Teaching physical diagnosis in the nursing home

Physical diagnosis has traditionally been taught in the inpatient hospital setting. Changes in hospital reimbursement, as well as a shift to outpatient directed care, has resulted in a sicker inpatient profile. These patients are less amenable to the needs of the student first learning how to take a history and perform a physical examination. The outpatient setting has not been found to be a practical setting for teaching physical diagnosis either. We have developed a program using an academic university-affiliated nursing home in the teaching of a physical diagnosis course. Nursing home patients are predesignated according to physical findings or chronic-care complaints characteristic of a specific pathologic process. Patients developing acute problems while in the nursing home are identified on a daily basis as well. These constitute the patients seen by the second-year students during the physical diagnosis course. Overall, the program was well received by both faculty and students. The spectrum of findings on both history and physical examination was broad. Many of the pitfalls found in both the inpatient and outpatient settings were minimized. We believe that the teaching nursing home can become a useful tool in the teaching of a physical diagnosis program.