Letters to the Editor
To the Editor: We applaud Kanter1 for his observations about the need for medical education in nursing homes. Exposure in nursing homes has been a positive experience for a variety of learners at our institution for over 25 years. Internal medicine residents see patients in skilled nursing, focusing on transitions of care and care of the older adult during a required geriatrics medicine rotation. Family medicine residents complete a required two-year longitudinal experience and provide skilled care on a block rotation. And Year 3 medical students care for nursing home patients on a required geriatrics medicine rotation.
As Kanter pointed out, advantages to teaching in this setting include patient availability and lack of time constraints. The learner can talk to the patient, completely examine the patient, and develop an assessment. The learner is also able to focus on functional status and quality of life in addition to purely medical needs. These are all absolute benefits to teaching outside the hospital and clinic. It is, unfortunately, unclear how many other institutions provide nursing home experience, but it is likely that there are only a few, since it is our understanding that only around a third of U.S. medical schools even require a geriatrics rotation.
Several of our learners have had life-changing moments after providing care in our teaching nursing homes. We recall a family medicine resident who questioned the need for education in a “rest home” and later became a geriatrician and full-time nursing home physician. We also remember internal medicine residents who reported completely modifying their discharge procedures and communication after learning on-site about transitions of care. And one of us (J.K.-R.) recalls her own experience as a Year 3 student at the same institution 10 years ago; it prompted her to become an academic geriatrician to provide the same experience to even more learners. Thus, although we thank Kanter for his editorial, we are sorry that he did not comment on the number of institutions like ours that are teaching in nursing homes.
We congratulate the medical centers that already provide education in long-term care and skilled nursing facilities and encourage others to join the ranks. As Kanter stated and as we firmly believe, relationships with these facilities “will improve clinical education, research, and, of course, the care of the nursing home patients.”
Jessica Kalender-Rich, MD
Assistant professor, Landon Center on Aging, University of Kansas School of Medicine, Kansas City, Kansas; firstname.lastname@example.org.
Daniel Swagerty, MD, MPH
Professor, Landon Center on Aging, University of Kansas School of Medicine, Kansas City, Kansas.
1. Kanter SL. The nursing home as a core site for educating residents and medical students. Acad Med. 2012;87:547–548