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Keywords:

  • medical education;
  • house calls;
  • medical students;
  • narrative analysis

Objectives

To develop a house call experience for first-year medical students introducing them to challenges that homebound, chronically ill elderly adults face.

Design

During the semester, two students were paired with a preceptor to see two to three patients.

Setting

The house call practices of the Division of Geriatric Medicine at the University of Pennsylvania and the Philadelphia Veterans Affairs Hospital.

Participants

One hundred sixty-five first-year medical students.

Measurements

Pairs of students worked together to write an essay after the visit. Essays addressed specific areas, as detailed in a provided checklist, including noting patients' functional limitations, identifying community supports available to patients, and writing about general surprises that the students discovered during their visit. These data were then measured using narrative analysis.

Results

In all domains, students identified core goals and objectives. In the first domain (meeting challenges of functional limitations), students recognized the importance of family support. In the second domain (mentioning of functional limitation), high levels of compliance were seen. In the third domain (community support), students mentioned specific formal supports. In the fourth domain (surprises during the visit), students identified many important geriatrics concepts.

Conclusion

In writing their essays, students demonstrated a high level of recognition of functional impairment and noted the importance of family, social networks, and home environment in enabling homebound, chronically ill elderly adults to stay in their homes. Many students also demonstrated an awareness of the possibilities of independence and happiness despite significant illness and disability.