Development and utilization of vignettes in assessing medical students' support of older and younger patients' medical decisions.

Currently no appropriate vignettes exist to examine issues of age-based care among students early in their medical careers. This paper addresses that issue in two parts. First, as the development of vignettes, widely used in medical research, is rarely described, suggestions for developing reliable and valid vignettes are presented. These suggestions are derived from the development of a series of vignettes assessing the support of older and younger patients' medical decisions among first year medical students. Second, the responses to the vignettes were analyzed quantitatively and qualitatively to assess potential age-based biases. Results indicate that students do not differ in their level of support for older and younger patients' medical decisions. However, students are more supportive of patients who desired aggressive treatments than of those who wished to end treatment. Many students did not focus on the age of the patient, but instead on the patient's quality of life.