Division of Geriatric Medicine and Gerontology, School of Medicine, the Johns Hopkins University, Baltimore, MD 21224, USA.
J Am Geriatr Soc. 2011 Jul;59(7):1340-9. doi: 10.1111/j.1532-5415.2011.03471.x. Epub 2011 Jun 30.
Physician house calls are an important mode of healthcare delivery to frail homebound older adults and positively affect patient outcomes and learner education, but most physicians receive scant training in home care medicine. A novel longitudinal curriculum in house call medicine for internal medicine residents was implemented in July 2006, and educational outcomes were evaluated over the following 3 years. The 2-year curriculum included didactic and experiential components. Residents made house calls with preceptors and alone and completed a series of computer modules outlining knowledge essential to providing home-based care. They discussed the important features of the modules in regularly scheduled small groups throughout the 2-year experience, and each taught a "house call morning report" in their senior resident year. Evaluation methods included surveys before, during, and at the end of the 2-year curriculum (knowledge and attitudes); direct observation by preceptors during house calls (skills); and an online, anonymous survey at the end of each year (attitudes). Results show statistically significant increases in residents' knowledge, skills, and attitudes relevant to home care medicine. Residents describe educationally significant and positive effects from their house call experiences. This novel curriculum improved medical residents' knowledge, attitudes, and skills in performing house calls for frail elderly individuals. The longer-term outcomes of this intervention will continue to be studied, with the hope that it may be used to help provide educational opportunities to prepare the physician workforce to meet the service needs of a growing segment of the population.
医生上门服务是为虚弱的居家老年人提供医疗服务的一种重要方式，对改善患者的治疗效果和学习者的教育成果有着积极影响，但大多数医生在家居护理医学方面的培训却少之又少。2006 年 7 月，我们为内科住院医师实施了一项新的家庭出诊医学纵向课程，在接下来的 3 年里对其教育成果进行了评估。该 2 年课程包括理论和实践两部分。住院医师在导师的指导下，或独自进行上门服务，并完成一系列概述提供居家护理必备知识的计算机模块。在整个 2 年的学习过程中，他们通过定期的小组讨论来探讨这些模块的重要特征，并且在高年级住院医师那年，每个人都要讲授一次“家庭出诊晨报”。评估方法包括在课程开始前、进行中和结束时（知识和态度）进行调查；导师在上门服务时进行直接观察（技能）；以及在每年结束时进行在线匿名调查（态度）。结果表明，住院医师在家居护理医学方面的知识、技能和态度均有显著提高。住院医师描述了他们从家庭出诊经历中获得的教育意义重大且积极的影响。这项新的课程提高了住院医师为虚弱老年人提供上门服务的知识、态度和技能。我们将继续研究该干预措施的长期效果，希望能够利用这些结果为医生提供更多的教育机会，使他们有能力满足不断增长的人口对医疗服务的需求。
