Evaluating Resident Home Visit Performance: Introducing a Feedback Form Linked to ACGME Milestones

Home visits (HVs) are increasingly important in ensuring access to healthcare as the US population ages. In individual exit interviews, our family medicine (FM) residents described an enhanced recognition of the difficulties that older adults face and were able to develop more insightful treatment plans by seeing patients at home, which is also supported by the literature. Because HVs have a positive effect on patient care and provider attitudes, The Christ Hospital/University of Cincinnati Family Medicine Residency Program created a home-based primary care (HBPC) practice, incorporating an HV curriculum for FM residents and a direct observation form (DOF) described in this article. The longitudinal HV curriculum provides exposure to HBPC for interns in the first 3 months of residency. The ultimate goal of the curriculum is to increase exposure to HVs, geriatric care, and social determinants of health (SDoH) while providing residents with the skills, confidence, and willingness to include HVs in their future practices. Residents have protected time to see patients in the home setting progressing through increasing roles of responsibility, decision making, and autonomy. First-year residents accompany the physician to see established HBPC patients. Attending faculty moves from role modeling to a precepting role over the course of the visits. Secondand third-year residents perform visits to continuity patients with the faculty preceptor in a teaching and observation role. The preceptor protects time for debriefing after each half-day session. By the end of residency, every participant will have completed a minimum of 10 HVs. Residents are assessed with post-visit faculty debriefs, end-of-year attitude surveys, and exit interviews. Results from surveys/interviews are forthcoming. We also added a DOF to track ability quantitatively throughout residency and give residents additional feedback to guide their learning. A thorough literature search was performed using PubMed and Scopus, but no milestone-based evaluation form for HVs could be identified. We developed an evaluation form by performing a literature search identifying critical competencies and attitudes central to HVs.