- Email: [email protected]
Knowledge and attitudes regarding geriatric care and training among student pharmacists
Available online at www.sciencedirect.com
Currents in Pharmacy Teaching and Learning 6 (2014) 226–232
Research
http://www.pharmacyteaching.com
Knowledge and attitudes regarding geriatric care and training among student pharmacists Jill Augustine, PharmD, MPHa,*, Amit Shah, PharmDb, Nirav Makadia, PharmD, BSc, Ankur Shah, PharmD, BSd, Jeannie K. Lee, PharmD, BCPS, CGPa a
College of Pharmacy, University of Arizona, Tucson, AZ b Target Corporation, Chandler, AZ c Target Corporation, Tempe, AZ d Kroger, Chandler, AZ
Abstract Objective: To assess the knowledge and attitudes of Doctor of Pharmacy (PharmD) students regarding geriatric care and training. Methods: The survey was administered to first, second, and third professional year PharmD students at a four-year public university during the fall semester of 2011. Groups were differentiated based on completion of a geriatrics-focused course, which is offered annually as a two-credit elective for a maximum of 100 health professional students. Results: A total of 193 student pharmacists completed the survey, which resulted in a response rate of 66.55%. The second and third professional year PharmD students who took the geriatrics-focused course showed significantly higher knowledge of geriatric care (mean ¼ 8.46 and 10.12, respectively) compared to their peers who did not take the course (mean ¼ 7.45, p ¼ 0.03; and mean ¼ 8.67, p ¼ 0.02, respectively). Second and third professional year students who participated in the geriatricsfocused course were more likely to be interested in additional geriatric care training compared to their peers who had not taken the course (p ¼ 0.05 each). First professional year students who did not have the opportunity to take the geriatrics course yet placed high importance on participating in a geriatrics-focused course in the pharmacy curriculum. Conclusion: Student pharmacists who took a geriatrics-focused course had stronger knowledge of geriatrics and more positive attitudes regarding geriatric care training. Therefore, schools and colleges of pharmacy should consider the positive impact of a geriatrics-focused course on students’ geriatric knowledge and their attitudes toward geriatric care training. r 2014 Elsevier Inc. All rights reserved. Keywords: Pharmacy; Geriatrics; Students; Curriculum
Introduction The growth of the older adult population (65 years or older) has been well documented and had reached over 35 million people in the year 2000.1 This number is expected to double by the year 2030.1 The increase in the number of older adults and their associated healthcare needs will increase the demand of healthcare services, including access * Corresponding author: Jill Augustine, PharmD, MPH, College of Pharmacy, University of Arizona, 1295 N. Martin Ave, PO BOX 210202, Tucson, AZ 85721-0202. E-mail: [email protected]
to prescription medications. Due to this increased demand, healthcare providers and students need to be trained and achieve competency in geriatric care, including Doctor of Pharmacy (PharmD) students. Previous research has shown that a student’s positive attitude toward geriatric patients care is largely impacted by interaction with healthcare professionals who have interest and passion for serving this population.2,3 Training in geriatric care as a student may influence their knowledge and attitudes. Because of this population shift and resulting healthcare demands, there is a continued need for health professional schools and colleges to assess the knowledge and attitudes
1877-1297/14/$ – see front matter r 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cptl.2013.11.001
J. Augustine et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 226–232
regarding geriatric care among their students. Assessments of dietetic students and podiatric medical students have shown that knowledge about geriatric care was low to adequate.4,5 However, the students’ overall knowledge score increased (by 1.8-fold) as they gained more exposure and training in geriatric care.6 Attitudes toward geriatric patients have varied among different healthcare professional students and their training levels. For example, some studies conducted in medical students and residents found that they had negative attitudes toward geriatric patients,3,7 while other studies found that they had neutral or positive attitudes toward this patient group.8–10 Changes in attitudes are evident when health professional students have increased exposure to geriatric training. Activities such as an aging game,11,12 a geriatric teaching program used to train medical students,13 and a clerkship experience provided to pharmacy students14 have shown to improve attitudes of these students toward older adults with a greater willingness to provide assistance to geriatric patients. These programs enlightened students to the challenges that are faced by geriatric patients and increased students’ empathy and positive attitudes toward caring for this population. Provided that such a large portion of the nation’s pharmacy healthcare resources are utilized by the geriatric population and the current PharmD students will become the future work force caring for them, it is necessary to gauge the knowledge of student pharmacists to fill the educational gaps they have regarding geriatrics. By gauging students’ attitudes toward geriatric care training, faculty and academic administrators can gain an acute understanding of how teachable the students are in the area of geriatric care. Both knowledge and attitudes assessment results may be used to implement needed changes to the geriatric-focused curriculum. A few previous studies examined the attitudes of student pharmacists.11,15–18 A study that examined the overall attitudes of students toward the elderly found these students had a favorable attitude toward this population.16 Some of these studies examined the impact of introductory and advanced clerkship experiences on attitudes toward treating geriatric patients,17,18 while one study assessed the impact of a geriatric game11 and another study evaluated the effect of a hybrid classroom component with long-term care team engagement.15 The changes in attitudes reported by the aforementioned studies included a better understanding of patient experiences, an increased willingness to provide assistance, and learning how to gain a patient’s trust and foster open communication with this population. However, the authors did not find any study that assessed a geriatricsfocused course within PharmD curriculum and its impact on students’ knowledge of geriatric care and attitudes regarding geriatric care training. The current study expanded upon the previous studies by examining the geriatric knowledge and attitudes toward geriatric care training of student pharmacists prior to beginning their advanced clerkship experiences and if
227
participation in a geriatrics-focused course made a difference. The first objective of this study was to assess the knowledge of geriatric-specific care among student pharmacists based on their participation in a geriatrics-focused elective course. The second objective was to assess student pharmacists’ attitudes toward geriatric care training based on their participation in a geriatrics-focused elective course. Methods Student pharmacists were eligible to participate in this study if they were actively enrolled in a public college of pharmacy and were in their first, second, or third professional year of school. Final professional year student pharmacists were excluded from this study because they were not taking courses in the classroom setting and they would have likely been exposed to geriatric care in their clinical rotations. The survey was distributed to students in the fall semester 2011 during one class period for each professional year, in which the highest number of students were expected to attend. Student pharmacists who were not in attendance during the selected course periods were excluded from the study. The researchers received permission from the course coordinator prior to administering the survey. A disclosure form was included with the survey informing the participants of the anonymity of the survey and that their responses would indicate consent to allow the investigators to use the results. The survey was developed to determine what student pharmacists understood about geriatric care (knowledgebased) and their attitudes toward geriatric care training (attitude-based). The knowledge-based questions were derived from geriatrics-focused elective course materials and were confirmed to be important information by the course coordinator. These questions tested students’ understanding regarding specific geriatric conditions, such as Alzheimer’s disease, physiological changes that occur with aging, and important medication considerations for the elderly. Nine multiple-choice questions and five true-orfalse questions were developed, with scores marked as either correct or incorrect. Each student received a final knowledge score that indicated the number of questions answered correctly. The reported mean knowledge score was determined by calculating the mean (and standard deviation) of the students’ final scores for each professional year class. The geriatrics-focused elective course entitled “Perspectives in Geriatrics” is a highly interactive learning experience of interprofessional perspectives in aging and geriatric care, which is taught by interprofessional experts. The course coordinator is a PharmD clinician with geriatric certification and a clinical faculty with vast experience in interprofessional geriatric care, who currently works in a Home-Based Primary Care service and university medical center-based geriatric clinic. The course is open to a maximum of 100 students per year, with a range of 50–92
228
J. Augustine et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 226–232
students who complete the course every year. The course is taught every spring semester and is offered to multiple graduate-level health professional students on campus via course cross listing. The majority of students who enroll in the course are student pharmacists; however, students from public health, audiology, speech, pathology, and nutrition also enroll in the elective course. The invited presenters include geriatric experts in the fields of gerontology, epidemiology, pharmacy, medicine, nursing, social work, nutrition, and occupational therapy. In addition, communitydwelling older adult volunteers are invited to share their life stories and experiences with the health professional students. The course combines these interprofessional expert speakers with hands-on, in-class activities that review and apply important concepts and tools used in geriatric care. The interactive component also includes case-based discussions, paired exercises, small group activities, simulated exercises, role-playing, and games. The students frequently learn about geriatric screening tools in the lecture portion of the two-hour class and then administer them to each other or to a simulated patient during the second hour and discuss their findings. Examples of the course objectives include to identify and explain sociological and psychological changes affecting the elderly and to determine important physiological changes and altered disease presentation associated with aging. Four questions were used to determine student pharmacists’ attitudes about the importance of understanding geriatric care training. The four attitude-based questions were adopted from a previous study that focused on health professionals’ educational needs in geriatric care.19 The first question asked students to rate the importance of taking a course focused on geriatric care within the pharmacy curriculum. The second question asked students to rate their knowledge of geriatrics. The third question asked students to rate their interest level in increasing their knowledge of geriatrics and geriatric care. The final question asked students to rate their beliefs regarding the adequacy of geriatric care training within the current curriculum. Students were asked to answer these questions using a 0–5 scale from “not at all” to “extremely important” or “very interested.” The mean scores were determined for each class based on their self-reported response of completion of the geriatric elective. Student pharmacists were grouped based on their completion of a geriatrics-focused elective course. Demographic information collected included age, gender, the pharmacy practice area they had experienced, and year in pharmacy school. This study was reviewed and approved by the university’s Institutional Review Board. The survey data were analyzed to determine the statistical differences between knowledge and attitudes of those students who had and had not completed the geriatrics course, using the average knowledge score and average attitude score. Independent group t-tests were performed comparing the mean score of student pharmacists who had taken the course
versus the mean score of student pharmacists who had not taken the course. The significance level was determined a priori at α of 0.05. The data were analyzed using STATA, version 12.1 (StataCorp, College Station, TX). Results Demographic information Of the possible 290 student pharmacists, 193 completed the survey, which resulted in a response rate of 66.6% (Table 1). Of the 193 students who completed the survey, 58 (30.1%) had participated in the college’s geriatricsfocused elective course, with the majority of these students (n ¼ 41) in the second professional year class. Female students represented 68.4% of the study population (n ¼ 132), with the most respondents younger than 25 years, as expected. There were no significant differences in demographic variables (gender, age, and pharmacy experience) between students who had completed the geriatrics-focused course and students who had not completed the course. Knowledge scores The average knowledge score for all respondents was 8.3 correct answers out of 14 questions (Table 2). Third professional year students had the highest average score of 9.40 (SD ¼ 1.93), compared to students in the other two years. The mean knowledge score of the third-year students who completed the geriatrics course was significantly higher than those who did not (10.12 ⫾ 2.09 versus 8.67 ⫾ 1.77, p ¼ 0.02). Similarly, the mean knowledge score among the second-year students who participated in the geriatrics course was significantly higher compared to those who did not (8.46 ⫾ 1.98 versus 7.45 ⫾ 1.91, p ¼ 0.03). The mean knowledge score of the first-year students, who were not yet offered the geriatrics course, was 6.68 (SD ¼ 1.82), which was less than 50% of correct answers (Table 3). Attitude scores Third professional year students who had taken the geriatrics course reported the highest-rated importance for taking a geriatrics-focused course (mean ¼ 4.35 ⫾ 0.70 out of six), which was significantly higher than the score reported by third-year students who did not take the course (mean ¼ 3.63 ⫾ 0.99, p o 0.01; Table 4). First-year students had the second highest rating for this attitude question (mean ¼ 4.22 ⫾ 1.08). Second-year students scored the lowest with no significant difference between those who had taken the geriatrics course and those who had not (mean ¼ 3.76 ⫾ 0.91 versus 3.32 ⫾ 1.22, p ¼ 0.10). Third professional year students who had taken the geriatrics-focused course reported the highest number on “adequacy of knowledge in geriatrics” question (mean ¼ 3.65 ⫾ 0.49), which was significantly higher than their
J. Augustine et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 226–232
229
Table 1 Characteristics of study participants
Gender Male Female Age o25 26–30 31–35 36–40 441 Experience Community Hospital LTC MMC Hospice
First professional year classa (n ¼ 74)
Second professional year class (n ¼ 72) Third professional year class (n ¼ 47)
Without geriatrics course
With geriatrics course
Without geriatrics course
With geriatrics course
Without geriatrics course
With geriatrics course
23 51
– –
11 20
12 29
12 18
3 14
63 8 0 2 1
– – – – –
19 6 3 3 0
31 9 1 0 0
9 14 6 0 1
8 5 3 0 1
41 28 4 4 4
– – – – –
22 10 6 5 0
27 15 17 8 3
25 18 14 2 0
14 12 7 2 0
LTC ¼ long-term care, MMC ¼ medication management center. a All students from the first professional year class had never taken a geriatrics-focused course, so no comparisons were completed.
counterparts (mean ¼ 2.70 ⫾ 0.70, p o 0.001). The same student group had the highest interest level for increasing their knowledge of geriatrics over all other groups (mean ¼ 4.12 ⫾ 0.86) and it was significantly higher than students in the same year who had not taken the geriatrics course (mean ¼ 3.53 ⫾ 1.11, p ¼ 0.05). Although second-year students had the lowest interest level among the classes, those who took the geriatrics course had a significantly higher interest level compared to those who did not (mean ¼ 3.54 ⫾ 1.19 versus 2.90 ⫾ 1.37, p o 0.05). Third professional year students who took the geriatric course reported the highest overall adequacy level (mean ¼ 3.24 ⫾ 1.03) compared to all other groups. First-year Table 2 Knowledge scores of student pharmacists Class in professional year
Without geriatrics With geriatrics course, mean (SD)a course, mean (SD)a
First yearb – (n ¼ 74) Second year 8.46 (1.98) (n ¼ 72) Third year 10.12 (2.09) (n ¼ 47) Overall mean, 9.29 (2.04) all classes (n ¼ 193) a
pValue
6.68 (1.82)
–
7.45 (1.91)
0.03
8.67 (1.77)
0.02
7.6 (1.83)
0.24
Out of 14 total points. Students from the first professional year class had not been offered a geriatrics-focused course, thus no comparison was assessed. b
students reported the second highest adequacy level (mean ¼ 3.22 ⫾ 1.24), even though they had not received geriatric care training as part of the pharmacy curriculum. The lowest reported adequacy level was from second-year students who had not taken the geriatrics course (mean ¼ 2.52 ⫾ 1.29), which was significantly lower than the level reported by their peers who had taken the geriatrics course (mean ¼ 3.15 ⫾ 0.94, p ¼ 0.03).
Discussion The results of this study revealed that student pharmacists who participated in a geriatrics-focused course demonstrated better understanding of geriatric care with higher knowledge level regarding disease states and medications that affect the older population compared with their peers who did not participate in the course. The students who had taken the geriatrics-focused course also reported more positive attitudes toward geriatric care training compared to students who had not taken the geriatrics-focused course. Overall, student pharmacists showed an interest in participating in a geriatrics-focused course. Based on the mean interest and adequacy scores, students are interested in learning more about geriatric care as they do not feel they have adequate knowledge of geriatrics or received adequate training in geriatric care. With an overall knowledge score lower than ten out of 14 with students who took the current elective geriatrics course scoring significantly higher than those who did not, requiring such a course may be a solution to exposing all PharmD students to geriatric care competencies. Previous research has shown that additional
230
J. Augustine et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 226–232
Table 3 Knowledge-based questions and response optionsa Knowledge-based questions
Response options
1. Which of the following is one of the first signs of Alzheimer's disease?
A. B. C. D.
Short-term memory lossb Long-term memory loss Changes in personality Problems with abstract thinking
2. Which of the following is the most clinically significant physiological change leading to medication-related problems in the elderly?
A. B. C. D.
Decreased liver function Decreased renal functionb Polypharmacy Increased GI absorption
3. Experts in the health literacy and communication recommend that handouts for elderly patients be written at what grade level?
A. No higher than first or second grade level B. No higher than third or fourth grade level C. No higher than fifth or sixth grade levelb D. No higher than seventh or eighth grade level
4. Which of the following are key nutrients important to the health of older adults?
Table 3 Continued
A. Calcium and Vitamin B2 B. Vitamin D and Vitamin B12b C. Calcium and Vitamin B1 D. Vitamin D and Vitamin B2
5. Which of the following factors does NOT place the elderly at risk for dehydration?
A. Less body water B. Decreased thirst response C. Increased ability to concentrate urineb D. Swallowing difficulty
6. Which of the following is FALSE concerning delirium?
A. Leads to loss of independence B. Increased risk of morbidity and mortality C. Impacts healthcare costs D. Delirium is also known as dementiab
7. According to the CDC, which of the following is NOT a proven risk factor for elderly falling?
A. Taking more than four medications B. Taking medications for memory, dementia, and depression C. Visual impairment D. Taking pain medicationsb
8. Which of the following medications are included on the Beer’s list and should be avoided in the elderly?
A. Hydrocodone and acetaminophen B. Acetaminophen and cimetidine C. Cimetidine and diphenhydramineb D. Diphenhydramine and hydrocodone
9. Which of the following is (are) a common presenting symptom(s) of pneumonia in elderly patients?
A. B. C. D.
Cough Confusionb Fever A and B only
10. Hyper-active or agitated delirium represents greater than 50% of all cases. 11. Dementia is not a normal part of aging, but age is number one risk factor. 12. Most older adults struggle with growing older. 13. As we age, the duration of our sleep lengthens. 14. Those Z85 years are the fastest growing segment of the population.
True Falseb Trueb False True Falseb True Falseb Trueb False
GI ¼ gastrointestinal; CDC ¼ Centers for Disease Control and Prevention. a This survey was developed in 2011, prior to the 2012 Beer’s criteria update.21 b Indicates the correct answer.
education and exposure to geriatrics-focused information can increase knowledge of other health professional students as well as student attitudes.2,5,9 An initial step to ensure that pharmacists are adequately prepared to care for a growing number of geriatric patients may be to ensure that all student pharmacists receive a standardized training through a geriatrics-focused course. According to a 2006 survey, only 43% of schools and colleges of pharmacy offered a stand-alone geriatrics course.20 While students in this program are exposed to some geriatric-specific information in their required non-geriatric coursework, mainly in pharmacokinetics and pharmacotherapeutics courses, participation in the geriatrics-focused course led to higher level of geriatric knowledge. In the current study, a steady increase in mean knowledge scores was seen from class to class, from the first professional year class to second and third professional year classes (6.68, 7.96, and 9.40, respectively). This may indicate that matriculating through the pharmacy program increases one’s knowledge of geriatric care. To the authors’ knowledge, this is the first study to examine pharmacy students’ knowledge of geriatric care derived from a geriatrics-focused coursework within the pharmacy curriculum, and the findings show that students need and are interested in further training in geriatric care prior to their clerkship rotations during the final professional year. Specific groups of student pharmacists indicated that they were interested in learning more about geriatric care. The students in their first and third professional years were more interested compared to those in the second professional year. It should be noted that the lack of interest
J. Augustine et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 226–232 Table 4 Attitude scores among student pharmacists toward geriatric training Attitude question,a With geriatrics class in professional course, mean year (SD)b
Without geriatrics course, p-Value mean (SD)b
Importance of taking a course focused on geriatric care First-year classc – 4.22 (1.08) (n ¼ 74) Second-year class 3.76 (0.91) 3.32 (1.22) (n ¼ 72) Third-year class 4.35 (0.70) 3.63 (0.99) (n ¼ 47) Adequacy of knowledge in geriatrics First-year classc – 1.41 (1.10) Second-year class 2.59 (1.05) 2.09 (0.94) Third-year class 3.65 (0.49) 2.70 (0.70) Interest in increasing knowledge of geriatrics – 3.93 (0.96) First-year classc Second-year class 3.54 (1.19) 2.90 (1.37) Third-year class 4.12 (0.86) 3.53 (1.11) Adequacy of training in geriatric care First-year classc – 3.22 (1.24) Second-year class 3.15 (0.94) 2.52 (1.29) Third-year class 3.24 (1.03) 3.10 (0.88)
– 0.10 0.01
– 0.04 o0.001 – o0.05 0.05 – 0.03 0.65
a Scale of questions ranged from 0 (not at all) to 5 (extremely important or very interested). b Out of six total points. c Students from the first professional year class had never taken a geriatrics-focused course, thus no comparison assessed.
among the second professional year students might have been due to a general lack of motivation and high stress among these students as they had the most intensive curricular demands of the three classes. Student pharmacists who had participated in the college’s geriatrics-focused course had higher (often significantly) knowledge scores and more positive attitudes regarding geriatric care and training compared to students who had not taken the course. Thus, providing PharmD students with a geriatrics-focused education was associated with not only higher level of knowledge but also more positive attitude toward geriatric care training. Previous research examined the positive impact on student pharmacists’ attitudes regarding geriatric care through exposure via an introductory practice experience,15,18 clerkship experience,14 geriatric game,11 and general coursework.16 However, these studies did not assess the impact on student pharmacists’ geriatric knowledge. Even though first professional year students did not have a comparison group, some information can be learned from the assessment of this group. The low knowledge scores shown may indicate limited geriatric care experience and interactions with the older adult population among the new PharmD students. On the other hand, high number reported on “importance of taking a course focused on geriatric care” and “interest in increasing knowledge of geriatrics”
231
questions may indicate their recognition of the need for knowledge gain in this area. The current study findings add to the body of the literature that has shown that exposure to geriatric patients and specific training activities lead to better attitudes regarding geriatric care. The interest level for geriatric care training and students’ attitudes toward such training should be examined by schools and colleges of pharmacy when considering updating or adding a geriatrics-focused course to their curriculum. In addition, assessing changes in knowledge level among student pharmacists after implementation of a geriatrics-focused course may be important in detecting impact of the course and outcome of such curricular training. Future studies should include multiple schools and colleges of pharmacy with diverse geriatric curricular components to increase generalizability of the results, construct further implications for a geriatricsfocused curriculum, and direct educational research agenda. Inclusion of final professional year students may be considered in future research to determine if clerkship rotations influenced students’ knowledge and attitudes regarding geriatric care and training and if participation in a geriatrics-focused course affected students’ knowledge and attitudes after completion of their clinical training. There are several limitations to consider for the current study. Because a survey was used, there may have been response bias among student pharmacists who participated. Still, the response rate was higher compared to other studentled survey projects conducted at the local university (typically less than 50%). One of the study objectives was to assess the attitudes of student pharmacists on geriatric care training. Students who chose to take the geriatrics elective course may inherently have more positive attitudes toward geriatric care and training and thus seek increased educational opportunities in the curriculum on geriatrics. Although the attitude-based questions were drawn from a previously published survey study,19 the current survey was not validated prior to distribution to ensure that questions accurately evaluated the study objectives. In addition, this survey was distributed to student pharmacists at one university, thus limiting generalizability. Yet, schools and colleges of pharmacy that have a geriatrics-focused elective component, rather than a required course, may glean insights from the study findings. Conclusions In the current study, student pharmacists who participated in a geriatrics-focused course showed higher level of knowledge in geriatrics and more positive attitudes regarding geriatric care training. In addition, the student pharmacists were interested in participating in additional training in geriatric care to prepare for serving the growing number of older patients in their future practice. Therefore, we recommend that schools and colleges of pharmacy consider implementing a geriatrics-focused course within their curriculum, preferably as a required course, to instill geriatric
232
J. Augustine et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 226–232
care competencies in student pharmacists and subsequently assessing the impact of such a course. References 1. He W, Sengupta M, Velkoff VA, DeBarros KA. 65þ in the United States: 2005. Washington, DC: National Institute of Aging, National Institutes of Health, US Department of Health and Human Services; 2005. 2. Damron-Rodriguez J, Kramer BJ, Gallagher-Thompson D. Effect of geriatric clinical rotations on health professions trainees’ attitudes about older adults. Gerontol Geriatr Educ. 1998;19(2):67–79. 3. Reuben DB, Fullerton JT, Tschann JM, Croughan-Minihane M. Attitudes of beginning medical students toward older persons: a five-campus study. J Am Geriatr Soc. 1995;43(12):1430–1436. 4. Kaempfer D, Wellman NS, Himburg SP. Dietetic students’ low knowledge, attitudes, and work preferences toward older adults indicated need for improved education about aging. J Am Diet Assoc. 2002;102(2):197–202. 5. Menz HB. The influence of geriatrics education on knowledge, attitudes, and career aspirations of podiatric medical students. J Am Podiatr Med Assoc. 2003;93(2):124–130. 6. Kishimoto M, Nagoshi M, Williams S, Masaki KH, Blanchette PL. Knowledge and attitudes about geriatrics of medical students, internal medicine residents, and geriatric medicine fellows. J Am Geriatr Soc. 2005;53(1):99–102. 7. Ten Haken JD, Woolliscroft JO, Smith JB, Wolf FM, Calhoun JG. A longitudinal investigation of changes in medical students’ attitudes toward the elderly. Teach Learn Med. 1995;7(1):18–22. 8. Fields SD, Jutagir R, Adelman RD, Tideiksarr R, Olson E. Geriatric education part I: efficacy of a mandatory clinical rotation for fourth year medical students. J Am Geriatr Soc. 1992;40(9):964–969. 9. Lindberg MC, Sullivan GM. Effects of an inpatient geriatrics rotation on internal medicine residents’ knowledge and attitudes. J Gen Intern Med. 1996;11(7):397–400.
10. Voogt SJ, Mickus M, Santiago O, Herman SE. Attitudes, experiences, and interest in geriatrics of first-year allopathic and osteopathic medical students. J Am Geriatr Soc. 2008;56 (2):339–344. 11. Chen AMH, Plake KS, Yehle KS, Kiersma ME. Impact of the geriatric medication game on pharmacy students’ attitude toward older adults. Am J Pharm Educ. 2011;75(8):Article 158. 12. Varkey P, Chutka DS, Lesnick TG. The Aging Game: improving medical students’ attitudes toward caring for the elderly. J Am Med Dir Assoc. 2006;7(4):224–229. 13. Hughes NJ, Soiza RL, Chua M, et al. Medical student attitudes toward older people and willingness to consider a career in geriatric medicine. J Am Geriatr Soc. 2008;56(2): 334–338. 14. Cooper JW, McCall CY, Marshburn RP, Burfield AH. A senior care clerkship for pharmacy students. Consult Pharm. 2006;21 (6):482–492. 15. Adkins DM, Mayhew SL, Gavaza P, Rahman S. Pharmacy students’ attitudes toward geriatric nursing home patients. Am J Pharm Educ. 2012;76(5):Article 81. 16. Shepherd MD, Erwin G. An examination of students’ attitudes toward the elderly. Am J Pharm Educ. 1983;47(1):35–38. 17. Sauer BL. Student-directed learning in a community geriatrics advanced pharmacy practice experience. Am J Pharm Educ. 2006;70(3):Article 54. 18. Woelfel JA, Boyce E, Patel RA. Geriatric care as an introductory pharmacy practice experience. Am J Pharm Educ. 2011;75(6):Article 115. 19. Goins RT, Gainor SJ, Pollard C, Spencer SM. Geriatric knowledge and educational needs among rural health care professionals. Educ Gerontol. 2003;29(3):261–272. 20. Odegard PS, Breslow RM, Koronkowski MJ, Williams BR, Hudgins GA. Geriatric pharmacy education: a strategic plan for the future. Am J Pharm Educ. 2007;71(3):Article 47. 21. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–631.
Currents in Pharmacy Teaching and Learning 6 (2014) 226–232
Research
http://www.pharmacyteaching.com
Knowledge and attitudes regarding geriatric care and training among student pharmacists Jill Augustine, PharmD, MPHa,*, Amit Shah, PharmDb, Nirav Makadia, PharmD, BSc, Ankur Shah, PharmD, BSd, Jeannie K. Lee, PharmD, BCPS, CGPa a
College of Pharmacy, University of Arizona, Tucson, AZ b Target Corporation, Chandler, AZ c Target Corporation, Tempe, AZ d Kroger, Chandler, AZ
Abstract Objective: To assess the knowledge and attitudes of Doctor of Pharmacy (PharmD) students regarding geriatric care and training. Methods: The survey was administered to first, second, and third professional year PharmD students at a four-year public university during the fall semester of 2011. Groups were differentiated based on completion of a geriatrics-focused course, which is offered annually as a two-credit elective for a maximum of 100 health professional students. Results: A total of 193 student pharmacists completed the survey, which resulted in a response rate of 66.55%. The second and third professional year PharmD students who took the geriatrics-focused course showed significantly higher knowledge of geriatric care (mean ¼ 8.46 and 10.12, respectively) compared to their peers who did not take the course (mean ¼ 7.45, p ¼ 0.03; and mean ¼ 8.67, p ¼ 0.02, respectively). Second and third professional year students who participated in the geriatricsfocused course were more likely to be interested in additional geriatric care training compared to their peers who had not taken the course (p ¼ 0.05 each). First professional year students who did not have the opportunity to take the geriatrics course yet placed high importance on participating in a geriatrics-focused course in the pharmacy curriculum. Conclusion: Student pharmacists who took a geriatrics-focused course had stronger knowledge of geriatrics and more positive attitudes regarding geriatric care training. Therefore, schools and colleges of pharmacy should consider the positive impact of a geriatrics-focused course on students’ geriatric knowledge and their attitudes toward geriatric care training. r 2014 Elsevier Inc. All rights reserved. Keywords: Pharmacy; Geriatrics; Students; Curriculum
Introduction The growth of the older adult population (65 years or older) has been well documented and had reached over 35 million people in the year 2000.1 This number is expected to double by the year 2030.1 The increase in the number of older adults and their associated healthcare needs will increase the demand of healthcare services, including access * Corresponding author: Jill Augustine, PharmD, MPH, College of Pharmacy, University of Arizona, 1295 N. Martin Ave, PO BOX 210202, Tucson, AZ 85721-0202. E-mail: [email protected]
to prescription medications. Due to this increased demand, healthcare providers and students need to be trained and achieve competency in geriatric care, including Doctor of Pharmacy (PharmD) students. Previous research has shown that a student’s positive attitude toward geriatric patients care is largely impacted by interaction with healthcare professionals who have interest and passion for serving this population.2,3 Training in geriatric care as a student may influence their knowledge and attitudes. Because of this population shift and resulting healthcare demands, there is a continued need for health professional schools and colleges to assess the knowledge and attitudes
1877-1297/14/$ – see front matter r 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cptl.2013.11.001
J. Augustine et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 226–232
regarding geriatric care among their students. Assessments of dietetic students and podiatric medical students have shown that knowledge about geriatric care was low to adequate.4,5 However, the students’ overall knowledge score increased (by 1.8-fold) as they gained more exposure and training in geriatric care.6 Attitudes toward geriatric patients have varied among different healthcare professional students and their training levels. For example, some studies conducted in medical students and residents found that they had negative attitudes toward geriatric patients,3,7 while other studies found that they had neutral or positive attitudes toward this patient group.8–10 Changes in attitudes are evident when health professional students have increased exposure to geriatric training. Activities such as an aging game,11,12 a geriatric teaching program used to train medical students,13 and a clerkship experience provided to pharmacy students14 have shown to improve attitudes of these students toward older adults with a greater willingness to provide assistance to geriatric patients. These programs enlightened students to the challenges that are faced by geriatric patients and increased students’ empathy and positive attitudes toward caring for this population. Provided that such a large portion of the nation’s pharmacy healthcare resources are utilized by the geriatric population and the current PharmD students will become the future work force caring for them, it is necessary to gauge the knowledge of student pharmacists to fill the educational gaps they have regarding geriatrics. By gauging students’ attitudes toward geriatric care training, faculty and academic administrators can gain an acute understanding of how teachable the students are in the area of geriatric care. Both knowledge and attitudes assessment results may be used to implement needed changes to the geriatric-focused curriculum. A few previous studies examined the attitudes of student pharmacists.11,15–18 A study that examined the overall attitudes of students toward the elderly found these students had a favorable attitude toward this population.16 Some of these studies examined the impact of introductory and advanced clerkship experiences on attitudes toward treating geriatric patients,17,18 while one study assessed the impact of a geriatric game11 and another study evaluated the effect of a hybrid classroom component with long-term care team engagement.15 The changes in attitudes reported by the aforementioned studies included a better understanding of patient experiences, an increased willingness to provide assistance, and learning how to gain a patient’s trust and foster open communication with this population. However, the authors did not find any study that assessed a geriatricsfocused course within PharmD curriculum and its impact on students’ knowledge of geriatric care and attitudes regarding geriatric care training. The current study expanded upon the previous studies by examining the geriatric knowledge and attitudes toward geriatric care training of student pharmacists prior to beginning their advanced clerkship experiences and if
227
participation in a geriatrics-focused course made a difference. The first objective of this study was to assess the knowledge of geriatric-specific care among student pharmacists based on their participation in a geriatrics-focused elective course. The second objective was to assess student pharmacists’ attitudes toward geriatric care training based on their participation in a geriatrics-focused elective course. Methods Student pharmacists were eligible to participate in this study if they were actively enrolled in a public college of pharmacy and were in their first, second, or third professional year of school. Final professional year student pharmacists were excluded from this study because they were not taking courses in the classroom setting and they would have likely been exposed to geriatric care in their clinical rotations. The survey was distributed to students in the fall semester 2011 during one class period for each professional year, in which the highest number of students were expected to attend. Student pharmacists who were not in attendance during the selected course periods were excluded from the study. The researchers received permission from the course coordinator prior to administering the survey. A disclosure form was included with the survey informing the participants of the anonymity of the survey and that their responses would indicate consent to allow the investigators to use the results. The survey was developed to determine what student pharmacists understood about geriatric care (knowledgebased) and their attitudes toward geriatric care training (attitude-based). The knowledge-based questions were derived from geriatrics-focused elective course materials and were confirmed to be important information by the course coordinator. These questions tested students’ understanding regarding specific geriatric conditions, such as Alzheimer’s disease, physiological changes that occur with aging, and important medication considerations for the elderly. Nine multiple-choice questions and five true-orfalse questions were developed, with scores marked as either correct or incorrect. Each student received a final knowledge score that indicated the number of questions answered correctly. The reported mean knowledge score was determined by calculating the mean (and standard deviation) of the students’ final scores for each professional year class. The geriatrics-focused elective course entitled “Perspectives in Geriatrics” is a highly interactive learning experience of interprofessional perspectives in aging and geriatric care, which is taught by interprofessional experts. The course coordinator is a PharmD clinician with geriatric certification and a clinical faculty with vast experience in interprofessional geriatric care, who currently works in a Home-Based Primary Care service and university medical center-based geriatric clinic. The course is open to a maximum of 100 students per year, with a range of 50–92
228
J. Augustine et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 226–232
students who complete the course every year. The course is taught every spring semester and is offered to multiple graduate-level health professional students on campus via course cross listing. The majority of students who enroll in the course are student pharmacists; however, students from public health, audiology, speech, pathology, and nutrition also enroll in the elective course. The invited presenters include geriatric experts in the fields of gerontology, epidemiology, pharmacy, medicine, nursing, social work, nutrition, and occupational therapy. In addition, communitydwelling older adult volunteers are invited to share their life stories and experiences with the health professional students. The course combines these interprofessional expert speakers with hands-on, in-class activities that review and apply important concepts and tools used in geriatric care. The interactive component also includes case-based discussions, paired exercises, small group activities, simulated exercises, role-playing, and games. The students frequently learn about geriatric screening tools in the lecture portion of the two-hour class and then administer them to each other or to a simulated patient during the second hour and discuss their findings. Examples of the course objectives include to identify and explain sociological and psychological changes affecting the elderly and to determine important physiological changes and altered disease presentation associated with aging. Four questions were used to determine student pharmacists’ attitudes about the importance of understanding geriatric care training. The four attitude-based questions were adopted from a previous study that focused on health professionals’ educational needs in geriatric care.19 The first question asked students to rate the importance of taking a course focused on geriatric care within the pharmacy curriculum. The second question asked students to rate their knowledge of geriatrics. The third question asked students to rate their interest level in increasing their knowledge of geriatrics and geriatric care. The final question asked students to rate their beliefs regarding the adequacy of geriatric care training within the current curriculum. Students were asked to answer these questions using a 0–5 scale from “not at all” to “extremely important” or “very interested.” The mean scores were determined for each class based on their self-reported response of completion of the geriatric elective. Student pharmacists were grouped based on their completion of a geriatrics-focused elective course. Demographic information collected included age, gender, the pharmacy practice area they had experienced, and year in pharmacy school. This study was reviewed and approved by the university’s Institutional Review Board. The survey data were analyzed to determine the statistical differences between knowledge and attitudes of those students who had and had not completed the geriatrics course, using the average knowledge score and average attitude score. Independent group t-tests were performed comparing the mean score of student pharmacists who had taken the course
versus the mean score of student pharmacists who had not taken the course. The significance level was determined a priori at α of 0.05. The data were analyzed using STATA, version 12.1 (StataCorp, College Station, TX). Results Demographic information Of the possible 290 student pharmacists, 193 completed the survey, which resulted in a response rate of 66.6% (Table 1). Of the 193 students who completed the survey, 58 (30.1%) had participated in the college’s geriatricsfocused elective course, with the majority of these students (n ¼ 41) in the second professional year class. Female students represented 68.4% of the study population (n ¼ 132), with the most respondents younger than 25 years, as expected. There were no significant differences in demographic variables (gender, age, and pharmacy experience) between students who had completed the geriatrics-focused course and students who had not completed the course. Knowledge scores The average knowledge score for all respondents was 8.3 correct answers out of 14 questions (Table 2). Third professional year students had the highest average score of 9.40 (SD ¼ 1.93), compared to students in the other two years. The mean knowledge score of the third-year students who completed the geriatrics course was significantly higher than those who did not (10.12 ⫾ 2.09 versus 8.67 ⫾ 1.77, p ¼ 0.02). Similarly, the mean knowledge score among the second-year students who participated in the geriatrics course was significantly higher compared to those who did not (8.46 ⫾ 1.98 versus 7.45 ⫾ 1.91, p ¼ 0.03). The mean knowledge score of the first-year students, who were not yet offered the geriatrics course, was 6.68 (SD ¼ 1.82), which was less than 50% of correct answers (Table 3). Attitude scores Third professional year students who had taken the geriatrics course reported the highest-rated importance for taking a geriatrics-focused course (mean ¼ 4.35 ⫾ 0.70 out of six), which was significantly higher than the score reported by third-year students who did not take the course (mean ¼ 3.63 ⫾ 0.99, p o 0.01; Table 4). First-year students had the second highest rating for this attitude question (mean ¼ 4.22 ⫾ 1.08). Second-year students scored the lowest with no significant difference between those who had taken the geriatrics course and those who had not (mean ¼ 3.76 ⫾ 0.91 versus 3.32 ⫾ 1.22, p ¼ 0.10). Third professional year students who had taken the geriatrics-focused course reported the highest number on “adequacy of knowledge in geriatrics” question (mean ¼ 3.65 ⫾ 0.49), which was significantly higher than their
J. Augustine et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 226–232
229
Table 1 Characteristics of study participants
Gender Male Female Age o25 26–30 31–35 36–40 441 Experience Community Hospital LTC MMC Hospice
First professional year classa (n ¼ 74)
Second professional year class (n ¼ 72) Third professional year class (n ¼ 47)
Without geriatrics course
With geriatrics course
Without geriatrics course
With geriatrics course
Without geriatrics course
With geriatrics course
23 51
– –
11 20
12 29
12 18
3 14
63 8 0 2 1
– – – – –
19 6 3 3 0
31 9 1 0 0
9 14 6 0 1
8 5 3 0 1
41 28 4 4 4
– – – – –
22 10 6 5 0
27 15 17 8 3
25 18 14 2 0
14 12 7 2 0
LTC ¼ long-term care, MMC ¼ medication management center. a All students from the first professional year class had never taken a geriatrics-focused course, so no comparisons were completed.
counterparts (mean ¼ 2.70 ⫾ 0.70, p o 0.001). The same student group had the highest interest level for increasing their knowledge of geriatrics over all other groups (mean ¼ 4.12 ⫾ 0.86) and it was significantly higher than students in the same year who had not taken the geriatrics course (mean ¼ 3.53 ⫾ 1.11, p ¼ 0.05). Although second-year students had the lowest interest level among the classes, those who took the geriatrics course had a significantly higher interest level compared to those who did not (mean ¼ 3.54 ⫾ 1.19 versus 2.90 ⫾ 1.37, p o 0.05). Third professional year students who took the geriatric course reported the highest overall adequacy level (mean ¼ 3.24 ⫾ 1.03) compared to all other groups. First-year Table 2 Knowledge scores of student pharmacists Class in professional year
Without geriatrics With geriatrics course, mean (SD)a course, mean (SD)a
First yearb – (n ¼ 74) Second year 8.46 (1.98) (n ¼ 72) Third year 10.12 (2.09) (n ¼ 47) Overall mean, 9.29 (2.04) all classes (n ¼ 193) a
pValue
6.68 (1.82)
–
7.45 (1.91)
0.03
8.67 (1.77)
0.02
7.6 (1.83)
0.24
Out of 14 total points. Students from the first professional year class had not been offered a geriatrics-focused course, thus no comparison was assessed. b
students reported the second highest adequacy level (mean ¼ 3.22 ⫾ 1.24), even though they had not received geriatric care training as part of the pharmacy curriculum. The lowest reported adequacy level was from second-year students who had not taken the geriatrics course (mean ¼ 2.52 ⫾ 1.29), which was significantly lower than the level reported by their peers who had taken the geriatrics course (mean ¼ 3.15 ⫾ 0.94, p ¼ 0.03).
Discussion The results of this study revealed that student pharmacists who participated in a geriatrics-focused course demonstrated better understanding of geriatric care with higher knowledge level regarding disease states and medications that affect the older population compared with their peers who did not participate in the course. The students who had taken the geriatrics-focused course also reported more positive attitudes toward geriatric care training compared to students who had not taken the geriatrics-focused course. Overall, student pharmacists showed an interest in participating in a geriatrics-focused course. Based on the mean interest and adequacy scores, students are interested in learning more about geriatric care as they do not feel they have adequate knowledge of geriatrics or received adequate training in geriatric care. With an overall knowledge score lower than ten out of 14 with students who took the current elective geriatrics course scoring significantly higher than those who did not, requiring such a course may be a solution to exposing all PharmD students to geriatric care competencies. Previous research has shown that additional
230
J. Augustine et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 226–232
Table 3 Knowledge-based questions and response optionsa Knowledge-based questions
Response options
1. Which of the following is one of the first signs of Alzheimer's disease?
A. B. C. D.
Short-term memory lossb Long-term memory loss Changes in personality Problems with abstract thinking
2. Which of the following is the most clinically significant physiological change leading to medication-related problems in the elderly?
A. B. C. D.
Decreased liver function Decreased renal functionb Polypharmacy Increased GI absorption
3. Experts in the health literacy and communication recommend that handouts for elderly patients be written at what grade level?
A. No higher than first or second grade level B. No higher than third or fourth grade level C. No higher than fifth or sixth grade levelb D. No higher than seventh or eighth grade level
4. Which of the following are key nutrients important to the health of older adults?
Table 3 Continued
A. Calcium and Vitamin B2 B. Vitamin D and Vitamin B12b C. Calcium and Vitamin B1 D. Vitamin D and Vitamin B2
5. Which of the following factors does NOT place the elderly at risk for dehydration?
A. Less body water B. Decreased thirst response C. Increased ability to concentrate urineb D. Swallowing difficulty
6. Which of the following is FALSE concerning delirium?
A. Leads to loss of independence B. Increased risk of morbidity and mortality C. Impacts healthcare costs D. Delirium is also known as dementiab
7. According to the CDC, which of the following is NOT a proven risk factor for elderly falling?
A. Taking more than four medications B. Taking medications for memory, dementia, and depression C. Visual impairment D. Taking pain medicationsb
8. Which of the following medications are included on the Beer’s list and should be avoided in the elderly?
A. Hydrocodone and acetaminophen B. Acetaminophen and cimetidine C. Cimetidine and diphenhydramineb D. Diphenhydramine and hydrocodone
9. Which of the following is (are) a common presenting symptom(s) of pneumonia in elderly patients?
A. B. C. D.
Cough Confusionb Fever A and B only
10. Hyper-active or agitated delirium represents greater than 50% of all cases. 11. Dementia is not a normal part of aging, but age is number one risk factor. 12. Most older adults struggle with growing older. 13. As we age, the duration of our sleep lengthens. 14. Those Z85 years are the fastest growing segment of the population.
True Falseb Trueb False True Falseb True Falseb Trueb False
GI ¼ gastrointestinal; CDC ¼ Centers for Disease Control and Prevention. a This survey was developed in 2011, prior to the 2012 Beer’s criteria update.21 b Indicates the correct answer.
education and exposure to geriatrics-focused information can increase knowledge of other health professional students as well as student attitudes.2,5,9 An initial step to ensure that pharmacists are adequately prepared to care for a growing number of geriatric patients may be to ensure that all student pharmacists receive a standardized training through a geriatrics-focused course. According to a 2006 survey, only 43% of schools and colleges of pharmacy offered a stand-alone geriatrics course.20 While students in this program are exposed to some geriatric-specific information in their required non-geriatric coursework, mainly in pharmacokinetics and pharmacotherapeutics courses, participation in the geriatrics-focused course led to higher level of geriatric knowledge. In the current study, a steady increase in mean knowledge scores was seen from class to class, from the first professional year class to second and third professional year classes (6.68, 7.96, and 9.40, respectively). This may indicate that matriculating through the pharmacy program increases one’s knowledge of geriatric care. To the authors’ knowledge, this is the first study to examine pharmacy students’ knowledge of geriatric care derived from a geriatrics-focused coursework within the pharmacy curriculum, and the findings show that students need and are interested in further training in geriatric care prior to their clerkship rotations during the final professional year. Specific groups of student pharmacists indicated that they were interested in learning more about geriatric care. The students in their first and third professional years were more interested compared to those in the second professional year. It should be noted that the lack of interest
J. Augustine et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 226–232 Table 4 Attitude scores among student pharmacists toward geriatric training Attitude question,a With geriatrics class in professional course, mean year (SD)b
Without geriatrics course, p-Value mean (SD)b
Importance of taking a course focused on geriatric care First-year classc – 4.22 (1.08) (n ¼ 74) Second-year class 3.76 (0.91) 3.32 (1.22) (n ¼ 72) Third-year class 4.35 (0.70) 3.63 (0.99) (n ¼ 47) Adequacy of knowledge in geriatrics First-year classc – 1.41 (1.10) Second-year class 2.59 (1.05) 2.09 (0.94) Third-year class 3.65 (0.49) 2.70 (0.70) Interest in increasing knowledge of geriatrics – 3.93 (0.96) First-year classc Second-year class 3.54 (1.19) 2.90 (1.37) Third-year class 4.12 (0.86) 3.53 (1.11) Adequacy of training in geriatric care First-year classc – 3.22 (1.24) Second-year class 3.15 (0.94) 2.52 (1.29) Third-year class 3.24 (1.03) 3.10 (0.88)
– 0.10 0.01
– 0.04 o0.001 – o0.05 0.05 – 0.03 0.65
a Scale of questions ranged from 0 (not at all) to 5 (extremely important or very interested). b Out of six total points. c Students from the first professional year class had never taken a geriatrics-focused course, thus no comparison assessed.
among the second professional year students might have been due to a general lack of motivation and high stress among these students as they had the most intensive curricular demands of the three classes. Student pharmacists who had participated in the college’s geriatrics-focused course had higher (often significantly) knowledge scores and more positive attitudes regarding geriatric care and training compared to students who had not taken the course. Thus, providing PharmD students with a geriatrics-focused education was associated with not only higher level of knowledge but also more positive attitude toward geriatric care training. Previous research examined the positive impact on student pharmacists’ attitudes regarding geriatric care through exposure via an introductory practice experience,15,18 clerkship experience,14 geriatric game,11 and general coursework.16 However, these studies did not assess the impact on student pharmacists’ geriatric knowledge. Even though first professional year students did not have a comparison group, some information can be learned from the assessment of this group. The low knowledge scores shown may indicate limited geriatric care experience and interactions with the older adult population among the new PharmD students. On the other hand, high number reported on “importance of taking a course focused on geriatric care” and “interest in increasing knowledge of geriatrics”
231
questions may indicate their recognition of the need for knowledge gain in this area. The current study findings add to the body of the literature that has shown that exposure to geriatric patients and specific training activities lead to better attitudes regarding geriatric care. The interest level for geriatric care training and students’ attitudes toward such training should be examined by schools and colleges of pharmacy when considering updating or adding a geriatrics-focused course to their curriculum. In addition, assessing changes in knowledge level among student pharmacists after implementation of a geriatrics-focused course may be important in detecting impact of the course and outcome of such curricular training. Future studies should include multiple schools and colleges of pharmacy with diverse geriatric curricular components to increase generalizability of the results, construct further implications for a geriatricsfocused curriculum, and direct educational research agenda. Inclusion of final professional year students may be considered in future research to determine if clerkship rotations influenced students’ knowledge and attitudes regarding geriatric care and training and if participation in a geriatrics-focused course affected students’ knowledge and attitudes after completion of their clinical training. There are several limitations to consider for the current study. Because a survey was used, there may have been response bias among student pharmacists who participated. Still, the response rate was higher compared to other studentled survey projects conducted at the local university (typically less than 50%). One of the study objectives was to assess the attitudes of student pharmacists on geriatric care training. Students who chose to take the geriatrics elective course may inherently have more positive attitudes toward geriatric care and training and thus seek increased educational opportunities in the curriculum on geriatrics. Although the attitude-based questions were drawn from a previously published survey study,19 the current survey was not validated prior to distribution to ensure that questions accurately evaluated the study objectives. In addition, this survey was distributed to student pharmacists at one university, thus limiting generalizability. Yet, schools and colleges of pharmacy that have a geriatrics-focused elective component, rather than a required course, may glean insights from the study findings. Conclusions In the current study, student pharmacists who participated in a geriatrics-focused course showed higher level of knowledge in geriatrics and more positive attitudes regarding geriatric care training. In addition, the student pharmacists were interested in participating in additional training in geriatric care to prepare for serving the growing number of older patients in their future practice. Therefore, we recommend that schools and colleges of pharmacy consider implementing a geriatrics-focused course within their curriculum, preferably as a required course, to instill geriatric
232
J. Augustine et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 226–232
care competencies in student pharmacists and subsequently assessing the impact of such a course. References 1. He W, Sengupta M, Velkoff VA, DeBarros KA. 65þ in the United States: 2005. Washington, DC: National Institute of Aging, National Institutes of Health, US Department of Health and Human Services; 2005. 2. Damron-Rodriguez J, Kramer BJ, Gallagher-Thompson D. Effect of geriatric clinical rotations on health professions trainees’ attitudes about older adults. Gerontol Geriatr Educ. 1998;19(2):67–79. 3. Reuben DB, Fullerton JT, Tschann JM, Croughan-Minihane M. Attitudes of beginning medical students toward older persons: a five-campus study. J Am Geriatr Soc. 1995;43(12):1430–1436. 4. Kaempfer D, Wellman NS, Himburg SP. Dietetic students’ low knowledge, attitudes, and work preferences toward older adults indicated need for improved education about aging. J Am Diet Assoc. 2002;102(2):197–202. 5. Menz HB. The influence of geriatrics education on knowledge, attitudes, and career aspirations of podiatric medical students. J Am Podiatr Med Assoc. 2003;93(2):124–130. 6. Kishimoto M, Nagoshi M, Williams S, Masaki KH, Blanchette PL. Knowledge and attitudes about geriatrics of medical students, internal medicine residents, and geriatric medicine fellows. J Am Geriatr Soc. 2005;53(1):99–102. 7. Ten Haken JD, Woolliscroft JO, Smith JB, Wolf FM, Calhoun JG. A longitudinal investigation of changes in medical students’ attitudes toward the elderly. Teach Learn Med. 1995;7(1):18–22. 8. Fields SD, Jutagir R, Adelman RD, Tideiksarr R, Olson E. Geriatric education part I: efficacy of a mandatory clinical rotation for fourth year medical students. J Am Geriatr Soc. 1992;40(9):964–969. 9. Lindberg MC, Sullivan GM. Effects of an inpatient geriatrics rotation on internal medicine residents’ knowledge and attitudes. J Gen Intern Med. 1996;11(7):397–400.
10. Voogt SJ, Mickus M, Santiago O, Herman SE. Attitudes, experiences, and interest in geriatrics of first-year allopathic and osteopathic medical students. J Am Geriatr Soc. 2008;56 (2):339–344. 11. Chen AMH, Plake KS, Yehle KS, Kiersma ME. Impact of the geriatric medication game on pharmacy students’ attitude toward older adults. Am J Pharm Educ. 2011;75(8):Article 158. 12. Varkey P, Chutka DS, Lesnick TG. The Aging Game: improving medical students’ attitudes toward caring for the elderly. J Am Med Dir Assoc. 2006;7(4):224–229. 13. Hughes NJ, Soiza RL, Chua M, et al. Medical student attitudes toward older people and willingness to consider a career in geriatric medicine. J Am Geriatr Soc. 2008;56(2): 334–338. 14. Cooper JW, McCall CY, Marshburn RP, Burfield AH. A senior care clerkship for pharmacy students. Consult Pharm. 2006;21 (6):482–492. 15. Adkins DM, Mayhew SL, Gavaza P, Rahman S. Pharmacy students’ attitudes toward geriatric nursing home patients. Am J Pharm Educ. 2012;76(5):Article 81. 16. Shepherd MD, Erwin G. An examination of students’ attitudes toward the elderly. Am J Pharm Educ. 1983;47(1):35–38. 17. Sauer BL. Student-directed learning in a community geriatrics advanced pharmacy practice experience. Am J Pharm Educ. 2006;70(3):Article 54. 18. Woelfel JA, Boyce E, Patel RA. Geriatric care as an introductory pharmacy practice experience. Am J Pharm Educ. 2011;75(6):Article 115. 19. Goins RT, Gainor SJ, Pollard C, Spencer SM. Geriatric knowledge and educational needs among rural health care professionals. Educ Gerontol. 2003;29(3):261–272. 20. Odegard PS, Breslow RM, Koronkowski MJ, Williams BR, Hudgins GA. Geriatric pharmacy education: a strategic plan for the future. Am J Pharm Educ. 2007;71(3):Article 47. 21. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–631.