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What is meant by “Frailty” in the context of undergraduate medical education? | British Geriatrics Society

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class="card-full-title"> What is meant by “Frailty” in the context of undergraduate medical education? </div> </h1> <span property="dc:title" content="What is meant by “Frailty” in the context of undergraduate medical education?" class="rdf-meta element-hidden"></span><span property="sioc:num_replies" content="3" datatype="xsd:integer" class="rdf-meta element-hidden"></span> <div class="node-header-details"> <div class="node-header-dates card-date-alt"> <div class="card-date"> <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2021-03-26T00:00:00+00:00">26 March 2021</span> </div> </div> <div class="card-topics-wrapper"><a href="/taxonomy/term/2937">Education, Training and Careers</a>, <a href="/taxonomy/term/2955">Frailty</a></div> </div> </div> <div class="view view-sections view-id-sections view-display-id-main view-dom-id-5167c2d9af6d554f07ca0267416995ca"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first section-row palette-default img-right "> <div class="section-inner"> <div class="card-original"> <picture > <!--[if IE 9]><video style="display: none;"><![endif]--> <source srcset="https://www.bgs.org.uk/sites/default/files/styles/nugget-wide/public/content/paragraphs/text/images/2021-03-26/Frailty%20Education%20v2.jpg?itok=Xgmu2rSG&amp;timestamp=1616779381 1x" media="(min-width: 75em)" /> <source srcset="https://www.bgs.org.uk/sites/default/files/styles/nugget-normal/public/content/paragraphs/text/images/2021-03-26/Frailty%20Education%20v2.jpg?itok=Z7kyC8It&amp;timestamp=1616779381 1x" media="(min-width: 60em)" /> <source srcset="https://www.bgs.org.uk/sites/default/files/styles/nugget-narrow/public/content/paragraphs/text/images/2021-03-26/Frailty%20Education%20v2.jpg?itok=gFn34nw-&amp;timestamp=1616779381 1x" media="(min-width: 45em)" /> <source srcset="https://www.bgs.org.uk/sites/default/files/styles/nugget-mobile/public/content/paragraphs/text/images/2021-03-26/Frailty%20Education%20v2.jpg?itok=bso3Lqq3&amp;timestamp=1616779381 1x" media="(min-width: 0em)" /> <!--[if IE 9]></video><![endif]--> <img src="https://www.bgs.org.uk/sites/default/files/styles/nugget-mobile/public/content/paragraphs/text/images/2021-03-26/Frailty%20Education%20v2.jpg?itok=bso3Lqq3&amp;timestamp=1616779381" alt="" title="" /> </picture> </div> <div class="card-body"> <p class="larger-text">Rebecca Winter is a ST6 in Geriatric Medicine and a Research Fellow at BSMS. Her thesis uses creative research methods to explore the current perceptions of and approaches to frailty in undergraduate medical education. She tweets on <a href="https://twitter.com/rebeccawinter27" rel="nofollow">@rebeccawinter27</a>.</p> <h6><em>&ldquo;And of how the snail, so small and frail, </em></h6> <h6><em>With her looping, curling, silvery trail, </em></h6> <h6><em>Saved the life of the humpback whale&rdquo;</em></h6> <h6>- Taken from the Snail and the Whale, Julia Donaldson and Axel Scheffler<br /> &nbsp;</h6> <p>I talk about frailty a lot. I hear the word &lsquo;frailty&rsquo; a lot. In the clinical environment, across academic literature, in the media to describe weakened politicians and even from my 3-year-old son (courtesy of the snail). I cannot recall being taught about frailty as a medical student, and as a geriatrician-in-training, a person passionate about teaching and learning about frailty, and as a person who has spent more than two years reading and writing about frailty, do I find it easy to teach about frailty to medical students? The answer is no.</p> <p>People living with frailty account for 20% of hospital inpatients and half of all hospital bed days in the UK<sup>1</sup>. Medical students will encounter patients with frailty, across a breadth of clinical specialities, which therefore requires an in-depth understanding of this topic. The 2018 General Medical Council (GMC) Outcomes for Graduates document reflects this, with a requirement that medical schools include frailty in their curriculum<sup>2</sup>. However, little is known about what it means to teach and learn about frailty in practice. A systematic review in postgraduate education found no relevant publications addressed the evidence of educational programmes for frailty prevention and/or frailty management<sup>7</sup>. This gap in training of healthcare professionals has been highlighted as a main barrier towards identifying and managing frailty<sup>8</sup>. There is some evidence to suggest that with teaching, the perceived importance of frailty and competence in assessing, diagnosing and managing frailty can improve<sup>9</sup>.</p> <p>Some of the challenges associated with teaching and learning about frailty include negative perceptions, lack of a universal definition and a variation in the interpretation among healthcare professionals<sup>3&ndash;6.</sup> This is partly due to the differing discourses between the medical construct of frailty introduced in the literature two decades ago to advance understanding of the heterogeneous health status of older people and the lay use of the word, which can be traced back to at least 2500 years ago.</p> <p><strong>How do medical students perceive frailty?</strong></p> <p>Work from our group, led by McCarthy<sup>10</sup>, aimed to explore medical student attitudes towards both older people and frailty over an entire UK medical school cohort. The study used a mixed-methods approach using validated questionnaires<sup>11,12</sup> and the creation of word clouds about older people and frailty. Participants (n=187) reported generally positive attitudes towards older people and frailty. The most positive attitudes towards both older people and frailty were held by year one students, and most negative by students in years three and four. The most negative attitudes towards older people were towards their reduced functional ability. The qualitative word clouds for older people and frailty differed noticeably from one another. Medical students associated positive qualities far more with older people whereas frailty was associated with more negative words. The five most common terms when students were asked to think about frailty were vulnerable, old, weakness, dependence, and illness, compared to experienced, wise, old, kind, and grandparents for older people.</p> <p><strong>How do medical schools perceive and approach frailty?</strong></p> <p>All UK medical schools were invited to complete an electronic survey in 2019<sup>13</sup>. Schools described educational strategies used to teach and assess frailty and provided frailty-related learning outcomes. Learning Outcomes (LOs) were grouped into categories and mapped to the domains of Outcomes for Graduates (knowledge, skills and values). 25/34 Medical schools (74%) participated. The interpretation of what frailty is varied widely between schools and the diversity of teaching strategies reflects this. Some provided LOs that represented frailty as a long-term condition within general medicine&nbsp; (the concept of frailty, frailty assessment tools such as the Clinical Frailty Scale- CFS) and others considered frailty to equate to the whole of GM (chronic conditions in the older patient, social impact of ageing, gerontology). The most common learning outcomes about frailty are about the concept of frailty, Comprehensive Geriatric Assessments and Roles of the MDT.</p> <p>Frailty teaching was widely delivered through ward rounds and clinical placements, commonly opportunistically. Simply being present in a clinical environment, however, does not guarantee that students will recognise or understand the concept of frailty. A number of schools discussed that students learn about frailty by completing or observing the CFS. The assessment examples and descriptions most commonly described Objective Structured Clinical Examinations (OSCEs) scenarios, including a history or communication station involving a frailty syndrome (fall, episode of delirium) or prescribing stations demonstrating polypharmacy.</p> <p><strong>What next?</strong></p> <p>The background work of my thesis has started to set the scene of frailty in medical education but there is much work to be done at individual, institutional and national levels to optimise teaching and learning about frailty for generations to come. I have included some suggestions below (a selection from a longer list)&nbsp;but in the spirit of the responsibility we all share for preparing medical students to meet the needs of future generations, please do comment below with your thoughts.</p> <ol> <li>Expert consensus should be reached regarding the core areas to include about the topic of frailty. This could be included in future versions of the undergraduate curriculum produced by the BGS.</li> <li>In view of the variation in frailty-related educational strategies, it would be good to further explore which strategies enhance student learning around frailty.</li> <li>Medical schools should ensure that frailty-related learning outcomes are taught and assessed to follow the educational principles of constructive alignment. Furthermore, there should be careful consideration as to which/how frailty assessments feature within the national Medical Licencing Assessment (MLA).</li> <li>In view of the fact that frailty teaching and learning currently is largely opportunistic by students being present on the ward, further research is required to understand how medical students and clinical teachers across specialties perceive frailty and how these perceptions impact what students learn in the clinical environment &ndash; watch this space for these results.</li> </ol> </div> <div class="card-view-4"> <div class="view view-attachment view-id-attachment view-display-id-main view-dom-id-dc459ea76ad508ba57ce3353a317c642"> </div> </div> </div> </div> <div class="views-row views-row-2 views-row-even views-row-last section-row palette-default "> <div class="section-inner"> <div class="card-body"> <p>More information can be found in our recently published articles about frailty in undergraduate medical education:</p> <ul> <li><a href="https://doi.org/10.1007/s41999-020-00430-y" rel="nofollow">An exploration of medical student attitudes towards older persons and frailty during undergraduate training</a> &nbsp;</li> <li><a href="https://link.springer.com/article/10.1007/s41999-021-00465-9?wt_mc=Internal.Event.1.SEM.ArticleAuthorOnlineFirst&amp;utm_source=ArticleAuthorOnlineFirst&amp;utm_medium=email&amp;utm_content=AA_en_06082018&amp;ArticleAuthorOnlineFirst_20210303" rel="nofollow">What is meant by &ldquo;frailty&rdquo; in undergraduate medical education? A national survey of UK medical schools</a></li> </ul> <p class="smaller-text"><strong>References</strong></p> <p class="smaller-text">1. &nbsp;&nbsp;&nbsp;&nbsp; Gilbert T, Neuburger J, Kraindler J, et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet. 2018;391(10132):1775-1782. doi:10.1016/S0140-6736(18)30668-8</p> <p class="smaller-text">2. &nbsp;&nbsp;&nbsp;&nbsp; GMC. Outcomes for Graduates. <a href="https://www.gmc-uk.org/-/media/documents/dc11326-outcomes-for-graduates-2018_pdf-75040796.pdf">https://www.gmc-uk.org/-/media/documents/dc11326-outcomes-for-graduates-...</a>. Published 2018. Accessed October 2, 2018.</p> <p class="smaller-text">3. &nbsp;&nbsp;&nbsp;&nbsp; Junius-Walker U, Onder G, Soleymani D, et al. The essence of frailty: A systematic review and qualitative synthesis on frailty concepts and definitions. Eur J Intern Med. 2018;56(March):1-8. doi:10.1016/j.ejim.2018.04.023</p> <p class="smaller-text">4. &nbsp;&nbsp;&nbsp;&nbsp; Britain Thinks. Frailty : Language and Perceptions A Report Prepared by BritainThinks on Behalf of Age UK and the British Geriatrics Society.; 2015. <a href="http://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Policy/health-and-wellbeing/report_bgs_frailty_language_and_perceptions.pdf?dtrk=true">http://www.ageuk.org.uk/Documents/EN-GB/For-professionals/Policy/health-...</a>.</p> <p class="smaller-text">5. &nbsp;&nbsp;&nbsp;&nbsp; Ambagtsheer RC, Archibald MM, Lawless M, Mills D, Yu S. General practitioners &rsquo; perceptions , attitudes and experiences of frailty and frailty screening. Aust J Gen Pract. 2019;48(7):426-434.</p> <p class="smaller-text">6. &nbsp;&nbsp;&nbsp;&nbsp; Archibald MM, Lawless M, Gill TK, Chehade MJ. Orthopaedic surgeons &rsquo; perceptions of frailty and frailty screening. BMC Geriatr. 2020;20(17):1-11.</p> <p class="smaller-text">7. &nbsp;&nbsp;&nbsp;&nbsp; Windhaber T, Koula ML, Ntzani E, et al. Educational strategies to train health care professionals across the education continuum on the process of frailty prevention and frailty management: a systematic review. Aging Clin Exp Res. 2018;30(12):1409-1415. doi:10.1007/s40520-018-0918-9</p> <p class="smaller-text">8. &nbsp;&nbsp;&nbsp;&nbsp; Avgerinou C, Kotsani M, Gavana M, et al. Perceptions, attitudes and training needs of primary healthcare professionals in identifying and managing frailty: a qualitative study. Eur Geriatr Med. 2020:1-12. doi:10.1007/s41999-020-00420-0</p> <p class="smaller-text">9. &nbsp;&nbsp;&nbsp;&nbsp; Arakawa Martins B, Jadczak AD, Dollard J, et al. Fifth-year medical students&rsquo; perceptions of the importance of frailty and competence in assessing, diagnosing and managing frailty before and after a geriatric medicine course. Australas J Ageing. 2020;39(3):e472-e477. doi:10.1111/ajag.12788</p> <p class="smaller-text">10. &nbsp;&nbsp; McCarthy F, Winter R, Levett T. An exploration of medical student attitudes towards older persons and frailty during undergraduate training. Eur Geriatr Med. 2020:1-7. doi:<a href="http://dx.doi.org/10.1007/s41999-020-00430-y">http://dx.doi.org/10.1007/s41999-020-00430-y</a></p> <p class="smaller-text">11. &nbsp;&nbsp; Wilson MAG, Tran Y, Wilson I, Kurrle S. Development of the Australian Ageing Semantic Differential, a new instrument for measuring Australian medical student attitudes towards older people. Australas J Ageing. 2019;38(3):e67-e74. doi:10.1111/ajag.12627</p> <p class="smaller-text">12. &nbsp;&nbsp; Christison G, Haviland M, Riggs M. The medical condition regard scale: measuring reactions to diagnoses. Acad Med. 2002;77(3):257-262.</p> <p class="smaller-text">13. Winter R, Al-Jawad M, Wright J. What is meant by &ldquo;frailty&rdquo; in undergraduate medical education? A national survey of UK medical schools. Eur Geriatric Med. 2021. <a href="https://doi.org/10.1007/s41999-021-00465-9">https://doi.org/10.1007/s41999-021-00465-9</a></p> </div> <div class="card-view-4"> <div class="view view-attachment view-id-attachment view-display-id-main view-dom-id-bf8ed8d0db46ff87bcc87692cf9e65db"> </div> </div> </div> </div> </div> </div> <div class="view view-sections view-id-sections view-display-id-additional view-dom-id-8c366aafafbd3db58fd4620121967a3e"> </div> <div id="comments" class="comment-wrapper comment-wrapper-nid-6196"> <h2 class="title">Comments</h2> <a id="comment-4443"></a> <div class="comment comment-by-anonymous ajax-comment-wrapper comment-wrapper-4443 clearfix" about="/comment/4443#comment-4443" typeof="sioc:Post sioct:Comment"> <h3 property="dc:title" datatype=""><a href="/comment/4443#comment-4443" class="permalink" rel="bookmark">I think the frailty is a</a></h3> <div class="submitted"> <a href="/comment/4443#comment-4443" class="permalink" rel="bookmark">Permalink</a> <span property="dc:date dc:created" content="2021-04-02T22:34:15+01:00" datatype="xsd:dateTime" rel="sioc:has_creator">Submitted by <span class="username" xml:lang="" typeof="sioc:UserAccount" property="foaf:name" datatype="">Mohamad Alhady ...</span> on Fri, 02/04/2021 - 22:34</span> </div> <div class="content"> <span rel="sioc:reply_of" resource="/blog/what-is-meant-by-%E2%80%9Cfrailty%E2%80%9D-in-the-context-of-undergraduate-medical-education" class="rdf-meta element-hidden"></span><div class="card-comment-body"> <p>I think the frailty is a condition of reduced strength, endurance, and physiologic reserve. It is characterized by decrease vulnerability to minor stressors.</p> <p>Frailty is diagnosed when 3 or more of 5 phenotypic components are present :</p> <p>Weight loss, weakness, walking speed become slow, exhaustion with low energy, and decline physical activities.</p> <p>Frail older adult is liable to disability, dependency, and even death.&nbsp;</p> </div> </div> <ul class="links inline"><li class="comment-reply first last"><a href="/comment/reply/6196/4443" class="use-ajax-comments ajax-comments-reply ajax-comments-reply-6196-4443">reply</a></li> </ul></div> <a id="comment-4451"></a> <div class="comment ajax-comment-wrapper comment-wrapper-4451 clearfix" about="/comment/4451#comment-4451" typeof="sioc:Post sioct:Comment"> <h3 property="dc:title" datatype=""><a href="/comment/4451#comment-4451" class="permalink" rel="bookmark">Thank you very much for your</a></h3> <div class="submitted"> <a href="/comment/4451#comment-4451" class="permalink" rel="bookmark">Permalink</a> <span property="dc:date dc:created" content="2021-04-06T13:01:48+01:00" datatype="xsd:dateTime" rel="sioc:has_creator">Submitted by <span class="username" xml:lang="" about="/users/emailregistrationjcuhzhuo7e" typeof="sioc:UserAccount" property="foaf:name" datatype="">email_registrat...</span> on Tue, 06/04/2021 - 13:01</span> </div> <div class="content"> <span rel="sioc:reply_of" resource="/blog/what-is-meant-by-%E2%80%9Cfrailty%E2%80%9D-in-the-context-of-undergraduate-medical-education" class="rdf-meta element-hidden"></span><div class="card-comment-body"> <p>Thank you very much for your post, I just have one comment, I finished my PhD this month. It was about understanding the implementation of frailty intervention in primary care. One key point that needs to be considered also is understanding older people&#39;s needs.&nbsp;&nbsp;Starting with what important to be considered from older people&#39;s perspectives? what matters to them? I think this is a key strategy that needs to be addressed in the future.&nbsp;</p> </div> </div> <ul class="links inline"><li class="comment-reply first last"><a href="/comment/reply/6196/4451" class="use-ajax-comments ajax-comments-reply ajax-comments-reply-6196-4451">reply</a></li> </ul></div> <a id="comment-4452"></a> <div class="comment ajax-comment-wrapper comment-wrapper-4452 clearfix" about="/comment/4452#comment-4452" typeof="sioc:Post sioct:Comment"> <h3 property="dc:title" datatype=""><a href="/comment/4452#comment-4452" class="permalink" rel="bookmark">Thank you very much for your</a></h3> <div class="submitted"> <a href="/comment/4452#comment-4452" class="permalink" rel="bookmark">Permalink</a> <span property="dc:date dc:created" content="2021-04-06T13:02:18+01:00" datatype="xsd:dateTime" rel="sioc:has_creator">Submitted by <span class="username" xml:lang="" about="/users/emailregistrationjcuhzhuo7e" typeof="sioc:UserAccount" property="foaf:name" datatype="">email_registrat...</span> on Tue, 06/04/2021 - 13:02</span> </div> <div class="content"> <span rel="sioc:reply_of" resource="/blog/what-is-meant-by-%E2%80%9Cfrailty%E2%80%9D-in-the-context-of-undergraduate-medical-education" class="rdf-meta element-hidden"></span><div class="card-comment-body"> <p>Thank you very much for your post, I just have one comment, I finished my PhD this month. It was about understanding the implementation of frailty intervention in primary care. One key point that needs to be considered also is understanding older people&#39;s needs.&nbsp;&nbsp;Starting with what important to be considered from older people&#39;s perspectives? what matters to them? I think this is a key strategy that needs to be addressed in the future.&nbsp;</p> </div> </div> <ul class="links inline"><li class="comment-reply first last"><a href="/comment/reply/6196/4452" class="use-ajax-comments ajax-comments-reply ajax-comments-reply-6196-4452">reply</a></li> </ul></div> <h2 class="title comment-form">Add new comment</h2> <form class="comment-form ajax-comments-reply-form-6196-0-0 ajax-comments-form-add" id="ajax-comments-reply-form-6196-0-0" action="/comment/reply/6196" method="post" accept-charset="UTF-8"><div><div class="form-item form-type-textfield form-item-name"> <label for="edit-name">Your name </label> <input type="text" id="edit-name" name="name" value="" size="30" maxlength="60" class="form-text" /> </div> <input type="hidden" name="form_build_id" value="form-LKfq4ChEoHx2B-EEHVtqkc0vxkgdLrmHUhHluGy6bSI" /> <input type="hidden" name="form_id" value="comment_node_blog_form" /> <div class="field-type-text-long field-name-comment-body field-widget-text-textarea form-wrapper" id="edit-comment-body"><div id="comment-body-add-more-wrapper"><div class="text-format-wrapper"><div class="form-item form-type-textarea form-item-comment-body-und-0-value"> <label for="edit-comment-body-und-0-value">Comment <span class="form-required" title="This field is required.">*</span></label> <div class="form-textarea-wrapper resizable"><textarea class="text-full wysiwyg form-textarea required" id="edit-comment-body-und-0-value" name="comment_body[und][0][value]" cols="60" rows="5"></textarea></div> </div> <div class="filter-wrapper form-wrapper" id="edit-comment-body-und-0-format"></div></div> </div></div><fieldset class="captcha form-wrapper"><legend><span class="fieldset-legend">CAPTCHA</span></legend><div class="fieldset-wrapper"><div class="fieldset-description">This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.</div><input type="hidden" name="captcha_sid" value="8311406" /> <input type="hidden" name="captcha_token" value="3418f326265f3aca2d3880ed4e22b054" /> <input type="hidden" name="captcha_response" value="Google no captcha" /> <div class="g-recaptcha" data-sitekey="6LdxcUsUAAAAABXmfqM-hujH0UGJIQjSzRbBKU2w" data-theme="light" data-type="image"></div></div></fieldset> <div class="form-actions form-wrapper" id="edit-actions"><input type="submit" id="edit-ajax-comments-reply-form-6196-0-0" name="op" value="Save" class="form-submit" /></div></div></form> </div> </article> </div> </section> <aside id="sidebar-second" role="complementary" class="sidebar"> <div class="sidebar-second-wrapper"> <section class="block block-views side-row"> <h2 class="block-title">Related</h2> <div class="view view-related view-id-related view-display-id-referenced view-dom-id-23df829e07a5c5148d16da49bdf8fcf7"> <div class="view-content view-content-main"> <div class="views-row views-row-1 views-row-odd views-row-first"> <div class="card-views-conditional"> <div class="field-content card-type">Resource</div> </div> <div class="card-date-display-override"> <div class="card-date">24 Jun 2020 (reviewed Jan 2023)</div> </div> <div class="card-title-et"> <h3><a href="/resources/frailty-hub-education-and-training">Frailty Hub: Education and training</a></h3> </div> </div> <div class="views-row views-row-2 views-row-even views-row-last"> <div class="card-views-conditional"> <div class="field-content card-type">Blog</div> </div> <div class="card-date-display-override"> <div class="card-date"><span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2018-07-09T00:00:00+01:00">09 July 2018</span></div> </div> <div class="card-title-et"> <h3><a href="/blog/the-paper-boat">The Paper Boat</a></h3> </div> </div> </div> </div> </section> </div> </aside> </div> </main> <footer id="site-footer" role="contentinfo"> <section class="footer-first"> <div class="outer-wrapper"> <section class="block block-views"> <div class="view view-footer-sections view-id-footer_sections view-display-id-orgs view-display-grid view-dom-id-3635818df32b8dabc79a0af4ae5f327f"> <div class="view-header"> <script> if(jQuery('#Main.CRM_Contribute_Form_Contribution_Main').length > 0){ jQuery('#Main.CRM_Contribute_Form_Contribution_Main').on('submit',function(e){ setTimeout(function(){ e.preventDefault(); 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