Residency redesign to accommodate trends in geriatrics: an RC-FM variance to establish a patient-centered medical home in an assisted living facility.

BACKGROUND AND OBJECTIVES Family physicians are poised to provide medical care to older adults residing in the broad range of facilities now currently available to this population. To date, geriatric training has focused on skilled nursing facilities, particularly for the required Review Committee for Family Medicine (RC-FM) longitudinal experience. This article describes the development and evaluation of an RC-FM approved assisted living curricular variance to the current nursing home longitudinal experience with emphasis on the principles of the Patient-centered Medical Home (PCMH) model and an interprofessional team concept. METHODS Second- and third-year family medicine residents were assigned as the primary care providers for two continuity patients in an assisted living facility. Patients were seen bimonthly within the construct of an interprofessional geriatric team. During the 2-year curricular variance, assessment of residents' skills, knowledge, and attitudes of the residents was conducted before and after the experience through direct skills observations, written testing, and focus groups. RESULTS Of 18 geriatric competencies evaluated by direct observation, there was statistically significant improvement in seven areas. The composite score for these competencies was statistically significant. The attitudinal scores were initially high and remained high throughout the 2-year period. Knowledge testing was not significantly different before or after the experience. CONCLUSIONS The assisted living facility is a viable clinical educational setting to develop geriatric competencies within a PCMH model. Providing geriatric clinical opportunities across the continuum of care can better prepare family medicine residents for future practice.