The determinants of attitudinal change among medical students participating in home care training: a multi-center study.
OBJECTIVE
To report attitudinal changes of medical students from five medical schools rotating through a home care program, and to determine which of the program characteristics influenced attitudes the most.


METHODS
A survey instrument covering four home care domains (general attitudes, home-based therapies, home care training, and time and reimbursement) was designed and validated by the five schools involved. Using pre- and post-rotation scores, analyses were done to evaluate for attitudinal changes within and among schools. The programs had similar basic characteristics (home visits, attending physicians' involvement, didactics), but had differing degrees of these components.


RESULTS
Significant improvements in attitude scores were found in three domains: general attitudes, homebased therapies, and home care training. For time and reimbursement, only three schools improved significantly between pre- and post-rotation scores. Among the five schools, there were significant differences in the homebased therapies and home care training domains (p <.05), and in the time and reimbursement domain the difference approached significance (p =.06). None of the students' characteristics but all of the programs' characteristics significantly correlated with changes in total scores. In the first multiple regression model, educational level (third year instead of fourth) was the only independent predictor of change in score, (adjusted r(2) =.14). In Model 2, the strongest predictor was "contact with physician-program director," followed by "number of visits" and "physician-precepted visits" (r(2) =.23).


CONCLUSIONS
Educational home care programs of varying intensities can positively affect medical students' attitudes towards home care. At least three program characteristics, (the physician-program director, number of visits, and physician-precepted home visits), are important parts of a successful program.
Flaherty
Joseph H
JH
Division of Geriatric Medicine, Saint Louis University Medical School, 1402 S Grand Blvd., St. Louis, Missouri 63104, USA. Flaherty@slu.edu
Fabacher
Diana A
DA
Miller
Roberta
R
Fox
Andrea
A
Boal
Jeremy
J
D000328:Adult; D001291:Attitude of Health Personnel; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D012044:Regression Analysis; D013337:Students, Medical / Q000523:psychology*; D014481:United States; D000078329:Workforce