Sr. Counsell et al., RESIDENT TRAINING IN NURSING-HOME CARE - SURVEY OF SUCCESSFUL EDUCATIONAL-STRATEGIES, Journal of the American Geriatrics Society, 42(11), 1994, pp. 1193-1199
OBJECTIVE: To identify educational strategies for resident training in
nursing home care deemed successful by a large number of programs. DE
SIGN: A mail survey with three follow-up mailings. PARTICIPANTS: Direc
tors of accredited internal medicine and family practice residency pro
grams. MEASUREMENTS: Open- and closed-ended questionnaire eliciting cu
rricular content, instructional strategies, and evaluation techniques
from programs offering a nursing home experience. Identification of ba
rriers to implementation of a nursing home curriculum and recommendati
ons for success were requested. MAIN RESULTS: Of the 814 surveys maile
d, 537 were returned for a response rate of 66%. Nursing home experien
ces were required in 86% of family practice residency programs but in
only 25% of internal medicine programs. Most geriatric medicine curric
ular content areas were taught in the nursing home; however, relativel
y little emphasis was given to rehabilitation, organization, and finan
cing of health care, and coordination of care between acute and chroni
c settings. Direct patient care, bedside rounds, and lectures were the
most common instructional strategies reported. Evaluation approaches
included faculty observations, resident attendance, and chart reviews
with written and skill based examinations infrequent. Availability of
faculty and conflict with other rotations were identified as the princ
ipal barriers to implementation of nursing home rotations. An organize
d nursing home curriculum supervised by enthusiastic faculty using a l
ongitudinal rotation format with resident involvement in an interdisci
plinary team was recommended. CONCLUSIONS: Educational strategies exis
t for successful implementation of a residency nursing home curriculum
. Greater priority must be given to training residents in nursing home
care and developing nursing home faculty to substantially increase th
e number and quality of physicians who practice in this setting.