Article Text

  1. S. A. Haist,
  2. D. W. Rudy,
  3. A. R. Hoellein,
  4. M. J. Lineberry,
  5. J. F. Wilson
  1. University of Kentucky, Lexington, KY


Background Geriatric patients account for about 40% of internists' office visits and there is an expected 115% increase for geriatric services by 2030. Older patients tend to have multiple condidtions, polypharmacy, and altered physiology. Therefore, geriatric medicine (GM) should be emphasized in the medical student curriculum. The purpose of this study is to determine the impact of a GM workshop (WS) using standardized patients (SP) on knowledge and clinical skills of third-year medical students.

Methods A 4-hour GM WS was developed as part of a new curriculum for a required third-year 4-week primary care internal medicine clerkship. The GM WS and three other novel WS were randomized for delivery to half of the rotational groups. The GM WS incorporates four SP cases representing different clinical challenges (dementia, depression, incontinence, and syncope). A faculty preceptor facilitates group discussion of sensitive approaches to the problems. Participating students are also provided with a 11-page GM reference. All students in every rotation group are assigned GM readings. At the end of the 4 weeks, all students take a 100-item written exam (seven GM questions) and nine-station SP exam (one GM station) including a post-SP encounter open-ended written exercise. Scores on the written exam GM items, GM SP checklist, and GM open-ended written exercise of workshop participants and nonparticipants were analyzed with simple means, standard deviations, and multiple regression approaches controlling for USMLE Step 1 scores and preventive care SP station checklist scores.

Results The GM WS was delivered to 6 of the 12 rotation groups during the 2004-2005 academic year. Forty-eight students participated in the workshop and 49 did not. Workshop participants performed significantly better than nonparticipants on the GM SP checklist (86.5 6 8.7% vs 79.7 6 10.0%, F = 13, p = .001) and showed positive trends for the post-encounter written exercise (78.9 6 6.9% vs 75.5 6 12.9%, F = 2.6, p = .112) and the seven written exam GM items (5.31 6 0.74 vs 4.98 6 0.98, F = 3.54, p = .063).

Conclusions Students participating in a 4-hour SP workshop display superior GM clinical skills as assessed by a SP clinical exam and there is a trend toward knowledge gain on a written examination. These findings lend additonal support to the theory that there are unique aspects to caring for older patients, which might be better taught using an interactive pedagogy.

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