title: When Contact Is Not Enough: Affecting First Year Medical Students' Image towards Older Persons.
abstract: BACKGROUND
  Many medical schools have initiated care internships to familiarize their students with older persons and to instil a professional attitude.
  
  
  OBJECTIVE
  To examine the impact of care internships on the image that first-year medical students have of older persons and to explore the underlying concepts that may play a role in shaping this image.
  
  
  METHODS
  Survey before and after a two-week compulsory care internship using the Aging Semantic Differential (ASD; 32 adjectives) and the Attitudes toward Old People (AOP; 34 positions) questionnaires.
  
  
  METHODS
  Before and after a care internship involving interpersonal contact, 252 and 244 first-year medical students at the Leiden University Medical Centre (LUMC) in the academic year 2012-2013 participated.
  
  
  METHODS
  Descriptive statistics, analyses of variance, and principal component analysis were used; clusters of adjectives and positions were reduced into concepts to examine dominant patterns of views. Changes in image were investigated as mean differences of the total and concept scores.
  
  
  RESULTS
  Both the ASD and the AOP questionnaires showed a poor general image of older persons that significantly worsened after the care internship (p < 0.01). The percentage of students considering over 75 years as being old increased from 17.2% to 31.2% (p < 0.01) and those who thought they would find as much satisfaction in care for older as for younger patients decreased from 78.5% to 62.1% (p < 0.001). Exploratory principal component analysis showed particularly low scores on 'comportment' and 'pleasurable interaction' whereas the scores on 'personality traits' and 'habitual behaviour' significantly deteriorated (both p < 0.001). These patterns were irrespective of the student's gender and previous contact experience.
  
  
  CONCLUSIONS
  Medical schools should carefully consider care internships to ensure that students do not worsen their views on older patients, which may occur due to inadequate contact depth and quality within a rather unsupportive context.
authors.affiliation: Department of Public Health, and Center for Healthy Aging University of Copenhagen, Copenhagen, Denmark.
authors.forename: Sasmita
authors.identifier: http://orcid.org/0000-0002-7748-1514
authors.initials: S
authors.lastname: Kusumastuti
authors.affiliation: Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: van Fenema
authors.affiliation: Leyden Academy on Vitality and Ageing, Leiden, the Netherlands.
authors.forename: Eugenie C F
authors.initials: EC
authors.lastname: Polman-van Stratum
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Wilco
authors.initials: W
authors.lastname: Achterberg
authors.affiliation: Leyden Academy on Vitality and Ageing, Leiden, the Netherlands.
authors.forename: Jolanda
authors.identifier: http://orcid.org/0000-0003-2547-9903
authors.initials: J
authors.lastname: Lindenberg
authors.affiliation: Department of Public Health, and Center for Healthy Aging University of Copenhagen, Copenhagen, Denmark.
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D025341:Principal Component Analysis; D013337:Students, Medical / Q000523:psychology*; D055815:Young Adult