Long-term care experience in an internal medicine residency program

J Am Med Dir Assoc. May-Jun 2002;3(3):125-9.


Objectives: To assess the impact of long- term care experience on internal medicine residents through prequestionnaires and postquestionnaires.

Design: A prospective study conducted from February 1999 to March 2000.

Setting: "Daughters of Israel," a 300-bed, long-term care institution in West Orange, New Jersey.

Participants: Twenty-five 3rd-year medical residents (PGY3) from Saint Barnabas Medical Center, Livingston, and Newark Beth Israel Medical Center, Newark, New Jersey, who each rotated in a long-term care setting.

Intervention: Medical residents completed validated questionnaires before and after their rotation.

Measurements: The questionnaire integrated three subcategories: self-reported skills, knowledge, and attitudes.

Results: Self-reported skills in performing: (a) Histories and physicals increased from mean of 3.65 to 4.48 (1 = low; 5 = high). P < 0.0005; (b) Functional assessment from mean of 3.47 to 4.53, P < 0.0005; and (c) Advance directive discussion from 3.78 to 4.37, P < 0.0005. All self-reported measures of knowledge in geriatrics increased significantly. All self-reported measures of attitudes toward the elderly also improved significantly. Career choice of geriatrics was not significantly altered by this experience.

Conclusions: There was improvement in self-reported skills, knowledge, and attitudes for medical residents completing a rotation in the nursing home. These conclusions were based on validated questionnaires and prospective data. Our results support recommendations by the American Medical Directors Association (AMDA)the American Geriatric Society (AGS) to include the long-term care setting as a site for the geriatric education of medical residents.