Correspondence

Medical Schools and Home Care

N Engl J Med 1994; 331:1098-1099October 20, 1994

Article

To the Editor:

As hospital stays are shortened and the population ages, more care must be provided at home. Physicians must be prepared to supervise home care as well as to provide it. Given the continuing evolution of vertically integrated health care systems, all physicians, both generalists and specialists, need to have these clinical skills and to understand the home care services available and the logistics of providing them.1-3 This is true whether home care is coordinated with hospital care, used instead of institutional care, or used to ensure the provision of the most humane and cost-effective care.4,5 Furthermore, by law physicians are required under many programs to authorize home care services.

We surveyed the 129 deans of education of all U.S. medical schools and affiliated campuses and received 123 responses. Only 66 schools (54 percent) offered some kind of home care training, and the experience varied markedly. Usually it consisted of an elective. Only 18 schools (15 percent) reported offering lectures on home care. Only 15 of the 123 schools (12 percent) required students to have a home care experience in the first two years, and 27 more (22 percent) required it in the last two years. In some programs the experience consists of a single home visit. In only three schools do all students make six or more home visits in the clinical years.

The present system of medical education in the United States prepares students inadequately to care for patients in the home. Medical-school faculties are responsible for designing a curriculum and ensuring that it is current and relevant to the needs of the population served. We earnestly hope that the curriculum committees of medical schools begin to address this deficit soon.

R. Knight Steel, M.D.
Melissa Musliner, M.A.
World Organization for Care in the Home and Hospice, Washington, DC 20002

Peter A. Boling, M.D.
Medical College of Virginia, Richmond, VA 23298

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Citing Articles (5)

Citing Articles

1. 1

   Helen Kao, Rebecca Conant, Theresa Soriano, Wayne McCormick. (2009) The Past, Present, and Future of House Calls. Clinics in Geriatric Medicine 25:1, 19-34
   CrossRef

2. 2

   Joseph H. Flaherty, Diana A. Fabacher, Roberta Miller, Andrea Fox, Jeremy Boal. (2002) The Determinants of Attitudinal Change among Medical Students Participating in Home Care Training. Academic Medicine 77:4, 336-343
   CrossRef

3. 3

   B. Leff, J. R. Burton. (2001) The Future History of Home Care and Physician House Calls in the United States. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 56:10, M603-M608
   CrossRef

4. 4

   (1998) House Calls. New England Journal of Medicine 338:20, 1466-1468
   Full Text

5. 5

   Marshall B. Kapp. (1995) Family caregiving for older persons in the home. Journal of Legal Medicine 16:1, 1-31
   CrossRef