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Geriatric assessment in undergraduate geriatric education – a structured interpretation guide improves the quantity and accuracy of the results: a cohort comparison
Elisabeth Igenbergs
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Tobias Deutsch
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Thomas Frese
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Hagen Sandholzer
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Department of Primary Care, Leipzig Medical School
,
Philipp-Rosenthal-Strae 55, Leipzig 04103
,
Germany
Background: With regard to the growing proportion of elderly multimorbid patients, a sound undergraduate geriatric education becomes more important. Therefore we included the execution and interpretation of a comprehensive geriatric assessment (CGA) into a mandatory two-week clerkship at a general practitioner's office. The present study examined the effect of a guide structuring the students' considerations when interpreting a CGA on the quantity and accuracy of the documented findings and conclusions. Methods: We compared random samples out of two cohorts of fourth-year medical students (interpreting the CGA with and without using the structured interpretation guide) completing their clerkship between April 2006 and March 2008 with regard to the content of the CGA interpretation and the grades the students achieved for their clerkship documentation, which were substantially determined by the quantity and accuracy of the documentation and interpretation of the CGA. Results: The structured interpretation guide led to significantly more mentions of aspects that have to be considered in geriatric patient care and to a higher documentation rate of respective positive results. Furthermore, students who analysed the CGA by using the interpretation guide achieved significantly better grades. Conclusions: An additional tool structuring medical students' considerations when interpreting a CGA increases the quantity and the accuracy of the documented findings and conclusions. This may enhance the students' learning gain.
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Background
During the past two decades, the life expectancy of
elderly people has increased in all European countries [1].
Several studies suggest an expansion of the time people
will live with multiple diseases and disability at the end
of their life [2,3]. Conclusively, the treatment of elderly
multimorbid patients will make up a larger part of the
clinical work of nearly every medical specialty [4,5].
Furthermore, a greater number of trained geriatricians will
be needed [5]. Already today there is a shortage of young
physicians who decide to take up a career in that area
[5,6]. Thus, it is important to motivate undergraduate
medical students to explore the field of geriatrics [6]. A
well-thought-out implementation of the field into the
undergraduate curriculum seems essential [4-7]. Tullo et al.
demonstrated in a current literature review (2010) that a
wide range of undergraduate educational interventions in
geriatrics potentially improve the respective knowledge,
skills and attitudes [7].
We established a mandatory office-based two-week
general practice clerkship for all fourth-year medical
students. An (in-home) comprehensive geriatric assessment
(CGA) was implemented as one core component of the
clerkship. Because CGAs are designed to cover a broad
spectrum of elderly patients concerns in different areas
of life, they seem particularly suitable for sensitizing
medical students to the complexity of the field. Furthermore,
it has been shown that CGAs are valuable and successful
tools for the comprehensive diagnostic and therapy of
elderly patients [8-11].
Initial experience revealed substantial difficulties of the
students to handle the amount and complexity of the
results of the CGA. Thus, we developed a guide serving as a
structuring aid for non-geriatricians when documenting
and interpreting the results of the CGA.
The present study was set out to examine whether this
structured interpretation guide increases the quantity
and accuracy of the documented findings and
conclusions that students draw from a CGA.
Methods
Sampling and design
We analysed the data of fourth-year (of a six-year
curriculum) medical students who completed their mandatory
two-week general practice clerkship between April 2006
and March 2008 in offices of general practitioners
collaborating with the Department of Primary Care of the Leipzig
Medical School (general practitioner teachers for
undergraduates [12]). The clerkship with one-to-one tutoring
included a home visit to an elderly patient to execute and
interpret a CGA. In 2007, a specially developed structured
interpretation guide (checklist) was implemented as an
aid for documenting and interpreting the results of the
CGA. In the present study, random samples of students
of respectively two years before and after the
implementation of the interpretation guide were compared. These
cohorts are in the following referred to as
non-checklist-group (Non-CL-group) and checklist-group
(CLgroup). Both groups were asked for a documentation
and interpretation of the findings from the CGA. While
the Non-CL-group used a few very general open questions
with free-text answers the CL-group was instructed to use
the checklist.
Random sampling was conducted on the basis of the
alphabetical order (...truncated)