Teaching Medical Students to Manage Clinical Complexity and Assess Function in Older Adults

Introduction: 

Bedside teaching, involving direct patient interaction, is central to undergraduate medical education, helping students integrate clinical knowledge and build practical skills in a supported learning environment. Managing older adults with multimorbidity, frailty, cognitive impairment and functional decline require students to develop higher-level skills in history taking, examination, and functional assessment to provide safe, holistic care. However, older adults with complex presentations are underrepresented in bedside teaching, and foundation doctors often lack confidence leading students in assessing these patients. 

Methods:

Foundation doctors teaching Years 3–5, at a UK district general hospital, completed a pre-intervention survey exploring barriers to teaching students, how to take histories and functionally assess complex older patients. A structured resource was then developed, providing guidance on patient selection, frameworks for sessions on multimorbidity, frailty, and cognitive impairment plus strategies to guide students through complex cases.

Results:

Of the 12 tutors, 10 (83%) recognized that students benefit from early exposure to complex older patients. However, 58% reported feeling uncertain facilitating these sessions, 75% feared overwhelming the students and 58% chose simpler cases, avoiding patients with cognitive impairment. 10 of 12 tutors requested guidance on patient selection and 9 of 12 wanted teaching frameworks taking histories, which the resource provided. 

Conclusion:

Foundation doctors lack confidence to include older adults with complex presentations in bedside teaching. Structured support enables them to confidently lead this teaching thus helping students to navigate complex presentations Ultimately, better preparing them for real-world of geriatric medicine.