The landscape of frailty
: Current perceptions of and approaches to frailty in undergraduate medical education

  • Rebecca Winter

    Student thesis: Doctoral Thesis


    Background: Frailty has important implications for the individual, for society and for how doctors are trained. UK Medical schools are now required to teach and assess medical students about frailty, yet the term is open to interpretation and it remains unclear what teaching or assessing frailty means in practice.

    Aim: To describe the current landscape of frailty in undergraduate medical education, specifically how frailty is perceived, discussed and approached in literature, at an institutional level, and within learning environments. To explore how these understandings may influence what is being taught and learnt about frailty.

    Methods: This thesis combines visual research methods with a scoping review, a national survey of UK medical schools, and responsive interviews involving 22 clinical teachers and medical students, analysed through reflexive thematic analysis.

    Results: There is widespread variation as to how frailty is perceived, approached and discussed in undergraduate medical education. Areas of consensus exist as to what should be included as core topics including the concept of frailty, Comprehensive Geriatric Assessment and roles of the multidisciplinary team. Across all methods, it was found that frailty was discussed as an adjective. This appears to lead to a binary and colloquial understanding of frailty, which has implications for practice; frailty is recognised through clinical gestalt; frailty is one-way towards death; a frailty status determines (and limits) clinical decisions; frailty is perceived as the responsibility of geriatricians; frailty as a term is problematic. Medical students have limited scope of reference to support their clinical reasoning about frailty; they do not ‘see’ frailty outside the context of geriatric medicine; they have little cues to base their diagnosis; are uncertain how to translate decision making into action; and are conflicted in the use of the term clinically and in educational sessions.

    Conclusion: The context in which a patient with frailty is seen and the use of frailty as an adjective appear to be key as to what medical students learn about frailty. Recommendations include; frailty should be explicitly discussed and signposted to students; patients with frailty should be involved in the planning and delivery of education; clinical reasoning about frailty may be enhanced through reflection on action; training and assessments should represent the complexity of reality; students should learn about frailty as a spectrum, across the context of primary and secondary care, potentially through longitudinal integrated clerkships.
    Date of AwardJun 2021
    Original languageEnglish
    Awarding Institution
    • University of Brighton
    SupervisorJuliet Wright (Supervisor) & Helen Johnson (Supervisor)

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