RESIDENT TRAINING IN NURSING-HOME CARE - SURVEY OF SUCCESSFUL EDUCATIONAL-STRATEGIES

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.