6 Geriatric Medicine in Undergraduate Written Assessments: Is There A Single Best Answer?

Abstract

Abstract Introduction It is increasingly important for new medical graduates to be knowledgeable and skilled in the care of older people. Single best answer questions (SBAQs) form the basis of written assessments in undergraduate courses but key areas of geriatric medicine have been shown to be underrepresented in medical school assessments (A L Gordon et al. Age and Aging 2010, 39:3, 385–388). This may contribute to a Hidden Curriculum that portrays geriatric medicine negatively amongst medical students (A Meiboom et al. Gerontology & Geriatrics Education 2014, 36:1, 30–44). Methods 1133 questions for third year medical students were reviewed. Questions labelled as assessing “Geriatrics” were analysed for their relevance and content when compared to the British Geriatric Society’s (BGS) Recommended Undergraduate Curriculum in Geriatric Medicine. Remaining questions were reviewed by topic to consider if they aligned with the BGS curriculum. Results 120 of 1,133 questions (10.59%) were labelled as assessing “Geriatrics”. Thirty-six (3.18%) of these questions covered outcomes specified in the BGS undergraduate curriculum. Questions were often inappropriately labelled as assessing “Geriatrics” due to patient age or association with certain pathologies. Of the remaining 1,013 questions, 27 (2.38%) focussed on topics outlined in the BGS undergraduate curriculum. In total 63 (5.56%) of 1,133 questions directly related to geriatric medicine. Many aspects of the BGS undergraduate curriculum including elder abuse, polypharmacy and frailty were not covered by the question bank. Conclusions Geriatric medicine continues to be underrepresented in SBAQs and is often misleadingly portrayed in analyses of question banks due to incorrect generalisations based on patient age or pathology. SBAQs may not be suitable for testing the knowledge and skills required in the effective care of older people and new assessment methods that better test these domains may be required. Improving the methods in which geriatric medicine is assessed at an undergraduate level may in turn counter negative attitudes that exist within a Hidden Curriculum for medical students.