Home care services as teaching sites for geriatrics in family medicine residencies

Evaluating the physical and psychological constitution of elderly patients and their social and cultural environments requires skills that should be taught to all physicians in training. A survey was conducted among all accredited U.S. residency programs in family medicine to examine training in geriatrics. The teaching sites most commonly used by the responding programs were the family practice center (used by 96.4 percent), nursing home (81.9 percent), family medicine inpatient ward (62.4 percent), and home care service (HCS) (48.2 percent). The professional most frequently in contact with the resident during training at an HCS was the attending physician. Longitudinal rotations (that is, long-term rotations involving part of each week for months or years) in geriatrics were used more often than block rotations. The HCS rotations ranked highest in residents' evaluations were those in which the resident followed patients long-term and discussed problems and management with a multidisciplinary team. A combined rotation involving a family practice center, a family medicine inpatient ward, and a home care service is discussed as an alternative method of teaching geriatrics in family medicine.