Aims: To investigate how a Geriatric Evaluation and Management (GEM) rotation influences prevocational doctors' knowledge and attitudes toward care of older patients, and to find potential differences between domestic medical graduates (DMGs) and international medical graduates (IMGs).
Methods: The study’s setting was at Monash Health Kingston Centre's GEM wards involving prevocational doctors (DMGs and IMGs) from two rotation periods between 13th November 2023 and 14th April 2024. A mixed-methods approach was used, including quantitative surveys — such as a modified University of California Los Angeles geriatrics knowledge test (UCLA-GKT) and geriatrics attitudes scale (UCLA-GAS), self-assessed confidence ratings—and qualitative focus groups and interviews exploring participants’ perceptions and experiences.
Results: Upon rotation completion, UCLA-GKT scores increased by 9% (p=0.11) with greater score improvements in IMGs compared to DMGs (14.6% vs 8%), and attitude test scores declined (29 to 27.5). Qualitative analysis themes developed were: (1) ‘Adjust your lens’, (2) ‘More than [just] medical management', (3) ‘Understanding occupational therapy/physiotherapy concerns’, (4) ‘Lots of small acts of kindness’.
Conclusion: There is value in a post-graduate GEM rotation for prevocational doctors, irrespective of their intended specialty, where the experience challenged preconceptions and triggered transformative learning. The decline in attitude scores may indicate normalisation of frail older patients and difficulties capturing nuanced attitudes through quantitative assessments, suggesting that these should be interpreted alongside qualitative insights. Future geriatric medicine rotations should integrate opportunities for critical reflection such as structured debriefings and regular supervisor discourse to support reflective practice and a positive approach to care of older patients.