Student Guide for Geriatric Home Visit and Write-up
All students in the internal medicine clerkship are required to complete one home visit with a geriatric patient during the 10 weeks of the clerkship. This home visit will result in a structured semi-reflective paper that takes the place of one of your required clerkship papers. You will also discuss your home visit in your precepting group and with your ward or outpatient clinic attending.
Goals: This exercise is intended to accomplish several goals. It will allow you to learn some geriatric assessment techniques by providing you with greater experience with a geriatric patient. The home visit will allow you to continue to develop an appreciation of health care in the context of the patient's life. Also, the home visit will give you a better perspective on chronic diseases, may allow you to discuss end of life issues with a patient that you know, and will provide better understanding of the physician-patient relationship.
Process: You will identify an appropriate patient. The ideal patient is one in the geriatric age range who would benefit from a home visit, according to your attending, resident, or yourself. This should be a patient that you have treated, but could be another patient on the team if that patient is better suited for a home visit and you know that patient. Examples of patients appropriate for a home visit would be a patient with a history of falling, a patient who seems to not be taking his/her medications regularly, a patient with a terminal illness near the end of life, or a patient who requires home health care or attention from a spouse. You are not limited to choosing patients meeting these criteria - the choice of patient is determined by you in consultation with your ward team or clinic attending. If the patient you wish to visit is cognitively impaired, discuss the home visit with the patient's spouse or primary caregiver.
Second, you will complete the geriatrics overview module and at least two to three other modules applicable to your patient. Please let us know whether you have difficulty accessing the website. This student guide is available both in your handbook and on the website.
Third, you will visit with your patient with a partner during weeks 3-4 of the clerkship block. This visit could occur in the context of a visit to a nursing home, rehabilitation facility or as a home visit. Your partner should most commonly be another student, but may be a visiting nurse, a physician on your team, or when the visit is in the context of a nursing home or rehabilitation facility, the staff of the facility. If visiting your patient with another student, both of you will be excused from other clerkship activities for up to one half day to complete the visit (although hopefully you can arrange times that won't conflict with required activities). If you have difficulty identifying a suitable patient, or if you have concerns about arranging transportation, please contact your site director for assistance. If you are uncertain of the safety of your patient's neighborhood or home situation, speak to your site director, who can assist you with this.
You are not providing care for the patient. You are there to learn from the patient, who is serving as your teacher. If the patient raises questions about his/her health care, do not give advice, but refer the patient to his/her provider. Backup assistance can be obtained from the patient's primary provider and/or your site director. If you encounter an emergent situation, contact local emergency services (911).
Fourth, you will complete the Geriatrics Home Visit Write-Up. You may choose to visit a patient about whom you have already written a paper. You must write up your own patient. While we encourage students to accompany each other to the home visits, you must write up your own patient and not your colleague's patient. We anticipate that this paper will take about the same amount of time as a preceptor write up (4-6 pages, 6-8 hours of work).