Integration of geriatrics into a spiral undergraduate medical curriculum in Pakistan: Evaluation and feedback of third-year medical students

Background: In the last decades there has been a sharp rise in the elderly population throughout the world. The unique needs of the elderly require a multidisciplinary and comprehensive medical approach. None of the 50 medical schools in Pakistan teach geriatrics in their undergraduate or postgraduate training. This paper discusses the development and implementation of the first geriatric curriculum in a medical school of Pakistan and its effect on knowledge and attitudes of third-year medical students. Methods: The curriculum was designed through collaboration and approval of various academic departments at the Aga Khan University in Karachi Pakistan. After a review of existing geriatric curricula at other institutions, a problem-based, inter-disciplinary spiral curriculum was designed. Strategy of student and course evaluation was planned and incorporated in the curricular program. No extra resources or funds were used. A component of the new curriculum was assessed by evaluating pre- and post- course knowledge, and seeking feedback from participating third-year students. Results: A significant improvement in mean scores for summed overall knowledge in geriatrics (pre-test mean 4.7 vs. post-test mean 6.4, p value of <0.001; out of a maximum possible of 9 was noted. Breakdown of knowledge mean scores into component areas of knowledge showed a significant increase in understanding in aging demographics (pretest 0.7 vs. post-test 1.7, p value of <0.001), geriatric history taking (pretest 0.64 vs. post-test 0.88, p 0.001) and geriatric assessments (pre- test 1.4 vs. post- test 1.7, p value 0.01). A strong majority (87%) of the students felt that the overall course objectives were achieved. All students were satisfied with the quality of teaching, 90% rating it good or higher. Conclusion: An important advance in medical education was achieved via integration of a low cost, spiral geriatrics curriculum in a medical university of Pakistan. We found that introduction of the geriatric curriculum improved the knowledge of third-year medical students. This was our school's initial step towards building professional capacity in response to a rising elderly population.