Improving frailty education for Undergraduate Medical Students at a UK teaching hospital

Background

'Instant Ageing' technologies and simulated ward rounds are established parts of geriatric medicine teaching in many centres. However, these once innovative methods received negative feedback when delivered during our undergraduate BMBS programme. We set out to explore whether adding gamification to established teaching methods could enhance student knowledge, attitudes towards frailty and perceptions of their attachment.

Methods

We designed a 'Frailty Escape Room' where students rotated around stations completing tasks related to falls, polypharmacy, delirium, frailty assessment, pressure sores, activities of daily living and Comprehensive Geriatric Assessment. Students undertook tasks under time conditions whilst wearing different 'instant aging' simulation equipment. Successful task completion generated a code that, when combined, enabled 'escape' from the room.

Students were assessed using pre-post session questionnaires. Four Likert-scale (score 1-4) questions evaluated empathy/understanding of life with frailty, confidence in assessing, managing and communicating with older people living with frailty. Sixteen single best answer multiple choice questions assessed core knowledge. Summary statistics were calculated and test item performance before and after teaching were compared using pairwise student t-tests and chi-square for parametric scale and categorical variables respectively.

Anonymous free-text feedback was collected at the end of the session to assess student satisfaction.

Results

121 students completed the Escape Room and pre/post-testing. Mean (SD) Likert scores increased from 2.2(0.7)-3.3(0.6), 2.5(0.5)-3.2(0.5), 2.1(0.5)-2.9(0.5) and 2.8(0.6)-3.4(0.5) for empathy/understanding, confidence investigating, managing and communicating with older people with frailty respectively (p<0.05 for all). Mean (SD) total knowledge score increased from 8.5(2.1)-11.8(1.9) (p<0.05), with significant improvements across all except three questions.

Free-text feedback indicated high student satisfaction, and attendance has improved markedly following the teaching intervention.

Conclusions

Introduction of gamification to existing simulated ward round and instant ageing teaching improved student attendance and satisfaction. The teaching improved knowledge of, and attitudes towards, care of older people.