When Contact Is Not Enough: Affecting First Year Medical Students’ Image towards Older Persons

Context
Many medical schools have initiated care internships to familiarize their students with older persons and to instil a professional attitude.
Objective
To examine the impact of care internships on the image that first-year medical students have of older persons and to explore the underlying concepts that may play a role in shaping this image.
Design
Survey before and after a two-week compulsory care internship using the Aging Semantic Differential (ASD; 32 adjectives) and the Attitudes toward Old People (AOP; 34 positions) questionnaires.
Participants
Before and after a care internship involving interpersonal contact, 252 and 244 first-year medical students at the Leiden University Medical Centre (LUMC) in the academic year 2012–2013 participated.
Method
Descriptive statistics, analyses of variance, and principal component analysis were used; clusters of adjectives and positions were reduced into concepts to examine dominant patterns of views. Changes in image were investigated as mean differences of the total and concept scores.
Results
Both the ASD and the AOP questionnaires showed a poor general image of older persons that significantly worsened after the care internship (p < 0.01). The percentage of students considering over 75 years as being old increased from 17.2% to 31.2% (p < 0.01) and those who thought they would find as much satisfaction in care for older as for younger patients decreased from 78.5% to 62.1% (p < 0.001). Exploratory principal component analysis showed particularly low scores on ‘comportment’ and ‘pleasurable interaction’ whereas the scores on ‘personality traits’ and ‘habitual behaviour’ significantly deteriorated (both p < 0.001). These patterns were irrespective of the student’s gender and previous contact experience.
Conclusion
Medical schools should carefully consider care internships to ensure that students do not worsen their views on older patients, which may occur due to inadequate contact depth and quality within a rather unsupportive context.