What is meant by “frailty” in undergraduate medical education? A national survey of UK medical schools

Key summary points

Aim

UK medical schools are required to teach about frailty but the term is open to interpretation. This national survey aims to understand how frailty has been perceived and approached by schools.

Findings

Frailty is perceived and approached in a broad variety of ways ranging from a long term condition to geriatric medicine in its entirety. A range of educational approaches have been used to teach and assess, with little constructive alignment to match learning outcomes. Teaching is most commonly opportunistic, by a student observing geriatric ward rounds.

Message

Frailty is open to individual interpretation. Expert consensus should be reached regarding the core areas to include in UGME around the topic of frailty. It would be prudent to explore which frailty-related educational strategies enhance student knowledge, attitudes and values towards frailty.

Abstract

Purpose

All UK medical schools are required to include frailty in their curriculum. The term is open to interpretation and associated with negative perceptions. Understanding and recognising frailty is a prerequisite for consideration of frailty in the treatment decision-making process across clinical specialities. The aim of this survey was to describe how frailty has been interpreted and approached in UK undergraduate medical education and provide examples of educational strategies employed.

Methods

All UK medical schools were invited to complete an electronic survey. Schools described educational strategies used to teach and assess frailty and provided frailty-related learning outcomes. Learning Outcomes were grouped into categories and mapped to the domains of Outcomes for Graduates (knowledge, skills and values).

Results

25/34 Medical schools (74%) participated. The interpretation of what frailty is vary widely and the diversity of teaching strategies reflect this. The most common Learning outcomes included as “Frailty” are about the concept of frailty, Comprehensive Geriatric Assessments and Roles of the MDT. Frailty teaching is predominantly opportunistic and occurred within geriatric medicine rotations in all medical schools. Assessments focus on frailty syndromes such as falls and delirium.

Conclusion

There is variation regarding how frailty has been interpreted and approached by medical schools. Frailty is represented in an array of teaching and assessment methods, with a lack of constructive alignment to related learning outcomes. Consensus should be agreed as to what frailty means in medical education. Further research is required to explore which frailty-specific educational strategies in undergraduate medical education enhance learning.