The educational impact of home care in community medicine training in a Japanese medical residency program.

Abstract

In light of Japan's aging society, the number of homebound people is expected to increase, and health care services for such patients will need to expand. The authors implemented a one-month pilot program in a rural hospital, which uses home care as an educational tool to further resident interns' understanding in community medicine. The program was conducted for nine medical residents. Each resident was involved in a series of eight home visits, accompanied by an experienced nurse. Upon completion, to investigate the effect of the training program, the residents were interviewed about their experiences. Responses were analyzed by using qualitative methodology. Six categories for residents' learning emerged from the analysis. They included: fostering good doctor-patient relationships while recognizing psychosocial aspects, decision-making in view of ethics and patients' preferences, the value of teamwork, medical knowledge in geriatric care, consideration of the notion of home care itself, and the significance of local characteristics. It was found that home care experience with a geriatric team can not only help deepen the residents' knowledge and skills regarding geriatric care at home, but also foster the residents' attitude toward consideration of psychosocial aspects. It was concluded that initiating a home care program is both a valuable and useful educational tool for residents in managing chronic elderly patients. Residents achieved a new viewpoint which integrated both patients' and physicians' perspectives while witnessing patients' daily lives in the community.