale, a 14-item questionnaire consisting of a mixture of positively and negatively worded questions answered on a five-point Likert scale. The data obtained were assessed using SPSS version 21. Results: The results indicate that although the medical students entering residency showed a moderately positive attitude (UCLA score 49.67 ± 5.02) toward older people, almost one-third (n = 20, 29%) of these 69 students had poor knowledge (25%–50% score), and the rest (n = 49, 71%) had minimal knowledge (51%–75% scores) on aging. Conclusion: These findings suggest that training in geriatrics is inadequate for MBBS students. More geriatric based content needs to be incorporated into the undergraduate curriculum to address the changing population demographics.

Keywords: Knowledge, attitudes, medical interns, Geriatric Medicine, Medical College, Kerala, India


How to cite this article:
Manjaly SP, Francis A, Kotturan AD. Do medical interns have adequate training in geriatric medicine? A study on the knowledge and attitudes of interns toward older patients at a medical college in Kerala, South India. J Indian Acad Geriatr 2020;16:107-10

How to cite this URL:
Manjaly SP, Francis A, Kotturan AD. Do medical interns have adequate training in geriatric medicine? A study on the knowledge and attitudes of interns toward older patients at a medical college in Kerala, South India. J Indian Acad Geriatr [serial online] 2020 [cited 2022 Sep 29];16:107-10. Available from: http://www.jiag.com/text.asp?2020/16/3/107/309988




  Introduction Top


The global population of older adults is projected to increase exponentially in the coming decades, especially in developing nations.[1] Older adults constitute about 8.2% of the Indian population, with Kerala having the highest proportion (13.1%) statewise.[2] The Indian medical graduate has limited exposure to older patients, and may not be familiar with the geriatric care aspects.[3] Lack of adequate clinical exposure to older patients could render our young doctors incompetent in managing our elderly. Therefore, it is imperative to gear up our health-care professionals according to this subgroup's needs.

Studies evaluating the impact of geriatric education in improving knowledge and attitude has been inconsistent.[3] Studies have shown that young physicians harbor a preconceived negative attitude toward elder care.[4] These stem from the belief that many illnesses are chronic and untreatable with an inevitable natural decline. Unfortunately, these attitudes may affect their eventual management of patients and therefore need to be addressed to generate more “elderly-friendly” physicians. Educational strategies may improve student attitudes toward geriatric patients,[3],[5],[6] which may encourage young doctors to develop an interest in Geriatric Medicine.[7],[8]

This study's objective was to determine the knowledge and attitudes of medical students entering internship, toward older people at a teaching hospital in Thrissur in Kerala, South India.


  Methodology Top


Participants

The study was undertaken among medical interns at a medical college in Kerala, South India, in March 2019.

Among the 82 interns who were to begin their internship program, 69 volunteered to participate in the study. The interns whose ages ranged between 18 and 20 years were asked to complete the self-administered questionnaires anonymously.

Measures

Knowledge of aging was assessed using the Revised Facts on Aging Quiz (r-FAQ), a 50-item test on aging. This is a short, easily administered and reliable tool, consisting of factual statements in a true or false format. It is designed to cover the basic physical, mental, and social facts and the most frequent misconceptions about aging. It is used to compare levels of information in different groups, particularly in medical education, and is validated across cross-cultural settings.[9],[10],[11],[12]

Knowledge of aging was assessed by the sum of correct responses, with higher scores indicating more excellent knowledge. Based on the correct responses, the participants were arbitrarily categorized into poor knowledge (<25%) minimal knowledge (25%–50%), limited knowledge (51%–75%), and adequate knowledge (>75%).

Attitudes toward geriatrics were measured using the University of California at Los Angeles (UCLA) Geriatric Attitudes Scale, a 14-item questionnaire consisting of a mixture of positively and negatively worded questions answered on a 5-point Likert scale (1 = strongly disagree, 2 = somewhat agree, 3 = neutral, 4 = somewhat agree, 5 = strongly agree). This scale was designed to assess general impressions about older people, the perceived value of older people, the distributive justice of societal resources toward older people, attitudes toward caring for older patients, perceived potential benefits of treating older patients, and personal economic concerns about caring for older patients. The scores were adjusted to ensure unidirectionality, such that a higher score reflects more positive geriatric attitudes.

This has been validated for measuring attitudes toward older patients among primary care residents in the US[13] and for use among medical students.[14] However, minor modifications were required to adapt the questionnaire to the local context in two questions which were “federal government” to “government,” “Medicare” to “care of the elderly” and the addition of “I believe” to question 8 as students did not have any prior clinical experience.

Procedures

The interns were requested to participate in the study voluntarily. Sixty-nine interns, who were present at the time of data collection, participated in the study after informed consent. Data were gathered during the newly joining interns' orientation program after obtaining approval from the Institutional Ethical and Review Board.

Analysis

The data obtained were assessed using SPSS version 21 (Statistical Package for the Social Sciences, International Business Machines, Corporation, New York, USA). Knowledge of aging was expressed as mean ± standard deviation and attitude toward geriatrics was expressed in frequency and percentage.


  Results Top


A total of 69 anonymously completed questionnaires were received.

None of the interns had adequate knowledge of aging. The majority (n = 49, 71%) were categorized as having limited knowledge, and the rest (n = 20, 29%) had minimal knowledge. There were not any categorized as with poor knowledge. The mean score on the r-FAQ was 27.3 (±2.95) (range 19–35) [Figure 1].
Figure 1: Histogram showing knowledge scoring among the interns

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The attitude scale scores were combined to broadly classify the responses into agreeing, disagree, and neutral [Table 1]. The bulk (n = 55 of 69, 79.7%) preferred to see younger patients to older ones, and (n = 52, 75.4%) felt that treating chronically ill older patients were hopeless (Q.3 and Q.11). However, nearly half of the interns felt that older people were pleasant to be with (Q.1) and a majority (n = 40, 58%) concurred that older patients were more appreciative of the doctor's effort (Q.7). Although most of the group were unsure, most did not think that (n = 33, 47.8) taking a medical history from an older patient was an ordeal.
Table 1: Responses scored by the interns on the University of California at Los Angeles Geriatric Attitude Scale

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In general, with a mean UCLA attitude score of 3.55 (±0.35), the interns had moderately positive attitudes toward older adults [Figure 2].
Figure 2: Histogram showing mean University of California at Los Angeles Geriatric attitude scores among the interns

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  Discussion Top


This survey of interns of a medical school in Kerala, South India, offers preliminary insights into a future cohort of physicians with regard to their knowledge and attitudes toward older adults. The interns' knowledge of aging matters was relatively poor compared to studies conducted among the 1st-year medical students.[8],[15],[16],[17]

In the present study, the attitudes of the interns were found to be moderately positive. This was in tune with western studies, where the medicos had a positive attitude toward aging.[7],[8],[18]

Though these interns' attitudes did not markedly differ, their knowledge levels were far poor compared to studies in other parts of the world. This comes as no surprise, as in most countries, Geriatric Medicine is integrated into the medical curriculum. Exposure to Geriatrics and Gerontology is an absolute necessity in preparing physicians to cater to an aging population.[5]

Although previous studies[8],[16],[18],[19] have not been able to draw a connection between attitude toward the elderly and knowledge of aging, it is reasonable to assume that adequate knowledge about aging can improve the attitudes among resident doctors towards older adults[4] and may help mitigate ageism.

Moreover, positive attitudes of young physicians toward older adults may directly influence their interest in Geriatric Medicine.[8] This is critical if we have to train our young doctors to address a burgeoning elderly population.

With over 75,000 students graduating annually, we need to re-structure our training program with more emphasis on the practical aspects of elderly care.[13] The existing practical teaching emphasizes a system-based and diagnostic evaluation rather than a holistic assessment of the patient. Older patients are perceived as ill and excluded from objective case discussions.[15]

Regretfully, the revised Competency-based medical education [20]does not recognize Geriatric Medicine as a core subject and offers only an “elective posting” that is unjust to medical students and the profession as a whole. The results of our study could serve as an effective catalyst for curriculum change.

Including modules that incorporate experiential learning, positive role modeling, and prolonged exposure to elderly patients through clinical rotations in geriatric medicine can[6] bring about the desired change in our physicians.

These results support previous studies in that medical students have limited knowledge about aging and have relatively positive attitudes towards elderly patients. To the best of our knowledge, this is the only study conducted among medical interns at any university in South India.

Our study has its' limitations. The students were asked to fill in the questionnaires, anonymously, and hence basic demographic data (age, gender) could not be obtained. Although the survey instruments are well-validated, its efficacy has been questioned regarding whether they reflect clinical practice behavior.[21]

The questionnaire itself limits a questionnaire-based study because many aspects are not evaluated in a cross-sectional study. The anonymity of the data precluded any correlation between sociodemographics, prior experience in caring for older persons, or knowledge and attitude, results of which may be more interesting. Further, these data were obtained from medical students from a single institution and should not be generalized.

Finally, the results provided a “snapshot view” of the interns' attitudes and knowledge at the start of their internship, which is likely to change toward their internship program. Therefore, they should be interpreted with caution.


  Conclusion Top


Medical institutions all over are responding to the surge in the geriatric population by strengthening geriatric care. To shape our doctors to cater to geriatric patients with their complexities, geriatric education must be implemented early in the undergraduate curriculum. This may help foster positive attitudes among physicians and a greater interest in geriatric medicine.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization Study on Global AGEing and Adult Health (SAGE) (NIH Publication no. 11-7737, October 2011). Available from: http://www.who.int/healthinfo/systems/sage/en/. [Last accessed on 2020 Aug 07].  Back to cited text no. 1
    
2.
Office of the Registrar General & Census Commissioner, India, Ministry of Home Affairs, Government of India. SRS Statistical Report; 2017. Available from: http://censusindia.gov.in/vital_statistics/SRS_Reports_2017.html. [Last accessed on 2020 Aug 07].  Back to cited text no. 2
    
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Tullo ES, Spencer J, Allan L. Systematic review: helping the young to understand the old. Teaching interventions in geriatrics to improve the knowledge, skills, and attitudes of undergraduate medical students. J Am Geriatr Soc 2010;58:1987-93.  Back to cited text no. 3
    
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Deary IJ, Smith R, Mitchell C, MacLennan WJ. Geriatric medicine: Does teaching alter medical students' attitudes to elderly people? Med Educ 1993;27:399-405.  Back to cited text no. 4
    
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Varkey P, Chutka DS, Lesnick TG. The Aging Game: Improving medical students' attitudes toward caring for the elderly. J Am Med Dir Assoc 2006;7:224-9.  Back to cited text no. 5
    
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Koh GC, Merchant RA, Lim WS, Amin Z. The knowledge-attitude dissociation in geriatric education: Can it be overcome? Ann Acad Med Singapore 2012;41:383-9.  Back to cited text no. 6
    
7.
Chua MP, Tan CH, Merchant R, Soiza RL. Attitudes of first-year medical students in Singapore towards older people and willingness to consider a geriatric career medicine. Ann Acad Med Singapore 2008;37:947-51.  Back to cited text no. 7
    
8.
Fitzgerald JT, Wray LA, Halter JB, Williams BC, Supiano MA. Relating medical students' knowledge, attitudes, and experience to an interest in geriatric medicine. Gerontologist 2003;43:849-55.  Back to cited text no. 8
    
9.
Palmore E. Facts on ageing: A short quiz. Gerontologist 1977;17:315-20.  Back to cited text no. 9
    
10.
Matthews AM, Tindale JA, Norris JE. The facts on aging quiz: A Canadian validation and cross-cultural comparison. Canadian J Aging 1984;3:165-74.  Back to cited text no. 10
    
11.
Luszcz MA. Facts on aging: An Australian validation. Gerontologist 1982;22:369-72.  Back to cited text no. 11
    
12.
Pennington R, Pachana NA, Coyle HS. Use of the facts on aging quiz in New Zealand: Validation of questions, performance of a student sample, and effects of a don't know option. Educ Gerontol 2001;27:409-16.  Back to cited text no. 12
    
13.
Reuben DB, Lee M, Davis JW Jr., Eslami MS, Osterweil DG, Melchiore S, et al. Development and validation of a geriatrics attitudes scale for primary care residents. J Am Geriatr Soc 1998;46:1425-30.  Back to cited text no. 13
    
14.
Kishimoto M, Nagoshi M, Williams S, Masaki KH, Blanchette PL. Knowledge and attitudes about geriatrics of medical students, internal medicine residents, and geriatric medicine fellows. J Am Geriatr Soc 2005;53:99-102.  Back to cited text no. 14
    
15.
Subramanyam AA, Palsetia DD, Agarwal SR, Kamath RM. Should undergraduates be introduced to geriatric training? A pilot study on knowledge, attitude, and perception in medical interns and postgraduate residents from a tertiary care hospital. Ann Indian Psychiatry 2018;2:33.  Back to cited text no. 15
    
16.
Wiese CH, Fragemann K, Keil PC, Bundscherer AC, Lindenberg N, Lassen CL, et al. Geriatrics in medical students' curricula: questionnaire-based analysis. BMC Res Notes 2014;7:472.  Back to cited text no. 16
    
17.
Kramer BJ, Damron-Rodriguez J, Lee M, Wong MM. Medical house staff performance on the facts of the aging quiz: A comparison of test formats. Gerontol Geriatr Educ 2001;21:41-51.  Back to cited text no. 17
    
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Lucchetti AL, da S Ezequiel O, Moreira-Almeida A, Lucchetti G. Measuring medical students' attitudes and knowledge about geriatrics and gerontology in Brazilian medical students: A comparison of instruments. Australas J Ageing 2018;37:E74-7.  Back to cited text no. 18
    
19.
Lee M, Reuben DB, Ferrell BA. Multidimensional attitudes of medical residents and geriatrics fellows toward older people. J Am Geriatr Soc 2005;53:489-94.  Back to cited text no. 19
    
20.
Competency-Based Undergraduate Curriculum for The Indian Medical Graduate; 2018. Available from: https://www.mciindia.org/CMS/information-desk/for-colleges/ug?-curriculum. [Last accessed on 2020 Aug 07].  Back to cited text no. 20
    
21.
Stewart TJ, Roberts E, Eleazer P, Boland R, Wieland D. Reliability and validity issues for two common measures of medical students' attitudes toward older adults. Educ Gerontol 2006;32:409-21.  Back to cited text no. 21
    


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