The nursing home as a learning environment: dealing with less is learning more.
OBJECTIVE
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.


METHODS
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.
Frederique
F
Molema
Raymond
R
Koopmans
Esther
E
Helmich
D000328:Adult; D005194:Family Practice / Q000193:education*; D005260:Female; D017144:Focus Groups; D005853:Geriatrics / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes; D036301:Qualitative Research