Download Geriatrics is rewarding but lacks earning potential

Research letters
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doi: 10.1093/ageing/afr033
Published electronically 31 March 2011
© The Author 2011. Published by Oxford University Press on behalf
of the British Geriatrics Society. All rights reserved. For Permissions,
please email: [email protected]
Geriatrics is rewarding but lacks earning
potential and prestige: responses from the
national medical student survey of
attitudes to and perceptions of geriatric
medicine
SIR—A survey of UK geriatricians conducted in 2005
showed that only 4% had chosen their specialty while at
university [1]. However, recent changes to UK postgraduate
training mean that doctors are expected to form career
plans earlier, starting while undergraduates [2–4]. Attitudes
and perceptions about geriatric medicine formed by
medical students are therefore increasingly important.
It is thought that students might be motivated to undertake a career in geriatrics following an attachment in the
specialty [5, 6], or following personal experience of caring
for older people [5, 7]. However, no attempt has been
made at a national level to explore how students feel about
geriatric medicine, or how their opinions are shaped by
teaching and extra-curricular experience.
Against this background we set out to describe attitudes
to, and perceptions of, geriatric medicine among the students of all UK medical schools.
Methods
A 39-question online survey was developed by medical students from the Universities of Nottingham and Oxford
with support from an academic geriatrician. The questionnaire was then sent to the British Geriatrics Society (BGS)
Education and Training Committee for expert content validation before piloting for usability with 30 students.
The resulting questionnaire comprised four sections
headed: demographics, teaching, extracurricular and career.
Question-styles were varied to include multiple choice,
Likert scales and short answer questions. A copy of the
questionnaire is available online [8].
A web-link to the survey was emailed to UK medical
students using the British Medical Association and Royal
Society of Medicine mailing lists, together reaching the
majority of students. As an incentive to respond, a prize
draw was advertised at the start of the questionnaire—participants were informed that this was for funding to attend
a BGS scientific meeting and invited to submit their email
address only after they had completed the survey. A reminder email was sent 3 weeks after the initial invitation.
Results
A total of 1,562 students responded from 29/31 UK
medical schools, representing 4% of medical students [9].
The median number of respondents per school was 31
(range 1–185; mode 31). The average duration of time at
medical school was 3.3 years with most responses from
year 4 students and least from year 6 (25.2 and 5.7% of
respondents, respectively). Of the total, 71% were female,
6.5% mature students and 8.9% graduate entry students,
with no difference in response by these variables. Although
incomplete responses were seen for several questions, no
consistent pattern of non-response was evident.
Among the respondents, 565 (36%) students had completed a separate teaching module in geriatric medicine, 723
(46%) had undertaken a clinical placement in the specialty
and 1,007 (65%) had been taught using cases focusing on
older patients during problem-based learning. The mean
scores for quality and enjoyment of teaching were 3.55 ±
1.01/5 and 3.42 ± 1.08/5, respectively (1 being poor and 5
excellent). Both were positively correlated with teaching by
non-doctor team members, exposure to inspiring geriatricians, attachments in community geriatrics and separate
teaching modules or dedicated clinical placements in the
specialty (P < 0.05 for all; Spearman’s correlation coefficient). Also, 830 (53%) students stated they would like
more teaching in geriatrics.
Of the total number, 1,193 (76%) respondents associated geriatrics with a positive impact on the lives of older
people, 842 (54%) considered it to involve contact with
likeable patients and 813 (52%) to be intellectually stimulating. However, 615 (39%) associated the specialty with low
earning potential and 820 (52%) with low prestige within
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Research letters
Table 1. Student perceptions of geriatric medicine
‘Please rate how much you think the following factors apply to a career in geriatric medicine ….’
Number (%) of respondents
1 (low)
2
3
4
5 (high)
9 (0.6)
205 (13)
48 (3)
146 (9)
19 (1)
50 (3)
30 (2)
33 (2)
273 (17)
51 (3)
29 (2)
23 (1)
6 (0.4)
27 (2)
410 (26)
146 (9)
343 (22)
75 (5)
189 (12)
128 (8)
169 (11)
547 (35)
271 (17)
232 (15)
106 (7)
32 (2)
128 (8)
549 (35)
498 (32)
490 (31)
330 (21)
347 (22)
372 (24)
373 (24)
402 (26)
636 (41)
619 (40)
297 (19)
158 (10)
465 (30)
170 (11)
539 (35)
310 (20)
538 (34)
497 (32)
576 (37)
536 (34)
127 (8)
354 (23)
415 (27)
584 (37)
558 (36)
747 (48)
41 (3)
142 (9)
86 (6)
410 (26)
294 (19)
266 (17)
277 (18)
42 (3)
79 (5)
91 (6)
377 (24)
635 (41)
....................................................................................
A desire to make a difference to the lives of older people
Good earning potential
Job opportunities available near desired place of work
Opportunities for research
Opportunities for team working
Variety of work
Likeable patients
Intellectual stimulation
Prestige within the medical community
Stress levels
Flexible working conditions
Meaningful interaction with patients
Positive impact on patients lives
the medical profession. These data are presented in
Table 1.
Among the respondents, 1,277 (82%) had cared for
older people before medical school; 707 (45%) had undertaken voluntary work and 268 (17%) paid work in a care
home or equivalent; 309 (20%) had cared for an older relative. Despite this, 839 (54%) had no ongoing extracurricular involvement with older people. Among the
respondents, 907 (58%) were aware of opportunities for
such involvement and 773 (49%) stated they would like to
become more involved.
Of the total number, 555 (36%) respondents stated they
would possibly undertake a career in geriatrics and 92 (6%)
probably or definitely would. Career intentions and
perceptions were not influenced by previous modules in
geriatric medicine whether undertaken as clinical attachments, problem-based learning or separate modules in the
specialty. Students were more likely to want to become a
geriatrician if they had experience of caring for older
people before university (P < 0.01). These data are summarised in Figure 1.
Discussion
This study is the largest survey of student perceptions and
attitudes to a single medical specialty: studies undertaken in
rheumatology [10], general surgery [11] and psychiatry [12]
Figure 1. Effect of caring for older adults before medical school on career intentions.
406
Research letters
were much smaller. Previous studies of student perceptions
towards geriatrics have focused upon a single university or
region [5, 6, 13–15].
Our main findings are that: the majority of respondents
rated their teaching in geriatrics highly in terms of quality
and enjoyment and this was positively correlated with
exposure to dedicated teaching in the specialty; the specialty
was well regarded by respondents, with the modal response
above average for 8/13 positive attributes; a third of
respondents were prepared to consider a career in geriatrics;
and the desire to do so was influenced by extra-curricular
but not curricular experiences.
The study’s strengths include questionnaire authorship
and piloting led by students alongside expert content validation, making it likely that questions were appropriate in
style and content for students while also addressing the
concerns of the specialty. The use of national mailing lists
from highly subscribed professional bodies helped ensure
wide circulation. The use of a prize fund and a reminder
e-mail has been shown to increase response rates in
meta-analyses of survey design [16]. The fact that the
nature of our prize was disclosed after survey completion
ensured that we did not bias our respondents towards
those who would want to attend a BGS meeting.
The main limitation is the low response rate. The results
are therefore open to response bias. Students might be
most likely to respond if they had positive attitudes towards
the specialty. The sample was biased towards female
respondents—71% were female, compared with 56% of
UK students [9]—and it has been reported that women are
more prepared to consider a career in geriatric medicine
[14, 17]. The distribution of respondents between universities was not uniform, raising the possibility of institutional
bias; 8 of the 10 highest responding schools previously participated in the National Survey of Undergraduate Teaching
in Ageing and Geriatric Medicine [18]. This indicates an
institutional enthusiasm for survey participation but
perhaps also that geriatrics is a particular focus in these
centres. In view of these potential biases, the positive view
of the specialty observed here may not be generalisable.
They should not, however, significantly bias the findings
around relationships between pre-university and student
experiences and career intentions. Another important limitation is the lack of comparison data for other specialties.
That a majority of respondents wanted more teaching in
geriatrics must therefore be treated with caution.
Acquiescence bias is an acknowledged issue with questionnaires [19] and it is easy for students to request more teaching when no trade-off is apparent.
Even though our sample may have been positively
biased towards geriatric medicine, the majority of responses
regarding perceptions were negative in three domains—
earning potential, research opportunities and prestige within
the medical community (Table 1). It is uncertain if such
perceptions imply that future geriatricians might be more
altruistic and less financially driven than other specialties,
or whether they might deter high quality candidates from
becoming geriatricians. The perceptions about earning
potential are almost certainly true by comparison with
procedure-based specialties [20]. The accuracy of the perceptions about research opportunities are less easy to judge:
although a reduction in academic geriatric medicine units
has been reported [21], a number of these still seem to be
flourishing within in the United Kingdom [22]. With regard
to prestige, it is unclear what aspects of a specialty lead students to regard it as prestigious and further research is
required to understand responses in this domain.
There was a correlation between experience of caring for
older adults pre-university and an interest in becoming a geriatrician. It has previously been reported that teaching
rotations in geriatrics increase the number of students with
career aspirations in the specialty but in our cohort there
was no such association [6]. It is not clear why this was the
case. It may be that the content of teaching is more important than mere attendance at a geriatrics module. An alternative interpretation is that medical students arrive at
university with their attitudes towards the specialty largely
set by their pre-university experience—in which case there
are implications for admission policies and student selection.
In conclusion, this large survey of UK students showed
that they held many positive attitudes towards geriatric
medicine despite concerns regarding earning potential,
prestige and research opportunities. What contributes to
specialty prestige in students’ eyes is unclear and should be
further researched. Further research is also necessary to
understand what components of teaching, if any, encourage
positive attitudes towards the specialty and whether and
how attitudes, present on arrival at medical school, are
modulated by teaching. The importance of pre-university
experience in influencing career decisions and hence possible effects upon the future workforce should be considered
by medical school selection panels.
Key points
• This is the largest survey of perceptions and attitudes
about a single medical specialty among UK undergraduates to date.
• The specialty was well regarded by respondents, being
seen as rewarding and intellectually stimulating.
• Over a third of respondents were prepared to consider a
career in geriatric medicine.
• Career intentions were influenced by extra-curricular but
not course-based experiences.
• Respondents rated the specialty poorly for prestige among
the medical profession, research opportunities and
earning potential.
Acknowledgements
The authors would like to acknowledge the support of: the
British Geriatrics Society which funded the prize draw and
407
Research letters
provided expert support through the Education and
Training Committee; the British Medical Association and
Royal Society for Medicine which allowed us to use their
medical student contact lists; and Dr John Beard, Director
of the Department of Ageing and Life Course, World
Health Organisation, for his advice during the early stages
of survey development.
Conflicts of interest
None declared.
Funding
The prize draw was funded by the British Geriatrics
Society.
TIMOTHY D. ROBBINS1, TIM CROCKER-BUQUE2,
CALUM FORRESTER-PATON3, ANNA CANTLAY4, JOHN R. F. GLADMAN5,
ADAM L. GORDON5,*
1
Oxford University Medical School, Oxford, UK
2
Whipps Cross Hospital NHS Trust, London, UK
3
Derby Hospitals NHS Foundation Trust, Derby, UK
4
Medical School, University of Nottingham, Nottingham, UK
5
Division of Rehabilitation and Ageing, Room B98, Medical School,
Queens Medical Centre, Nottingham NG7 2UH, UK
Tel: (+44) 0115 8230242; Fax: (+44) 0115 8230231.
Email: [email protected]
*To whom correspondence should be addressed
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doi: 10.1093/ageing/afr034
Published electronically 22 March 2011
© The Author 2011. Published by Oxford University Press on behalf
of the British Geriatrics Society. All rights reserved. For Permissions,
please email: [email protected]