title: Teaching physical diagnosis in the nursing home: a prospective, controlled trial.
abstract: OBJECTIVE
  To investigate the suitability of the nursing home as a site for teaching physical diagnosis to second-year medical students.
  
  
  METHODS
  Prospective comparison of teaching sessions in the nursing home to concurrent control sessions in acute care wards.
  
  
  METHODS
  Nursing Home Care Unit (NHCU) and acute care hospital wards of a Veterans Affairs Medical Center.
  
  
  METHODS
  Sessions with 38 NHCU patients and 68 hospital patients.
  
  
  RESULTS
  Patient interviews and student questionnaires were used to obtain responses on a 1-10 scale (1 = poor, 10 = excellent). Patient responses were very favorable in both settings for overall quality of experience (mean score NHCU vs control: 8.8 vs 8.6) and willingness to participate again (8.4 vs 8.2). Student ratings showed no significant differences for patient attitude (7.4 vs 8.4) or quality of exam (7.2 vs 7.7) while quality of history (6.0 vs 7.6) and overall quality of session (7.6 vs 8.6) were rated higher (P less than 0.05) for the control sessions. Students rated both environments highly (8.6 vs 8.4) but reported that fewer NHCU sessions were interrupted (15% vs 25%) or disrupted by noise (6% vs 30%, P less than 0.005).
  
  
  CONCLUSIONS
  Advantages of the nursing home include readily available patients who view participation favorably, instructive physical findings, and a suitable environment. However, students rate the quality of the histories obtained there lower. This problem could be addressed by more careful patient selection and greater emphasis by course instructors on other goals of the history in addition to exploring the chief complaint.
authors.affiliation: VAMC, Manchester, NH 03104.
authors.forename: M F
authors.initials: MF
authors.lastname: Mayo-Smith
authors.forename: V
authors.initials: V
authors.lastname: Gordon
authors.forename: E
authors.initials: E
authors.lastname: Gillie
authors.forename: A
authors.initials: A
authors.lastname: Brett
mesh_terms: D000368:Aged; D004504:Education, Medical, Undergraduate / Q000592:standards*; D005853:Geriatrics / Q000193:education*; D006707:Homes for the Aged / Q000592:standards*; D006744:Hospital Bed Capacity, 100 to 299; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D008487:Medical History Taking; D009513:New Hampshire; D009735:Nursing Homes / Q000592:standards*; D010808:Physical Examination; D015397:Program Evaluation / Q000706:statistics & numerical data; D011446:Prospective Studies