Current Medical Education Leaves Gaps in Knowledge About Post-Acute Care

November 17, 2021

Confirming the need for more medical education addressing post-acute and long-term care, a national survey of internal medicine residents identified common knowledge gaps about this care setting. According to an article in the November issue of JAMDA, these gaps did not improve through residency without deliberate exposure to post-acute care (PAC) environments.

In A Cross-Sectional Survey of Internal Medicine Residents’ Knowledge, Attitudes, and Current Practices Regarding Patient Transitions to Post-Acute Care, the authors found that, despite residents’ confidence about their ability to transition patients to PAC, only 31% knew how often patients received skilled therapies at skilled nursing facilities (SNFs) and just 23% were aware of how frequently nursing services are provided in this setting. Most survey respondents (79%) identified the discharge summary as their main means of communicating care instructions to the SNF. However, only 55% reported always completing this report prior to discharge.

Upper-level residents were more likely to know how much therapy patients received at a SNF, the authors discovered, but resident knowledge about PAC didn’t vary otherwise by residency year or experience. Residents who experienced a clinical rotation at a SNF had higher levels of knowledge about this care sector compared to residents who didn’t, the authors observed. However, they noted that these residents still had gaps in knowledge about issues such as the frequency of home health care services. This, they said, “has significant implications for their ability to identify patients who would benefit from home health care or effectively counsel patients on what to expect.”

These gaps in PAC knowledge, the authors concluded, “do not improve with the usual experience that comes during internal medicine residency. This suggests that more inpatient rotations or outpatient continuity clinics are not sufficient to improve resident knowledge.” They indicated that developing resident curricula to improve knowledge of PAC and of PAC discharge “has the potential to have significant impact by influencing patient care practices during and beyond residency training.” They urged further investigation and expressed hope that their study may be used to guide educational intervention development and the impact of enhanced training on resident knowledge, attitudes, and practices, as well as patient outcomes.

The study was conducted by researchers at the Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; VA Eastern Colorado Health Care System, Aurora, CO; Center for Health Equity Research and Promotion, Corporal Crescenz Medical Center, Philadelphia, PA; Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA; VA Puget Sound Health Care System, Seattle, WA; Department of Medicine, University of Texas Health San Antonio, San Antonio, TX; and South Texas Veterans Health Care System, San Antonio, TX.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.