To the Editor: We concur with Dr. Kanter1 that nursing homes are an ideal site for medical education. Our experience suggests that clinical encounters in the nursing home offer an excellent opportunity to teach students about the physician–patient relationship. At the University of Rochester School of Medicine and Dentistry, we recently developed a course to increase clinical training in history and physical examination and student exposure to patients with chronic illness/disability.2 All 104 first-year students spend four half-days in nursing homes with a geriatrics physician. Students work in teams to independently evaluate patients and then review findings with the preceptor. Formal partnerships now exist with 14 community nursing homes.
Students’ narrative feedback illustrates their insight into and appreciation of the patient–physician relationship after the nursing home experience.
Even in their most depressed states, all the patients I worked with had wonderful stories to share and they deserve to be heard. I will always remember to look at these patients as a whole and not just lament their disabilities.
I was scared and nervous about trying to communicate with someone much older than myself and I felt as if I did not know how to do that. I was lucky my first patient was able to remind me that my job was to build a relationship with her and to use that relationship to help her feel better.
Mrs. X helped me to realize the importance of being a good healer in addition to being a sound physician technician…. There are times when the only thing a good doctor can do is to give emotional support and a hand to hold onto.
It can be easy, and dangerous, to make assumptions about a patient’s personal situation. All of these patients seemed like sad cases of old age, poor health, and loneliness, when in fact their lives were rich and outlook on life optimistic.
Given this kind of feedback, we enthusiastically echo your call for medical education to include the nursing home as a training venue.
Suzanne M. Gillespie, MD, RD
Assistant professor of medicine, University of Rochester School of Medicine and Dentistry, and medical director, Senior Living Services, Thompson Health, Canandaigua, New York.
Annette Medina-Walpole, MD
Professor of medicine; course director, Skills in Complete Patient Evaluation; and medical director, Highlands Living Center, Pittsford, New York; email@example.com.
David R. Lambert, MD
Professor of medicine and senior associate dean for medical education, University of Rochester School of Medicine and Dentistry, Rochester, New York.
1. Kanter SL. The nursing home as a core site for educating residents and medical students. Acad Med. 2012;87:547–548
2. Medina-Walpole A, Mooney CJ, Lyness JM, Lambert DR, Lurie SJ. Medical student attitudes towards diverse patient populations: The impact of a patient evaluation course. Teach Learn Med. 2012;24:117–121