The Mercy Family Medicine Residency Program redesigned its home visit program in 2006 to incorporate all ACGME competencies into the home visit, identify unique learning opportunities for residents and meet individualized needs of continuity patients across their lifespan.

The redesign had several specific goals:

1. Match patient care needs to an identified resident learning need (Patient Care and Medical Knowledge)
2. Utilize screening, developmental, and educational tools that improve patient care, patient safety and promote the physician-patient relationship (Communication, Evidence-Based Learning and Improvement)
3. Promote multidisciplinary teams by using a Clinical Nurse Specialist preceptor experienced in Community Medicine (Professionalism, System-Based Practice)
4. Limit home care visits to a one-time event that meets the holistic needs of the patient or caregivers including educational, psychosocial and medical or safety needs.

We used the results from an IRB-approved written survey that assesses resident attitudes, concerns, expectations for educational opportunities, expectations for preceptor involvement, and tools residents were most interested in using to improve the home care program and determine if the program is achieving its educational objectives. In addition, residents complete a pre-home visit planning worksheet before the visit and a 2nd IRB-approved survey after the home visit that are placed in their portfolio as a learning assessment tool. Analysis of blinded data collection is ongoing.

Our survey confirms that residents benefit from choosing the continuity patients that are best served from a home care visit, which makes the visit more relevant to the individual resident and the physician-patient relationship. A one-time visit allows for greater flexibility in scheduling and learning opportunities for faculty and residents. Residents that identify their own learning needs and educational objectives for the home visit take personal responsibility for lifelong learning. Using a non-physician preceptor encourages teamwork and professional respect for the expertise of other healthcare professionals in the system.