A Novel, Multi-Institutional Geriatrics Assessment Identifies Knowledge Gaps in Health Professions Trainees

TL;DR

A new assessment tool for geriatrics knowledge in medical students reveals significant gaps despite high self-reported preparedness.

Contribution

The development and pilot of the AF-KAT, a standardized geriatrics knowledge assessment for clinical trainees.

Findings

Only 25% of students reached a 70% passing threshold on the AF-KAT.

Curricular exposure and understanding of age-friendly systems significantly predicted performance.

Negative attitudes toward older people correlated with worse assessment performance.

Abstract

Medical students are expected to care for older people shortly after graduation, yet there are no standardized assessments of geriatrics knowledge. We describe the development and multi-site pilot of the Age-Friendly Knowledge Assessment Tool (AF-KAT), a new assessment evaluating Geriatrics knowledge in clinical trainees. The AF-KAT is a 20-item, case-based multiple-choice questionnaire written by Geriatrics experts and reviewed by general internists and professional editorial staff, including several rounds of peer-review for psychometric and content validity. The AF-KAT questions address the Geriatrics 5M’s and were mapped to updated Geriatrics competencies for medical students and residents. In the first at-scale deployment of this tool, we describe findings from the assessment of 275 graduating medical students across four medical schools (University of Washington, UTHealth Houston, Stanford, and Harvard). Participants self-reported their Geriatrics exposure, attitudes towards aging, and perceived sufficiency of training and completed the AF-KAT. Despite high self-reported preparedness, the mean proficiency score was 60%. Only 25% of students reached a “passing” threshold of 70%. Linear modeling revealed that more curricular exposure (β = 0.37*) and greater understanding of age-friendly systems (β = 0.55*) significantly predicted performance. Negative attitudes toward older people correlated with worse performance (r = -0.20***). This case highlights the feasibility and diagnostic value of using the AF-KAT as an individual-level and program-level assessment tool, with potential uses across health professions trainees. Results underscore the need for a universal and competency-based approach to Geriatrics education, to ensure new physicians are equipped to deliver competent, age-friendly care in an aging society.