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 conditions, polypharmacy, and altered physiology. Therefore, geriatruc 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 (SPs) 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 WSs 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. Participating students are also provided with an 11-page GM reference. All students in every rotation group are assigned GM readings. At the end of the last week, all students take a 100-item written examination (seven GM questions) and a nine-station SP examination (one GM station), including a post-SP encounter open-ended written exercise. Written examination GM item scores, GM SP checklist scores, and GM open-ended written scores of workshop participants and nonparticipants were compared by means, standard deviations, and multiple regression approaches solving for performance on a preventive medicine station and USMLE step 1 scores.
Results The GM WS was delivered to 12 of the 24 rotation groups during the 2004-2006 academic years. Ninety-one students participated in the workshop and 95 did not. WS participants performed significantly better than nonparticipants on the GM SP checklist (14.9 ± 13.6 vs 9.8 ± 11.0, F = 10.0, p = .002) and postencounter written exercise (3.5 ± 1.8 vs 3.0 ± 1.6, F = 4.8, p = .030), and there was no difference in scores on the seven written examination GM items (5.3 ± 0.8 vs 5.2 ± .9, F = 1.3, p = .248).
Conclusions Students participating in a 4-hour SP workshop display superior GM clinical skills as assessed by a SP clinical examination 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 that might be better taught using an interactive pedagogy.
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