Postdischarge Follow‐Up Visits for Medical/Pharmacy Students

The increasing burden of chronic illness has prompted concerns about the traditional education model that focuses on management of acute disease.13 Chronic illness has replaced acute disease as the major cause of disability and total national health care expenditures.46 Medical educators have called for improved chronic disease curricula,2, 3 and the Institute of Medicine has asserted that health professions, including medicine and pharmacy, must reexamine how students are educated to manage patients with complex illnesses.7, 8 Despite the rising prevalence of chronic illness, the positive attitudes of medical students toward providing care to such patients decline during training.2, 9 One theory is that the current model of core clerkship training excessively exposes students to highly complex, seriously ill hospitalized patients. Students may become disillusioned and overwhelmed by these encounters, particularly without the opportunity to see improvement or thriving in the outpatient setting.2

There are few curricula on how to transition chronically ill patients from an inpatient to an outpatient setting and the inherent safety risks of this transition. For these patients, the posthospital discharge period is particularly confusing because of the sudden change in health status and new medication regimens.1012 It is very likely that communication among providers and patients will be insufficient during the discharge process,11, 1315 yet physicians tend to overestimate patients' understanding of postdischarge treatment plans and thereby underanticipate problems.16 One intervention to address these concerns is a postdischarge visit. Home visits have been shown to improve students' understanding of continuity of care and of the impact of chronic illness on their patients' medical and psychosocial situations.1719

There is scant structured teaching of third‐year medical students about another critical aspect of transitional care: the role of different health care disciplines. Although research about the impact of undergraduate interdisciplinary education on patient outcomes is limited, training students in interdisciplinary collaboration may improve their ability to provide quality care.2022 Multiple disciplines are critical for a smooth transition of chronically ill patients from an inpatient to an outpatient setting. In particular, pharmacist involvement in a predischarge medication review, patient counseling, and telephone follow‐up has been associated with improved outcomes.11, 12, 23, 24 Early introduction of interdisciplinary team training can improve student attitudes about working within a team.25

To teach the importance of safe discharges and interdisciplinary collaboration in caring for chronically ill patients, we developed an inpatient medicine clerkship curriculum for medical and pharmacy students that included postdischarge visits to students' own team patients. The purpose of the study was to assess the impact of this didactic and experiential curriculum on students' attitudes and self‐assessed skills in the interdisciplinary care and transitional care of chronically ill patients. We hypothesized that the discharge curriculum would improve student attitudes and self‐assessed skills in these domains. Finally, we hypothesized that visiting a patient's home would highlight for students the potential challenges of care transitions for patients.

METHODS

Intervention (Curriculum Description)

We developed a 3‐part pilot interdisciplinary curriculum (Fig. 1). During the first 2 weeks of the IM clerkship, interdisciplinary faculty, including 3 pharmacists, 2 hospitalists, and occasionally a social worker and geriatric clinical nurse specialist, led a 1‐hour interactive workshop on transitional care. The 3 workshop topics were: roles that various disciplines such as social work and pharmacy play in discharge care; the challenges a patient faces around the time of discharge, using a typical case; and discussion of elements of a postdischarge visit.

Figure 1

Medical and pharmacy students were partnered based on clerkship team assignments in teams of up to 3 student partners (1 or 2 medical students and 1 pharmacy student). Partners were advised to select a consenting patient known to them from the ward team for 1 postdischarge visit. Suggested selection criteria were at least 1 chronic illness, 1 prior hospitalization, and older than age 65 because patients fitting these criteria are most at risk for readmission or adverse outcomes following discharge.15, 26, 27 The student partners scheduled a postdischarge visit by the end of the rotation to the patient's home, nursing home, or subacute care facility. Each patient and the patient's primary care provider (PCP) gave informed consent.

During the postdischarge visit, student partners assessed medication discrepancies, environmental safety, and clinical status using structured data collection protocols developed by the investigators after review of the literature.28, 29 After the visit, students reported back to the ward teams on the patient's status and wrote a visit summary letter to the patient's PCP. The letter described the patient's clinical status and home environment, any medication discrepancies, and follow‐up plans and included a reflection piece. Reflection questions included, How did the visit change your perspective of patient discharge? What were the most critical aspects of this or any discharge? How do you think this experience will affect your future practice? What was the best thing about this experience?

During the last 2 weeks of the rotation, all student participants met with faculty preceptors for an hour‐long group debriefing session on the postdischarge visits.

RESULTS

DISCUSSION

A discharge curriculum that included a postdischarge visit to a recently hospitalized patient improved the attitudes and self‐assessed skills of third‐year medical students and fourth‐year pharmacy students about interdisciplinary collaboration and transitions in care. It also deepened their appreciation of the impact of chronic illness on individual patients. To our knowledge, this is the first study to report an interdisciplinary curriculum with postdischarge home visits for students on their inpatient medicine clerkship.

Our curriculum was unique because its activities were linked to patients the students had cared for in the inpatient setting, a relationship that was key to students accepting the curriculum, as was the autonomy they had in selecting one of their patients for a visit. Although home visits are often part of medical school training, they generally occur in the preclinical years5, 19 or during third‐year primary care rotations, during which students are assigned patients at home or in outpatient facilities.17, 32 Home visits have been qualitatively reported to be a valuable aspect of geriatric, primary care, and other ambulatory‐based rotations of medical students.17, 19, 32 Postdischarge visits in graduate medical education have been shown to improve residents' awareness of and skills with transitions in care.28, 33, 34

Another novel aspect of this curriculum was the interdisciplinary collaboration in discharge planning and postdischarge visits. Although educators have implemented conferences on interdisciplinary education in preclinical medical education,3537 patient‐centered curricula in real‐time allow realistic interdisciplinary collaboration between medical and pharmacy students in their core clerkships. In our study, quantitative and qualitative data showed that the student partners valued each other's expertise in the context of a clinically relevant activitydischarge planning and a follow‐up home visit. Students reported confidence in their collaborative abilities after completing the curriculum, and comments supported a broadened understanding of other professionals' roles in patient care. Given that pharmacist involvement in discharge planning has been shown to improve patient outcomes,11, 24 our study supports the idea that medical educators should develop structured curricula on interdisciplinary training in core clerkships.

By evaluating the impact of hospitalization and chronic illness on their patients after discharge, our students developed an appreciation for safe transitions and opportunities to improve patients' health and level of function. We observed that students also appreciated the positive effect of the home environment on patient health and well‐being. From their postdischarge visit, students also became aware of the need for communication with primary care providers, particularly for patients with comorbidities. This type of transitional care experience may help to counter the negative attitudes toward chronic illness that students typically develop during clerkships.2, 9, 38, 39

Of note, although pharmacy students reported improvement in their attitudes and skills with transitional care, the trend toward significance was less than that for medical students. This difference was consistent with the broader rotation goals of each group. At the end of the curriculum, the pharmacy students expressed more comfort with medication review than did medical students, although the latter were better able to conduct transitional care including postdischarge visits and identification of barriers or facilitators to a safe discharge. Another interesting note is that pharmacy students came into the curriculum with a better understanding of the roles of physicians, whereas the medical students had a less clear idea of the pharmacist's role. A possible explanation is that pharmacy students are better trained in their preclinical years to work as a team with medical personnel. The pharmacy school curriculum places an emphasis on independent learning and interdisciplinary collaboration, which may lead to the greater comfort felt by the pharmacy students.

This study had several limitations. The absolute number of visits was small overall; however, nearly all student partners completed their visits. Although the response rate to the postcurriculum survey was high, the response rate to matched prepost surveys was lower. In addition, the survey questions were not validated. Further, although there was significant improvement in students' attitudes and self‐assessed skills after completion of the curriculum, we cannot be certain whether this improvement was a result of the curriculum or of other rotation experiences. We attempted to clarify this effect by asking if the curriculum added to their learning beyond other clerkship experiences, and students perceived that our curriculum was responsible for the positive effect. Also, the curriculum was used at 1 academic site and may not be generalizable to other hospitals, student populations, or team structures. The patients were selected by students, and thus the results may not be reproducible for every population; in some situations, students had to ask several patients until a patient consented to a postdischarge visit.

In implementing this interdisciplinary curriculum, we were challenged by the discordant schedules of the medical and pharmacy students. Initially, it was also difficult to overcome students' concerns about adding an additional expectation to an already busy rotation. The medical students, in particular, voiced concerns about having to leave the hospital during their inpatient rotation. However, this has become much less of an issue with time as the value of the postdischarge visit has become clear to students and team members, with the latter now aware of and supportive of the program.

This discharge curriculum represents a clinically relevant experience that addresses national educational mandates regarding interdisciplinary care and chronic illness across care settings. We are now expanding the curriculum from the original site to our other clerkship sites and are evaluating its impact on patient safety and clinical outcomes. Future research should focus on whether these interdisciplinary postdischarge patient visits lead to improved attitudes and skills during residency training or practice and whether, ultimately, they lead to improved patient outcomes.

The increasing burden of chronic illness has prompted concerns about the traditional education model that focuses on management of acute disease.13 Chronic illness has replaced acute disease as the major cause of disability and total national health care expenditures.46 Medical educators have called for improved chronic disease curricula,2, 3 and the Institute of Medicine has asserted that health professions, including medicine and pharmacy, must reexamine how students are educated to manage patients with complex illnesses.7, 8 Despite the rising prevalence of chronic illness, the positive attitudes of medical students toward providing care to such patients decline during training.2, 9 One theory is that the current model of core clerkship training excessively exposes students to highly complex, seriously ill hospitalized patients. Students may become disillusioned and overwhelmed by these encounters, particularly without the opportunity to see improvement or thriving in the outpatient setting.2

There are few curricula on how to transition chronically ill patients from an inpatient to an outpatient setting and the inherent safety risks of this transition. For these patients, the posthospital discharge period is particularly confusing because of the sudden change in health status and new medication regimens.1012 It is very likely that communication among providers and patients will be insufficient during the discharge process,11, 1315 yet physicians tend to overestimate patients' understanding of postdischarge treatment plans and thereby underanticipate problems.16 One intervention to address these concerns is a postdischarge visit. Home visits have been shown to improve students' understanding of continuity of care and of the impact of chronic illness on their patients' medical and psychosocial situations.1719

There is scant structured teaching of third‐year medical students about another critical aspect of transitional care: the role of different health care disciplines. Although research about the impact of undergraduate interdisciplinary education on patient outcomes is limited, training students in interdisciplinary collaboration may improve their ability to provide quality care.2022 Multiple disciplines are critical for a smooth transition of chronically ill patients from an inpatient to an outpatient setting. In particular, pharmacist involvement in a predischarge medication review, patient counseling, and telephone follow‐up has been associated with improved outcomes.11, 12, 23, 24 Early introduction of interdisciplinary team training can improve student attitudes about working within a team.25

To teach the importance of safe discharges and interdisciplinary collaboration in caring for chronically ill patients, we developed an inpatient medicine clerkship curriculum for medical and pharmacy students that included postdischarge visits to students' own team patients. The purpose of the study was to assess the impact of this didactic and experiential curriculum on students' attitudes and self‐assessed skills in the interdisciplinary care and transitional care of chronically ill patients. We hypothesized that the discharge curriculum would improve student attitudes and self‐assessed skills in these domains. Finally, we hypothesized that visiting a patient's home would highlight for students the potential challenges of care transitions for patients.

METHODS

Intervention (Curriculum Description)

We developed a 3‐part pilot interdisciplinary curriculum (Fig. 1). During the first 2 weeks of the IM clerkship, interdisciplinary faculty, including 3 pharmacists, 2 hospitalists, and occasionally a social worker and geriatric clinical nurse specialist, led a 1‐hour interactive workshop on transitional care. The 3 workshop topics were: roles that various disciplines such as social work and pharmacy play in discharge care; the challenges a patient faces around the time of discharge, using a typical case; and discussion of elements of a postdischarge visit.

Figure 1

Medical and pharmacy students were partnered based on clerkship team assignments in teams of up to 3 student partners (1 or 2 medical students and 1 pharmacy student). Partners were advised to select a consenting patient known to them from the ward team for 1 postdischarge visit. Suggested selection criteria were at least 1 chronic illness, 1 prior hospitalization, and older than age 65 because patients fitting these criteria are most at risk for readmission or adverse outcomes following discharge.15, 26, 27 The student partners scheduled a postdischarge visit by the end of the rotation to the patient's home, nursing home, or subacute care facility. Each patient and the patient's primary care provider (PCP) gave informed consent.

During the postdischarge visit, student partners assessed medication discrepancies, environmental safety, and clinical status using structured data collection protocols developed by the investigators after review of the literature.28, 29 After the visit, students reported back to the ward teams on the patient's status and wrote a visit summary letter to the patient's PCP. The letter described the patient's clinical status and home environment, any medication discrepancies, and follow‐up plans and included a reflection piece. Reflection questions included, How did the visit change your perspective of patient discharge? What were the most critical aspects of this or any discharge? How do you think this experience will affect your future practice? What was the best thing about this experience?

During the last 2 weeks of the rotation, all student participants met with faculty preceptors for an hour‐long group debriefing session on the postdischarge visits.

RESULTS

DISCUSSION

A discharge curriculum that included a postdischarge visit to a recently hospitalized patient improved the attitudes and self‐assessed skills of third‐year medical students and fourth‐year pharmacy students about interdisciplinary collaboration and transitions in care. It also deepened their appreciation of the impact of chronic illness on individual patients. To our knowledge, this is the first study to report an interdisciplinary curriculum with postdischarge home visits for students on their inpatient medicine clerkship.

Our curriculum was unique because its activities were linked to patients the students had cared for in the inpatient setting, a relationship that was key to students accepting the curriculum, as was the autonomy they had in selecting one of their patients for a visit. Although home visits are often part of medical school training, they generally occur in the preclinical years5, 19 or during third‐year primary care rotations, during which students are assigned patients at home or in outpatient facilities.17, 32 Home visits have been qualitatively reported to be a valuable aspect of geriatric, primary care, and other ambulatory‐based rotations of medical students.17, 19, 32 Postdischarge visits in graduate medical education have been shown to improve residents' awareness of and skills with transitions in care.28, 33, 34

Another novel aspect of this curriculum was the interdisciplinary collaboration in discharge planning and postdischarge visits. Although educators have implemented conferences on interdisciplinary education in preclinical medical education,3537 patient‐centered curricula in real‐time allow realistic interdisciplinary collaboration between medical and pharmacy students in their core clerkships. In our study, quantitative and qualitative data showed that the student partners valued each other's expertise in the context of a clinically relevant activitydischarge planning and a follow‐up home visit. Students reported confidence in their collaborative abilities after completing the curriculum, and comments supported a broadened understanding of other professionals' roles in patient care. Given that pharmacist involvement in discharge planning has been shown to improve patient outcomes,11, 24 our study supports the idea that medical educators should develop structured curricula on interdisciplinary training in core clerkships.

By evaluating the impact of hospitalization and chronic illness on their patients after discharge, our students developed an appreciation for safe transitions and opportunities to improve patients' health and level of function. We observed that students also appreciated the positive effect of the home environment on patient health and well‐being. From their postdischarge visit, students also became aware of the need for communication with primary care providers, particularly for patients with comorbidities. This type of transitional care experience may help to counter the negative attitudes toward chronic illness that students typically develop during clerkships.2, 9, 38, 39

Of note, although pharmacy students reported improvement in their attitudes and skills with transitional care, the trend toward significance was less than that for medical students. This difference was consistent with the broader rotation goals of each group. At the end of the curriculum, the pharmacy students expressed more comfort with medication review than did medical students, although the latter were better able to conduct transitional care including postdischarge visits and identification of barriers or facilitators to a safe discharge. Another interesting note is that pharmacy students came into the curriculum with a better understanding of the roles of physicians, whereas the medical students had a less clear idea of the pharmacist's role. A possible explanation is that pharmacy students are better trained in their preclinical years to work as a team with medical personnel. The pharmacy school curriculum places an emphasis on independent learning and interdisciplinary collaboration, which may lead to the greater comfort felt by the pharmacy students.

This study had several limitations. The absolute number of visits was small overall; however, nearly all student partners completed their visits. Although the response rate to the postcurriculum survey was high, the response rate to matched prepost surveys was lower. In addition, the survey questions were not validated. Further, although there was significant improvement in students' attitudes and self‐assessed skills after completion of the curriculum, we cannot be certain whether this improvement was a result of the curriculum or of other rotation experiences. We attempted to clarify this effect by asking if the curriculum added to their learning beyond other clerkship experiences, and students perceived that our curriculum was responsible for the positive effect. Also, the curriculum was used at 1 academic site and may not be generalizable to other hospitals, student populations, or team structures. The patients were selected by students, and thus the results may not be reproducible for every population; in some situations, students had to ask several patients until a patient consented to a postdischarge visit.

In implementing this interdisciplinary curriculum, we were challenged by the discordant schedules of the medical and pharmacy students. Initially, it was also difficult to overcome students' concerns about adding an additional expectation to an already busy rotation. The medical students, in particular, voiced concerns about having to leave the hospital during their inpatient rotation. However, this has become much less of an issue with time as the value of the postdischarge visit has become clear to students and team members, with the latter now aware of and supportive of the program.

This discharge curriculum represents a clinically relevant experience that addresses national educational mandates regarding interdisciplinary care and chronic illness across care settings. We are now expanding the curriculum from the original site to our other clerkship sites and are evaluating its impact on patient safety and clinical outcomes. Future research should focus on whether these interdisciplinary postdischarge patient visits lead to improved attitudes and skills during residency training or practice and whether, ultimately, they lead to improved patient outcomes.

The increasing burden of chronic illness has prompted concerns about the traditional education model that focuses on management of acute disease.13 Chronic illness has replaced acute disease as the major cause of disability and total national health care expenditures.46 Medical educators have called for improved chronic disease curricula,2, 3 and the Institute of Medicine has asserted that health professions, including medicine and pharmacy, must reexamine how students are educated to manage patients with complex illnesses.7, 8 Despite the rising prevalence of chronic illness, the positive attitudes of medical students toward providing care to such patients decline during training.2, 9 One theory is that the current model of core clerkship training excessively exposes students to highly complex, seriously ill hospitalized patients. Students may become disillusioned and overwhelmed by these encounters, particularly without the opportunity to see improvement or thriving in the outpatient setting.2

There are few curricula on how to transition chronically ill patients from an inpatient to an outpatient setting and the inherent safety risks of this transition. For these patients, the posthospital discharge period is particularly confusing because of the sudden change in health status and new medication regimens.1012 It is very likely that communication among providers and patients will be insufficient during the discharge process,11, 1315 yet physicians tend to overestimate patients' understanding of postdischarge treatment plans and thereby underanticipate problems.16 One intervention to address these concerns is a postdischarge visit. Home visits have been shown to improve students' understanding of continuity of care and of the impact of chronic illness on their patients' medical and psychosocial situations.1719

There is scant structured teaching of third‐year medical students about another critical aspect of transitional care: the role of different health care disciplines. Although research about the impact of undergraduate interdisciplinary education on patient outcomes is limited, training students in interdisciplinary collaboration may improve their ability to provide quality care.2022 Multiple disciplines are critical for a smooth transition of chronically ill patients from an inpatient to an outpatient setting. In particular, pharmacist involvement in a predischarge medication review, patient counseling, and telephone follow‐up has been associated with improved outcomes.11, 12, 23, 24 Early introduction of interdisciplinary team training can improve student attitudes about working within a team.25

To teach the importance of safe discharges and interdisciplinary collaboration in caring for chronically ill patients, we developed an inpatient medicine clerkship curriculum for medical and pharmacy students that included postdischarge visits to students' own team patients. The purpose of the study was to assess the impact of this didactic and experiential curriculum on students' attitudes and self‐assessed skills in the interdisciplinary care and transitional care of chronically ill patients. We hypothesized that the discharge curriculum would improve student attitudes and self‐assessed skills in these domains. Finally, we hypothesized that visiting a patient's home would highlight for students the potential challenges of care transitions for patients.

METHODS

Intervention (Curriculum Description)

We developed a 3‐part pilot interdisciplinary curriculum (Fig. 1). During the first 2 weeks of the IM clerkship, interdisciplinary faculty, including 3 pharmacists, 2 hospitalists, and occasionally a social worker and geriatric clinical nurse specialist, led a 1‐hour interactive workshop on transitional care. The 3 workshop topics were: roles that various disciplines such as social work and pharmacy play in discharge care; the challenges a patient faces around the time of discharge, using a typical case; and discussion of elements of a postdischarge visit.

Figure 1

Medical and pharmacy students were partnered based on clerkship team assignments in teams of up to 3 student partners (1 or 2 medical students and 1 pharmacy student). Partners were advised to select a consenting patient known to them from the ward team for 1 postdischarge visit. Suggested selection criteria were at least 1 chronic illness, 1 prior hospitalization, and older than age 65 because patients fitting these criteria are most at risk for readmission or adverse outcomes following discharge.15, 26, 27 The student partners scheduled a postdischarge visit by the end of the rotation to the patient's home, nursing home, or subacute care facility. Each patient and the patient's primary care provider (PCP) gave informed consent.

During the postdischarge visit, student partners assessed medication discrepancies, environmental safety, and clinical status using structured data collection protocols developed by the investigators after review of the literature.28, 29 After the visit, students reported back to the ward teams on the patient's status and wrote a visit summary letter to the patient's PCP. The letter described the patient's clinical status and home environment, any medication discrepancies, and follow‐up plans and included a reflection piece. Reflection questions included, How did the visit change your perspective of patient discharge? What were the most critical aspects of this or any discharge? How do you think this experience will affect your future practice? What was the best thing about this experience?

During the last 2 weeks of the rotation, all student participants met with faculty preceptors for an hour‐long group debriefing session on the postdischarge visits.

RESULTS

DISCUSSION

A discharge curriculum that included a postdischarge visit to a recently hospitalized patient improved the attitudes and self‐assessed skills of third‐year medical students and fourth‐year pharmacy students about interdisciplinary collaboration and transitions in care. It also deepened their appreciation of the impact of chronic illness on individual patients. To our knowledge, this is the first study to report an interdisciplinary curriculum with postdischarge home visits for students on their inpatient medicine clerkship.

Our curriculum was unique because its activities were linked to patients the students had cared for in the inpatient setting, a relationship that was key to students accepting the curriculum, as was the autonomy they had in selecting one of their patients for a visit. Although home visits are often part of medical school training, they generally occur in the preclinical years5, 19 or during third‐year primary care rotations, during which students are assigned patients at home or in outpatient facilities.17, 32 Home visits have been qualitatively reported to be a valuable aspect of geriatric, primary care, and other ambulatory‐based rotations of medical students.17, 19, 32 Postdischarge visits in graduate medical education have been shown to improve residents' awareness of and skills with transitions in care.28, 33, 34

Another novel aspect of this curriculum was the interdisciplinary collaboration in discharge planning and postdischarge visits. Although educators have implemented conferences on interdisciplinary education in preclinical medical education,3537 patient‐centered curricula in real‐time allow realistic interdisciplinary collaboration between medical and pharmacy students in their core clerkships. In our study, quantitative and qualitative data showed that the student partners valued each other's expertise in the context of a clinically relevant activitydischarge planning and a follow‐up home visit. Students reported confidence in their collaborative abilities after completing the curriculum, and comments supported a broadened understanding of other professionals' roles in patient care. Given that pharmacist involvement in discharge planning has been shown to improve patient outcomes,11, 24 our study supports the idea that medical educators should develop structured curricula on interdisciplinary training in core clerkships.

By evaluating the impact of hospitalization and chronic illness on their patients after discharge, our students developed an appreciation for safe transitions and opportunities to improve patients' health and level of function. We observed that students also appreciated the positive effect of the home environment on patient health and well‐being. From their postdischarge visit, students also became aware of the need for communication with primary care providers, particularly for patients with comorbidities. This type of transitional care experience may help to counter the negative attitudes toward chronic illness that students typically develop during clerkships.2, 9, 38, 39

Of note, although pharmacy students reported improvement in their attitudes and skills with transitional care, the trend toward significance was less than that for medical students. This difference was consistent with the broader rotation goals of each group. At the end of the curriculum, the pharmacy students expressed more comfort with medication review than did medical students, although the latter were better able to conduct transitional care including postdischarge visits and identification of barriers or facilitators to a safe discharge. Another interesting note is that pharmacy students came into the curriculum with a better understanding of the roles of physicians, whereas the medical students had a less clear idea of the pharmacist's role. A possible explanation is that pharmacy students are better trained in their preclinical years to work as a team with medical personnel. The pharmacy school curriculum places an emphasis on independent learning and interdisciplinary collaboration, which may lead to the greater comfort felt by the pharmacy students.

This study had several limitations. The absolute number of visits was small overall; however, nearly all student partners completed their visits. Although the response rate to the postcurriculum survey was high, the response rate to matched prepost surveys was lower. In addition, the survey questions were not validated. Further, although there was significant improvement in students' attitudes and self‐assessed skills after completion of the curriculum, we cannot be certain whether this improvement was a result of the curriculum or of other rotation experiences. We attempted to clarify this effect by asking if the curriculum added to their learning beyond other clerkship experiences, and students perceived that our curriculum was responsible for the positive effect. Also, the curriculum was used at 1 academic site and may not be generalizable to other hospitals, student populations, or team structures. The patients were selected by students, and thus the results may not be reproducible for every population; in some situations, students had to ask several patients until a patient consented to a postdischarge visit.

In implementing this interdisciplinary curriculum, we were challenged by the discordant schedules of the medical and pharmacy students. Initially, it was also difficult to overcome students' concerns about adding an additional expectation to an already busy rotation. The medical students, in particular, voiced concerns about having to leave the hospital during their inpatient rotation. However, this has become much less of an issue with time as the value of the postdischarge visit has become clear to students and team members, with the latter now aware of and supportive of the program.

This discharge curriculum represents a clinically relevant experience that addresses national educational mandates regarding interdisciplinary care and chronic illness across care settings. We are now expanding the curriculum from the original site to our other clerkship sites and are evaluating its impact on patient safety and clinical outcomes. Future research should focus on whether these interdisciplinary postdischarge patient visits lead to improved attitudes and skills during residency training or practice and whether, ultimately, they lead to improved patient outcomes.