Out of the classroom and into the home: A mixed methods analysis of medical students' lessons learned from geriatric home visits

ABSTRACT

Home visits are an important and positive part of geriatric education for medical students (MS), but the main lessons learned by MS are not known. As part of the new Aging/End of Life Care curricular theme at Harvard Medical School, first year medical and dental students participate in older adult home visits with geriatrics faculty to learn about the geriatric assessment. Our mixed methods analysis explores students' main lessons learned. We collected anonymous evaluation forms from 310 students following a one-time geriatric home visit over a 3 year period. Using a 5-point Likert scale, MS rated their comfort with various aspects of geriatric assessment and rated whether their interest in geriatrics increased after the home visit. MS described two lessons learned. Two coders analyzed 604 lessons learned and identified major themes which were then organized into the Geriatric 5Ms Framework (Multicomplexity, Mobility, Mind, Matters Most, Medications). Qualitative and quantitative data were analyzed using Excel, Dedoose and JMP statistical software. A majority of MS (72%) reported their interest in geriatrics somewhat or greatly increased after the home visit. Of the 604 lessons learned that were coded, 51% related to mobility. 56% of responses related to multicomplexity, of which the most common was understanding different living facilities (43%). After a geriatric home visit, MS interest in geriatrics increases as they learn about applying the Geriatric 5Ms Framework. The most common lessons learned related to mobility and multicomplexity, essential areas of focus in a geriatrics curriculum. Though more difficult to arrange in the COVID-19 era, educational home visits are an important opportunity to increase MS interest in geriatrics and build their skills to improve the care of older adults.