Frailty Simulation-Based Teaching Improves Medical Student Confidence in Caring for Older Adults

Introduction: Frailty is increasingly encountered in clinical practice, yet undergraduate opportunities to develop confidence in managing older adults with frailty remain limited. We developed and evaluated a simulation-based teaching session aiming to enhance Swansea University medical students’ confidence in assessing and managing common frailty presentations.

Methods: A frailty simulation teaching session was delivered to Year 3 Graduate Entry Medicine students during their frailty specialty attachment clinical placement. The sessions were delivered across two clinical sites, with each site facilitated by a different clinical tutor. The session comprised five high-fidelity simulation scenarios (falls, delirium, polypharmacy, deterioration in Parkinson’s disease and recognising and managing end-of-life care), each followed by a facilitated debrief. Students completed pre- and post-session questionnaires rating their confidence in seven frailty-related GMC Outcomes for Graduates competencies and the five clinical scenarios using a five-point Likert scale. Responses were compared using the Mann–Whitney U test.

Results: Twenty students participated. Self-rated confidence improved significantly across all seven frailty-related GMC competencies and all five clinical scenarios (all p<0.05). For GMC competencies, median scores increased from 2-3 pre-session to 4 post-session, with the largest improvements seen in adapting management for older adults with frailty (2 to 4), safe prescribing in frailty (2 to 4), and formulating patient-centred management plans (2 to 4). Median confidence for the five clinical scenarios increased from 2-3 pre-session to 3-4 post-session, including falls (3 to 4), delirium (3 to 4), polypharmacy (2 to 4), deterioration in Parkinson’s disease (2 to 4) and recognising and managing end-of-life care (2 to 3).

Conclusion: A single simulation-based frailty teaching session was associated with significant improvements in medical students’ confidence across core frailty competencies and common geriatric presentations. Simulation represents a valuable approach to undergraduate frailty education and may help prepare future doctors to deliver safe, person-centred care for an ageing population. Further research should evaluate its impact on objective knowledge, clinical skills and clinical performance.