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.