Date of Award
1-1-2019
Document Type
Open Access Thesis
Degree Name
Medical Doctor (MD)
Department
Medicine
First Advisor
Tracy L. Rabin
Abstract
Home-based care training is largely absent from internal medicine (IM) graduate medical education, and home-based care program evaluation largely focuses on resident attitudes and satisfaction, rather than impact on practice or the patient experience. In the 2015-16 academic year, the Yale Primary Care Internal Medicine residency program (YPC) incorporated required home visits for all PGY-1s and PGY-2s. These visits are intended to build unique clinical skillsets, enhance education about the role of psychosocial determinants of health, and potentially impact resident wellbeing. A qualitative method was used to evaluate this program with the goal of characterizing the impact of one-time home visits as an educational intervention for resident trainees, and as a home-based clinical care experience for patients. From July –Oct 2016 semi-structured interviews were conducted with YPC residents who had participated in home visits (n=9) and with visited patients from the resident panels (n=10). Patient and randomly chosen control charts were also reviewed for socio-demographics, healthcare utilization and co-morbidities (Charlson Co-morbidity Index) and data was analyzed using chi-squared significance testing. Interview analysis identified emerging themes. Key provider topics included: 1. Educational value; 2. Patient impact; and 3. Impact on burnout. Key patient topics included: 1. Provider relationship impact; 2. Improved communication; and 3. Resource connections. This work is unique in evaluating the impact that one-time visits with residents, can have for patients. As time investment and funding are often obstacles to program implementation in graduate medical education, this implies that even infrequent home visit opportunities can be a worthwhile addition to residency training for both residents and patients.
Recommended Citation
Rosenfeld, Amitte, "Home Visits In Internal Medicine Graduate Medical Education" (2019). Yale Medicine Thesis Digital Library. 3528.
https://elischolar.library.yale.edu/ymtdl/3528
