Abstract
Introduction
In the context of an ageing population, the demand for specialized health services for older adults is increasing rapidly, but the number of physicians capable of providing these specialized services is extremely limited. This study aims to explore the impact of a social practice intervention program for older adults on medical students’ future career choices.
Methods
A total of 558 students majoring in clinical medicine at the Clinical College of Anhui Medical University were divided into 2 groups, an intervention group and a control group. The intervention group performed social practice activity for older adults, whereas the control group did not. A multidimensional assessment, including self-evaluation, course participation, course performance and career development, was administered to evaluate the impact on students over 2 years. Chi-square (χ2) tests and t tests were performed in SPSS. P < .05 was considered to indicate statistical significance.
Results
Social practice activities increased medical students’ interest in learning (P < .05) and influenced their future career choices (P < .05).
Conclusions
Regular social practice activity for older adults may enable more medical students to potentially become geriatricians and neurologists in the future, thereby contributing to healthy ageing.
Introduction
According to the 7th national census, by 2020, 18.7% of China's population was over 60 years old and 13.5% of the population was over 65 years old. 1 Nowadays, this means that people aged 60 and above make up at least one-fifth of the total population in China. China has therefore become one of the countries with the largest older population in the world. 2 The United Nations estimated that by 2050, there will be 395 million people older than 65 and 135 million older than 80 in China. 3 Due to the ageing of the population, people's life expectancy continues to increase. Various geriatric syndromes such as frailty, cognitive impairment and ageing occur continuously, significantly reducing the quality of life of older adults and increasing the risks of a series of adverse health events including falls,4,5 fractures, 6 disability, 7 hospitalization 8 and even death. 9 A large cross-sectional study in China reported prevalence rates of 6.0% for dementia, 3.9% for Alzheimer's disease, and 15.5% for mild cognitive impairment among people over 60 years of age. 10 Nearly a quarter of individuals with dementia live in China. Therefore, the Chinese government also faces considerable economic 11 and health burdens. 12 Consequently, the demand for professional and specialized services catering to older adults is also increasing sharply. 13
In contrast to the increasing number of professional and specialized services for older individuals, the number of physicians who can provide these specialized and dedicated services to older adults is significantly limited. 14 There might be several reasons for this contradiction. First, the rapid increase in population ageing is difficult to manage in the context of the previously stable health care system. 15 Then, people have not yet realize the importance of providing health services for older adults when they plan their future careers; thus, they ignore the possibility of becoming neurologists or geriatricians.16,17 To increase the happiness and independence of older adults later in life in accordance with the concept of healthy ageing proposed by the World Health Organization, there is a strong demand for clinical physicians who can provide specialized and professional health services. 18 Accordingly, it is necessary to inspire and encourage more medical students to become physicians who serve older adults (eg, neurologists and geriatricians). To date, however, rarely studies have explored on this aspect.
To help medical students realize the importance of serving older people, it is beneficial to bring them closer to older adults at an early stage, such as through social practice activities for older adults. In China, it is common for college students to engage in many types of social practice activities. 19 Therefore, we hypothesize that providing regular social practice activities to older adults can help medical students develop awareness about providing health services to older population in the future. This study aimed to examine the effects of a 2-year social practice program to older adults on medical students’ career development in helping older adults in the future.
Methods
Design
This study employed a quasi-experimental design. All participants independently applied to and enrolled in the same course, and they were unaware of the specific practical content when they signed up. According to the different social practice targets, the course naturally formed 2 groups: the intervention group with older adults as the practice object, and the control group with nonolder adults as the practice object. Students in the intervention and control groups were both assigned to participate in different forms of social practice activities on weekends from September 2023 to September 2025 in Hefei City, Anhui Province. All the students participating in this study were required to sign a paper-based informed consent form. These informed consent forms were uniformly kept by the project leader for a period of 5 years after the project concludes. This study was approved by the medical ethics committee of Anhui Medical University (Approval No. 84230109).
Participants
The inclusion criteria for this study were as follows: (1) junior undergraduate students majoring in clinical medicine, (2) voluntary participation in this study and signing a paper-based informed consent form and (3) Students who have no serious violation of discipline, and have never received any disciplinary actions during their school years. The exclusion criteria was students with special circumstances such as suspension from school or dropping out.
A total of 568 juniors majoring in clinical medicine at the Clinical College of Anhui Medical University were recruited. Among them, 10 of these students refused to participate. Therefore, 558 students were ultimately included. To ensure that the students can successfully complete the 2-year social practice program, the department would provide them with the corresponding practice certificates (Figure 1).
Study Flow Diagram.
Blinding
This study employed a single-blind design. All the social practice activities had been arranged in advance. This social practice program was conducted in the form of an elective course. All the participating students not only obtained the corresponding practical certificates, but also earned the corresponding credits. To reduce selection bias, when students chose courses, they can only see the course names but cannot know the specific practical contents. Moreover, the system for selecting social practice positions was randomly assigned and available on a first-come, first-served basis. However, the back-end administrators, including the project leader, can view the course selection situation at any time in the course selection system.
Interventions
This social practice program was essentially an experiential learning program. All the participating students were arranged to take part in various forms of social practice activities on Saturday or Sunday, each activity lasting for 1 to 2 h. The specific social practice service arrangements are detailed in Table 1.
Details of the Social Practice Arrangements.
Assessment
This study systematically evaluated the effectiveness of social practice intervention by integrating the Kirkpatrick Model. 20 Accordingly, a multidimensional assessment was administered in this study. The assessment covered 4 main aspects: self-evaluation, course participation, course performance and career development (Figure 2). The students self-reported their interest in learning gerontology and neurology via a 5-point Likert scale with the following response options: very uninterested, uninterested, neutral, interested and very interested. Course participation was evaluated by randomly checking the students’ attendance rates for 10 times on gerontology and neurology over the 2-year study period. Course performance was measured on the basis of final exam scores (out of a total score of 100 points) for subjects including gerontology and neurology. Career planning was evaluated by assessing students’ professional choices made in the 5th year, which was the year before graduation. The specific assessment time is detailed in Table 2.
Multidimensional Assessment.
Details of the Specific Assessment Time.
Statistical Analysis
SPSS 23.0 software (SPSS, Hefei, China) was used to perform chi-square (χ2) tests and independent-samples t tests for between-group comparisons. Class attendance and course performance data are presented as means with standard deviations. Other variables are expressed in terms of frequency. P < .05 was the threshold for statistical significance.
Results
The average ages of the students in the intervention and control groups were 21.11 ± 0.83 and 21.10 ± 0.78 years, respectively. There were 149 males in the intervention group and 170 males in the control group. The intervention and control groups did not differ significantly in terms of age or sex (P > .05).
Learning Interest Differed Significantly Between Groups
The results revealed that the intervention group reported greater interest in learning gerontology and neurology than the control group did (P = .000) (Figure 3). However, the vast majority of the students did not show interest in learning about geriatrics or neurology (Table 3).
Questionnaire of Interest in Learning About Gerontology and Neurology Among Different Groups.
Questionnaire of Interest for Different Groups.
Course Attendance and Exam Scores Did Not Differ Significantly Between Groups
There was no significant difference in class attendance between the intervention group and the control group (P = .069). The mean neurology exam score in the intervention group was 73.92 ± 11.22, and the mean gerontology exam score was 77.51 ± 8.50. In the control group, the mean neurology exam score was 72.95 ± 10.97, and the mean gerontology exam score was 76.18 ± 8.64. There were no significant differences in neurology exam scores and gerontology exam scores between the intervention group and the control group (P = .308, .069) (Table 4).
Characteristics of Class Attendance and Scores in Different Groups.
Medical Specialty Choices Differed Significantly Between Groups
The medical specialty choices of the intervention group and the control group at graduation were compared. The intervention group was more likely to choose geriatrics and neurology than the control group was. In the intervention group, 8.91% of the students chose the gerontology specialty, and 7.29% chose the neurology specialty. In the control group, 3.54% of the students chose the gerontology specialty, and 2.89% chose the neurology specialty (Figure 4). The differences between the groups were significant (P = .001) (Table 5). These data indicate that regular social practice activities to serve older adults can influence medical students’ subsequent career development and planning. Moreover, the results also suggest that few medical students in the control group intended to serve older adults in the future.
Major Choice for Different Groups.
Major Choice for Different Groups.
Discussion
Given the context of global population ageing, more medical students, such as those specializing in geriatrics and neurology, are needed to become clinical physicians who serve older adults in the future. Therefore, it is necessary to increase medical students’ awareness of providing health services for older adults at an early stage. In this study, a 2-year social practice program that involved serving older adults as a special experience was implemented to evaluate the impact on medical students. Meanwhile, the Kirkpatrick Model was used to systematically assess the effectiveness of social practice interventions.
Interpretation of the Impact of Social Practice on Academic Performance
In our study, compared with the control group, the intervention group that participated in the older orientation social practice did not show statistically significant advantages in the examination results of neurology and geriatrics courses. This result may suggest that the main mechanism of the impact of such experiential learning programs lies in their influence on the social and emotional aspects (such as attitudes, empathy, and career identity), rather than their direct effect on the memorization of structured knowledge. The examination results in neurology and geriatrics can be used as an assessment tool. Their sensitivity may be more focused on “what is known” (accumulation of knowledge), rather than “what is felt” or “what is intended to be done” (attitude and intention). Standardized tests often fail to capture the implicit learning outcomes derived from social practice activities, such as communication skills, an understanding of the complexity of the elderly population, and the internalized attitude changes in combating age discrimination. The design logic of this social practice intervention is to reduce the unfamiliarity and stereotypes toward older adults through a cycle of “contact–experience–reflection,” and to cultivate empathy and service motivation. This kind of experiential learning has its effects more directly reflected in emotional attitudes, behavioral intentions and career values. The improvement of exam scores usually requires systematic knowledge organization, repeated memorization, and problem-solving training, which is different from the main output path of experiential learning.
Interpretation of the Impact of Social Practice on Learning Interest and Professional Attitude
The results of this study show that although there was no difference in the knowledge dimension between the intervention group and the control group, there was a significant difference in learning interest. This suggests that the direct effect of a limited number of social practices may primarily influence the “response” (satisfaction, interest) dimension of the participants rather than immediately translating into a memory advantage for highly structured textbook knowledge. More importantly, in this study, the intervention group showed a positive trend in career intentions compared to the control group. Our findings indicate that social practice programs aimed at influencing medical students’ long-term career choices should focus on indicators such as attitudes, beliefs, and career planning, rather than relying solely on traditional written test scores. This result supports the view that a diversified assessment system is needed in medical education. At the same time, it also indicates that improving students’ willingness to serve the older population and enhancing their knowledge of geriatric medicine are 2 independent goals that medical education curriculum designers should consider simultaneously but may adopt different teaching strategies. Future research needs to conduct long-term tracking to evaluate whether these early positive attitudes truly translate into clinical behaviors and practice choices.
Conclusion
This study systematically examined the effectiveness of social practice intervention using the Kirkpatrick Model framework. It was found that regular older social practice interventions can significantly influence the career choice intentions of medical students in the future.
Limitations
Some limitations in this study can be list as follows: First, the calculation and justification of the sample size selected for this study was not done. Second, the social practice project adopted in this study is essentially an experiential learning project. Due to the extremely small number of students who refused to participate, a blank control group was not involved, which consequently affected the scope of the results of this study. Future studies will need to incorporate larger sample sizes and conduct fully randomized controlled experiments to verify the results of this research. Then, in this study, when allocating the intervention group and the control group, no complete randomization, controlled trial, or double-blind method was followed, which may lead to selection bias. Future study designs should employ randomization after consent to avoid this bias. Finally, in this study, only the final exam scores of the course were used as the evaluation indicator for knowledge acquisition. Future research could explore the development of assessment tools that can better reflect the comprehensive care capabilities of older adults in clinical situations, or conduct longer-term follow-ups to observe whether the early attitude changes will be transformed into more positive knowledge-seeking behaviors and deeper knowledge integration in the subsequent clinical internship stages.
Footnotes
Ethics Approval and Consent to Participate
The study was approved by the academic ethics committee of the Clinical College of Anhui Medical University (Approval No. 84230109). All students provided written informed consent to participate in this study when they agreed to participate, which was conducted in accordance with relevant guidelines and regulations.
Author Contributions
J.H.H. and Q.S.W. were responsible for the conception and design of the study; J.H.H. interpreted the data; J.H.D., S.Y.Z., Y.J.F., and N.W. prepared the figures and tables and collect the data; J.H.H. wrote the first draft of the manuscript, interpreted the data, and wrote the final version. All authors critically revised the article for important intellectual content and read and approved the final version.
Funding
This work was supported by the Project of Natural Science Research of Anhui Province in 2021, the Project of Natural Science Research of Anhui Province in 2025, the Key Teachers of the Clinical College of Anhui Medical University, the Research Project of Education and Teaching Reform of Anhui Province in 2023, the Research Project of Education and Teaching. Reform of Anhui Province in 2024, the Project of Health Commission of Hefei City's Applied Medical Research, and School-level Specialized Educational Reform Project in 2025 (Grant Nos. KJ2021A1229, 2025AHGXZK40211, 2025GGJS005, 2022JYXM783, 2023JYXM0985, HWK2024YB004, and 2025XJ022).
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Availability of Data and Materials
The datasets generated and analyzed during the current study are not publicly available but are available from the corresponding author upon reasonable request.