First-Year Internal Medicine Residents' Reflections on Nonmedical Home Visits to High-Risk Patients
- 8 December 2017
- journal article
- research article
- Published by Taylor & Francis Ltd in Teaching and Learning in Medicine
- Vol. 30 (1), 95-102
- https://doi.org/10.1080/10401334.2017.1387552
Abstract
Problem: Patients who are high utilizers of care often experience health-related challenges that are not readily visible in an office setting but paramount for residents to learn. A nonmedical home visit performed at the beginning of residency training may help residents better understand social underpinnings related to their patient's health and place subsequent care within the context of the patient's life. Intervention: First-year internal medicine residents completed a nonmedical home visit to an at-risk patient prior to seeing the patient in the office for his or her first medical visit. Context: We performed a thematic analysis of internal medicine interns' (n = 16) written narratives on their experience of getting to know a complex patient in his or her home prior to seeing the patient for a medical visit. Narratives were written by the residents immediately following the visit and then again at the end of the intern year, to assess for lasting impact of the intervention. Residents were from an urban academic residency program in Baltimore, Maryland, USA. Outcome: We identified four themes from the submitted narratives. Residents discussed the visit's impact on future practice, the effect of the community and support system on health, the impact on the depth of the relationship, and the visit as a source of professional fulfillment. Whereas the four themes were present at both time points, the narratives completed immediately following the visit focused more on the themes of impact of future practice and the effect of the community and support system on health. The influence of the home visit on the depth of the relationship was a more prevalent theme in the end-of-the-year narratives. Lessons Learned: Although there is evidence to support the utility of learners completing medical home visits, this exploratory study shows that a nonmedical home visit can be rewarding and formative for early resident physicians. Future studies could examine the patient's perspective on the experience and whether a nonmedical home visit is a valuable tool in other patient populations.This publication has 23 references indexed in Scilit:
- In the Wake of the 2003 and 2011 Duty Hours Regulations, How Do Internal Medicine Interns Spend Their Time?Journal of General Internal Medicine, 2013
- Understanding Health Care as a Complex SystemJAMA, 2012
- Effects of a Focused Patient-Centered Care Curriculum on the Experiences of Internal Medicine Residents and their PatientsJournal of General Internal Medicine, 2011
- Educational Outcomes from a Novel House Call Curriculum for Internal Medicine Residents: Report of a 3-Year ExperienceJournal of the American Geriatrics Society, 2011
- Reducing Heart Failure Readmissions by Teaching Patient-Centered Care to Internal Medicine ResidentsArchives of Internal Medicine, 2011
- Primary Care and Accountable Care — Two Essential Elements of Delivery-System ReformThe New England Journal of Medicine, 2009
- The impact of low health literacy on the medical costs of Medicare managed care enrolleesThe American Journal of Medicine, 2005
- Hospital to HomeAcademic Medicine, 2003
- There's No Place Like Home: Evaluating Family Medicine Residents' Training in Home CareHome Health Care Services Quarterly, 2002
- Frustrating patientsJournal of General Internal Medicine, 1991