Do geriatric home visits enhance learning of post graduate trainees ? – A qualitative study from Pakistan

Introduction: The Family Medicine Residency Program at the Aga Khan University, Karachi incorporated a didactic and clinical course on elderly care in 2009. To enhance experiential learning; a pilot home visit program was added for the final year residents. This was the first time that home visits were incorporated as part of post-graduate training in Pakistan. Home visits are unique as they allow physicians to assess and experience the health problems of the aged in their own environment. Objective: The objective of this study was to identify residents’ in-depth perspectives, positive and negative learning experiences of residents and to assess if nursing home visits were fulfilling the objectives of geriatric training. Method: Two batches of final year residents (n=9) consented to participate. Focused observations, focused group discussion (FGD) and phone interviews were conducted. A trained facilitator used broad questions made by the research team to explore participant perceptions. Responses were video- taped, transcribed and shared with participants for member checking. Phone interviews conducted were also recorded, transcribed and collated with data from FGD. Members of the research team then coded the data and generated themes independently which were then compared, merged and analyzed. Quotations by participants were documented. Result: The home visit experience was regarded as overwhelming positive and innovative. Uniqueness of nursing home visits in skill building was reported by most participants. Complexity of assessing and managing geriatric patients was acknowledged. Trainees expressed frustration with point of care testing and treatment adherence which hindered their learning in terms of patient outcomes. They also reported these visits as opportunities for self-reflection and introspection. One participant reported the possibility of choosing geriatrics as a career choice. Conclusion: The nursing home program strengthened geriatric knowledge and skills of trainees, fulfilling their learning objectives and provided a unique experiential opportunity to care for the elderly. Such programs may be replicated in regional universities to enhance geriatric skills in trainees.