Letters to the Editor
To the Editor: In one of your recent editorials,1 you made a good case for the nursing home as a core site for medical education. With that in mind, we would like to point out that in the Netherlands, strong academic affiliations exist between medical schools and nursing homes in so-called university nursing home networks. These networks provide an infrastructure for teaching as part of the undergraduate medical curriculum, the specialist training program for elderly care physicians,2 and research. The Radboud University Nijmegen Medical Centre, for instance, offers students a Year 1 nursing attachment and a Year 5 mandatory clerkship, both in nursing homes.
In order to clarify if and how early clinical placements (i.e., Year 1) in nursing homes or hospitals may lead to particular learning outcomes, we carried out three consecutive studies in which we compared nursing homes and hospitals as learning environments.3–5 Nursing homes and hospitals were found to be equally suitable for the enhancement of students’ early professional development.4 Students reported similar educational experiences and learning activities in both these institutions. However, students in nursing homes more frequently referred to their own relationships with patients.5 Placements in hospitals resulted in more negative perceptions of the personal attitudes of doctors. In nursing homes, collaborative and patient-centered behavior seemed to be better modeled.3
These findings, although drawn from data about first-year medical students representing one local context, offer fresh evidence that medical students can adequately develop desired competencies within so-called “teaching,” or “academic,” nursing homes. We think that further research exploring the characteristics of the nursing home as a learning environment is urgently needed.
Esther Helmich, MD, PhD
Elderly care physician and university teacher, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; firstname.lastname@example.org.
Raymond Koopmans, MD, PhD
Elderly care physician and professor in elderly care, Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, Nijmegen, Netherlands.
1. Kanter SL. The nursing home as a core site for educating residents and medical students. Acad Med. 2012;87:547–548
2. Koopmans RT, Lavrijsen JC, Hoek JF, Went PB, Schols JM. Dutch elderly care physician: A new generation of nursing home physician specialists. J Am Geriatr Soc. 2010;58:1807–1809
3. Helmich E, Derksen E, Prevoo M, Laan R, Bolhuis S, Koopmans R. Medical students’ professional identity development in an early nursing attachment. Med Educ. 2010;44:674–682
4. Helmich E, Bolhuis S, Laan R, Koopmans R. Early clinical experience: Do students learn what we expect? Med Educ. 2011;45:731–740
5. Helmich E, Bolhuis S, Prins J, Laan R, Koopmans R. Emotional learning of undergraduate medical students in an early nursing attachment in a hospital or nursing home. Med Teach. 2011;33:e593–e601