Photo-elicitation for teaching awareness of age-related biases: the experience of infusing gerontology into a medical humanities curriculum

Abstract

Background and Aims With the increased exposure to frail and vulnerable older patients coupled with recent advances in anti-ageing and regenerative medicine, medical students may develop the tendency to view the ageing negatively. Age-related biases in medical students might include seeing ageing as a frustrating process of decline, infirmity and decay, or assuming older adults are inherently “end-of-life” patients. A recent cross-sectional survey in China reported that first-year medical students had more favourable attitudes toward older adults than senior students, suggesting that attitudes on ageing might have been affected by knowledge in the medical school. In Hong Kong, data showed that general public and healthcare professionals would prioritize the young than the old when it comes to allocating healthcare resources. This phenomenon is perhaps even more worrisome at a time that the COVID pandemic has exacerbated intergenerational tension, and that society’s rationing of healthcare resources on some occasions have been based arbitrarily on chronological age. Recently, the United Nations Decade of Healthy Ageing (2021-2030), adopted by consensus in the UN General Assembly on December 14, 2020 (Resolution 75/131), is calling for international action to “change how we think, feel and act towards age and ageing”. Methods In 2019-20, a total of 71 Year 4 MBBS students and 14 older adults participated in a 3-hr mandatory photo-elicitation Workshop as part of a “Campus Ageing Mix Project for University Students” (GIE-CAMPUS) and implemented under a longitudinal Medical Humanities (MH) Curriculum at The University of Hong Kong. The Workshop intended to elicit stereotypical views and unconscious biases, to evoke personal experiences, and to enable insight into participants' previously unexplored age-related beliefs. We designed the Workshop based on intergroup contact theory and a student-driven approach to learning, inviting students to contribute real-life images which illustrated their personal perceptions of the human ageing process, followed by in-depth intergenerational exchange with senior volunteers. Prior to class, students were asked to take photos from their daily in response to the trigger question “What is Ageing?”. In class, intergenerational small-group discussions were convened to jointly uncover hidden assumptions and to reconstruct meanings of these photo prompts. Results Student attitudes towards older generation and the process of ageing were assessed before and after the workshop using Chinese version of Kogan’s Attitudes toward Older People (KAOP), a popular scale that consists of 34 items regarding impression of older people. After class, these student attitudes toward 'being old' have significantly improved (100% response rate). Myriad topics, from “beauty of ageing”, “polypharmacy”, “loneliness”, “autonomy”, to “healthy ageing”, were covered during class time. A limitation was that senior volunteers participating in this teaching initiative were all well-educated, healthy, financially independent older adults with no functional disability. Students could mentally compartmentalize these senior volunteers and frail older patients in the wards. Conclusions The workshops offered a unique space within the MBBS curriculum for medical students to reflect upon their own personal perceptions of the human ageing process and their prior exposure to topics of ageing in the medical school.