Youth-Elder Co-Learning Model in Psychiatric Long-Term Care Education: Mixed Methods Evaluation of Communication and Empathy Outcomes
Clinical Snapshot
PICO Framework
| P — Population | Adult learners and continuing education students (n=38, aged 19–64 years) enrolled in an 18-week elective community psychiatric long-term care course in Taiwan; 76.3% had no prior practical LTC experience |
| I — Intervention | Youth-elder co-learning instructional model integrating intergenerational contact, micro-movie discussions, and an intergenerational empathy board game within a structured 18-week curriculum |
| C — Comparator | No comparator group; single-group pre-post design with participants serving as their own historical controls |
| O — Outcomes | Primary: professional knowledge, communication competence, empathic development (self-assessed and peer-evaluated at pre-, mid-, and post-course). Secondary: overall learning satisfaction; qualitative narrative shifts identified via thematic analysis of reflective journals |
Bottom Line
This Taiwanese mixed methods study evaluates a novel youth-elder co-learning model for psychiatric long-term care education, integrating intergenerational contact, micro-movie discussions, and an empathy board game across an 18-week elective course. Among 38 adult learners, statistically significant improvements were observed in peer-evaluated outcomes and self-assessed communication competence, while self-assessed professional knowledge and empathy scores showed non-significant trends. Qualitative findings from reflective journals identified meaningful attitudinal shifts, including dismantling of generational stereotypes and translation of nonviolent communication theory into practice. Course satisfaction was high (92–95%). However, the study's single-group pre-post design without a control arm, small convenience sample, absence of effect sizes and confidence intervals, and reliance on self-report instruments substantially limit causal inference. Selection bias from elective enrolment and maturation effects cannot be excluded. The qualitative interpretation of non-significant empathy scores as reflecting 'reflective humility' — while theoretically plausible — remains speculative. For Australian educators in nursing, psychiatry, and aged care, this model offers a conceptually sound and low-cost pedagogical framework worthy of pilot adaptation, but adoption should await replication in controlled, multi-site trials before integration into core curricula.
Key Findings
P Value: Peer-evaluated outcomes: P<.001; self-assessed communication competence: P=.004; self-assessed professional knowledge: P=.14; self-assessed empathy: P=.09
Effect Size: Not reported
Primary Outcome: Significant improvements in peer-evaluated outcomes and self-assessed communication competence; non-significant improvements in self-assessed professional knowledge and empathy
Nnt Or Sensitivity: Not applicable for this educational intervention study; no NNT, sensitivity, specificity, or hazard ratio reported. Course satisfaction: 92.4–95.3%
Confidence Interval: Not reported
Clinical Application
The intervention components — micro-movie discussions, intergenerational board games, and structured reflective journaling — are relatively low-cost and adaptable to existing curricula. However, successful implementation requires access to older adult community participants for intergenerational contact, curriculum development resources, and faculty trained in facilitative pedagogy. Scaling beyond a single elective course would require institutional commitment and fidelity monitoring. Australia faces comparable demographic pressures, with the proportion of Australians aged 65 and over projected to reach 22% by 2066 (Australian Institute of Health and Welfare). The aged care and psychiatric nursing workforce faces well-documented shortages, highlighted by the Royal Commission into Aged Care Quality and Safety (2021). RACGP and ANMAC curricula increasingly emphasise person-centred communication and empathy in aged and mental health care. Intergenerational learning models align with the Australian Government's aged care reform agenda. However, direct adoption of this Taiwanese model would require cultural adaptation, particularly regarding intergenerational dynamics, and validation in Australian educational settings. No PBS or TGA considerations apply to this educational intervention. Nursing, allied health, and medical students or continuing education professionals undertaking training in aged care, psychiatric care, or community long-term care settings; particularly relevant for learners with limited prior clinical exposure
Abstract
BACKGROUND: Taiwan is projected to become a "super-aged" society by 2025, leading to an increasing demand for community psychiatric long-term care (LTC). This demographic shift necessitates frontline professionals equipped with specialized communication skills and deep empathy. However, traditional didactic teaching often fails to adequately prepare students for the complex emotional and practical challenges of real-world psychiatric caregiving. OBJECTIVE: This study aimed to evaluate the effectiveness of the innovative youth-elder co-learning instructional model, which uniquely integrates micro-movie discussions and an intergenerational empathy board game, on adult learners' professional knowledge, communication competence, empathic development, and overall learning satisfaction. METHODS: A mixed methods, single-group, pre-post design was used. The educational intervention was implemented within an 18-week elective community psychiatric LTC course. Participants included 38 adult learners and continuing education students (aged 19-64 years). Notably, the majority of the cohort (n=29, 76.3%) had no prior practical experience in LTC. Quantitative data were collected using self-assessed and peer-evaluated scales for professional knowledge, communication competence, and empathy at pre-, mid-, and post-course time points, alongside an end-of-semester course student feedback survey. Qualitative data were systematically gathered through structured reflective journals and analyzed using a rigorous 6-phase thematic analysis framework. RESULTS: Students reported high course satisfaction rates, ranging from 92.4% to 95.3%. Quantitative analysis revealed a notable divergence: there were significant improvements in peer-evaluated outcomes (P<.001) and self-assessed communication competence (P=.004), but there was more conservative, statistically nonsignificant growth in self-assessed scores for professional knowledge (P=.14) and empathy (P=.09). This discrepancy likely reflects adult learners' heightened awareness of professional complexity and self-reflective humility. Furthermore, the qualitative thematic analysis uncovered the following three narrative shifts: (1) the dismantling of generational stereotypes through authentic, face-to-face interaction with real older adults; (2) an empathic awakening regarding the often-invisible burden of family caregivers, catalyzed by the micro-movies; and (3) the successful translation of theoretical nonviolent communication concepts into real-time clinical problem-solving during board game role-plays. CONCLUSIONS: The youth-elder co-learning model shows promise as an innovative, experiential pedagogical approach. By bridging theoretical frameworks with authentic intergenerational contact, the intervention supported students in translating general empathic concepts into actionable communication competencies. However, given the exploratory nature of this study and the absence of a control group, the quantitative findings must be interpreted cautiously. Future research using randomized controlled trial designs across multiple institutions is warranted to establish definitive causal impacts.
References
- 1.Chueh, K.-H., Chen, J.-W., Lee, L.-A., Hsu, H.-I., Lin, Y.-J., & Wang, H.-T. (2026). Youth-elder co-learning model in psychiatric long-term care education: Mixed methods evaluation of communication and empathy outcomes. JMIR Medical Education. https://doi.org/10.2196/82812
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