A competency-based medical student curriculum: taking the medication history in older adults

Older adults are the largest consumers of prescription medications. Taking multiple medications, which interact with medical, psychological, and socioeconomic factors, increases a person's risk of nonadherence and adverse events. A curriculum was developed to train medical students to identify these risks and make recommendations for improving medication safety. The curriculum, consisting of a self-study computer tutorial, a small-group simulated-patient (SP) experience, and an online competency assessment, was implemented in the students' second year of training. Groups (N = 28) of five to seven students interviewed the SP and were assessed on their ability to identify medication concerns (N = 18) and make recommendations (N = 18) on improving medication safety. On average, student groups identified 16.1 concerns and made 15.4 recommendations. On the competency assessment several months later, students were given a case scenario and again asked to identify concerns (N = 7) and make recommendations (N = 7). Students (N = 176) were required to achieve a preset performance standard on the assessment. A high percentage (97.2%) of students achieved the standard (a score of 8/14) on their first attempt; the remainder achieved the standard on their second attempt. Student evaluations indicated high levels of satisfaction with the curriculum. The learning objectives, competency assessment, and instructional activities were closely aligned. Instructional activities provided students with an opportunity to practice the competency in a nonthreatening environment. The SP session materials are available through MedEdPORTAL and can readily be incorporated by other institutions into existing curricula.