Reflections of Medical Students on Visiting Chronically Ill Older Patients in the Home

Abstract

The expanding number of Americans living with chronic illness necessitates educating future physicians about chronic illness care. Weill Cornell Medical College's Chronic Illness Care in the Home Setting Program (CIC-HSP), a mandatory part of the primary care clerkship, exposes medical students to persons with chronic illness via a half day of house calls with a geriatrics team. The investigators sought to qualitatively assess the effect of the CIC-HSP on medical students and recent medical graduates. Fifty-two prospective participants were approached, and 50 (96%) with varying training levels and time since completing the program were interviewed. Most respondents (63%) found that the home visits taught them important approaches to caring for the chronically ill, such as individualizing care to meet patients' individual needs and improving quality of life as a goal of care. Students remarked that the experience enhanced their empathy (18%) and sensitivity (20%) toward chronically ill patients and increased their appreciation for chronic illness care (35%). Many participants reported that patients were more empowered in the home (55%) and perceived greater rapport and warmth between the doctor and patient (57%) in the home (vs office) setting. The vast majority of recent medical graduates (84%) related that this educational exposure continued to positively influence their approach to patient care. A home visit experience with a geriatrics team can help foster medical students' understanding of the psychosocial and medical aspects of chronic illness, teach relevant approaches to patient care, and improve students' attitudes toward caring for the chronically ill.

Combining the Creative Arts and the House Call to Teach Medical Students About Chronic Illness Care

“…8 In a previous survey of 50 WCMC medical students and recent graduates regarding their home visit experience, the authors found that the house call exposure improved students' attitudes toward caring for chronically ill people and their understanding of the medical and psychosocial aspects of chronic illness care. 9 This current study expands upon and corroborates that research, with an added focus on how creative projects, group reflection, and faculty guidance enrich the understanding of chronic illness.…”

A Prospective Controlled Trial of the Influence of a Geriatrics Home Visit Program on Medical Student Knowledge, Skills, and Attitudes Towards Care of the Elderly

“…4 A recent qualitative report found positive effects on empathy and attitudes towards caring for the chronically ill based on interviews with medical students and recent graduates regarding a mandatory geriatric home visit experience. 5 This study has limitations. It is a single institution study.…”

“…6 Geriatric home visits can enhance geriatric and palliative care curricular content. 5,7 Similarly, narrative writing, where the learner reflects on the care provided or upon a critical incident, promotes reflection and may enhance professionalism. [7][8][9] At the Uniformed Services University, we developed a novel geriatrics home visit (GHV) program characterized by studentdriven patient selection, goal setting, independent study, and a structured reflective writing experience.…”

“…The American Geriatrics Society has called for major revision of the educational approaches to geriatrics, 2 and the Association of American Medical Colleges (AAMC) and Hartford Foundation recently published a set of minimum geriatric competencies for graduating medical students. 3 Home visits with geriatric patients improve attitudes towards caring for the elderly, 4,5 and medical educators recommend home visits to develop well-rounded physicians. 6 Geriatric home visits can enhance geriatric and palliative care curricular content.…”

Professional Writers and Empathy: Exploring the Barriers to Anticipating Reader Problems

“…The fourth strategy is based on experiential learning: students are forced to take the position of the patient and experience their reality. They may visit chronically ill people at home, talk with them, get to know them and see how they live [24]. They may even be forced to literally go through the experiences of patients, like the nursing students who had to wear disposable undergarments both dry and wet to experience continence management issues themselves [25].…”