Objective: To test the benefits, for medical students, of visiting elderly mentally ill patients at home.
Design: Third year medical students were assigned to a home-visit or a control group. Satisfaction with home-visit participation and attitudes toward geriatrics were assessed.
Materials and Methods: Third year medical students were randomly assigned to a home-visit condition or a control condition. Home-visit students attended one house call of a patient aged 65 or older who required psychiatric consultation, and were supervised by geropsychiatry attendings or fellows. Students submitted a written psychiatric evaluation, and contacted community-based agencies, physicians and social workers as part of the experience. The home-visit group was administered a questionnaire which contained 5 questions about the experience keyed to Likert scale responses (1= not at all useful, 4=extremely useful), with additional questions to allow comments. Both home-visit and control groups completed the Maxwell-Sullivan Attitudes scale (MSAS) at the beginning and end of their clerkship. The MSAS assesses physician views about geriatric practice, and includes sub-tests on “General Attitudes”, “Cost Effectiveness”, and “Therapeutic Potential” of geriatric practice, among others. It consists of 28 questions, keyed to Likert scale responses (1= strongly agree, 5=strongly disagree). Higher MSAS scores indicate more negative attitudes towards geriatric practice.
Results: To date 10 students have been randomized to home-visits and 18 to the control condition. Mean ratings from the home-visit questionnaire were: 3.5 (out of 4) for seeing the patient’s home environment ; 3 for conducting psychiatric evaluation in the home; 3 for contacting other people involved in patient’s care; 2.5 for writing the clinical evaluation; and 3.3 for overall experience. Positive comments from the questionnaire included observations that patients appear to be more comfortable being interviewed in the home environment and that important information about the patient’s illness can be obtained from observation of the home. Negative comments mainly concerned the time required to complete all activities. The mean MSAS scores for students in the home-visit condition at Time 1 (beginning of clerkship) was 87 with a standard deviation (s.d.) of 6.16, compared to 85.2 (s.d. = 6.22) at Time 2 (end of clerkship). For controls, the mean score at Time 1 was 90 (s.d. = 3.75), compared to 89.4 (s.d. = 6.51) at Time 2. The differences between Time 1 and Time 2 of mean MSAS scores were not statistically significant for either group as measured by paired Student’s t-test.
Conclusion: The home-visit questionnaires revealed that this educational experience, particularly the opportunity to see the home environment, was useful for medical students. We did not find a significant change in the student’s attitudes towards geriatric practice. With a larger study group we could look for effects of home visitation on sub-tests of the MSAS.
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