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The Nursing Home as a Learning Environment: Dealing With Less Is Learning More

Molema, Frederique MD; Koopmans, Raymond MD, PhD; Helmich, Esther MD, PhD

doi: 10.1097/ACM.0000000000000143
Research Reports

Purpose: Despite the imperative to develop adequate competence in caring for the growing demographic of elderly patients with complex health care problems, nursing homes are underused as learning environments for the education of future doctors; thus, the authors aimed to gain more insight into the characteristics of the nursing home as a learning environment.

Method: Approaching the nursing home as a learning environment from a predominantly sociocultural perspective, the authors carried out five focus group interviews (December 2011 through February 2012) with 36 family medicine and elderly care medicine residents during their nursing home placements. Data analysis was an iterative process following a grounded theory approach. The software ATLAS.ti supported data analysis.

Results: The authors identified 23 themes in five categories regarding the nursing home as a learning environment: organization, medical opportunities, communication, teamwork, and supervision. Working and learning in a nursing home was characterized by “dealing with less” (i.e., fewer resources), yet the residents reported that dealing with less resulted in “learning more.” Family medicine and elderly care residents from different backgrounds differed in their perceptions and specific learning needs.

Conclusions: To the authors’ knowledge, this study is one of the first to identify characteristics of the nursing home as a learning environment. The main challenge in the nursing home is dealing with less, which, according to the residents in the present study, often leads to learning more. To ensure that learning really happens, the authors call for high-quality supervision to support learners in the nursing home environment.

Dr. Molema is a former elderly care resident at Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Nijmegen, the Netherlands. She is currently working as an elderly care physician at Heijendaal, Arnhem, the Netherlands.

Prof. Koopmans is an elderly care physician and full professor at Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Nijmegen, the Netherlands.

Dr. Helmich is an elderly care physician and assistant professor at Amsterdam Medical Center/University of Amsterdam, Center for Evidence-Based Education, Amsterdam, the Netherlands.

Funding/support: None reported.

Other disclosures: None reported.

Ethical approval: Under Dutch law, educational research is exempt from formal ethics approval, but the authors took all necessary precautions to ensure study participants’ well-being as described in more detail in the report.

Correspondence should be addressed to Dr. Helmich, Amsterdam Medical Center/University of Amsterdam, Center for Evidence-Based Education, PO BOX 22660, 1100 DD Amsterdam, the Netherlands; telephone: (+31) 20-566-1278; e-mail: e.helmich@amc.uva.nl.

© 2014 by the Association of American Medical Colleges