Jan Pols

Disseminating educational innovations in health care practice: Training versus social networks

Improvements and innovation in health service organization and delivery have become more and more important due to the gap between knowledge and practice, rising costs, medical errors, and the organization of health care systems. Since training and education is widely used to convey and distribute innovative initiatives, we examined the effect that following an intensive Teach-the-Teacher training had on the dissemination of a new structured competency-based feedback technique of assessing clinical competencies among medical specialists in the Netherlands. We compared this with the effect of the structure of the social network of medical specialists, specifically the network tie strength (strong ties versus weak ties). We measured dissemination of the feedback technique by using a questionnaire filled in by Obstetrics & Gynecology and Pediatrics residents (n=63). Data on network tie strength was gathered with a structured questionnaire given to medical specialists (n=81). Social network analysis was used to compose the required network coefficients. We found a strong effect for network tie strength and no effect for the Teach-the-Teacher training course on the dissemination of the new structured feedback technique. This paper shows the potential that social networks have for disseminating innovations in health service delivery and organization. Further research is needed into the role and structure of social networks on the diffusion of innovations between departments and the various types of innovations involved.

Conflicts and conflict management in the collaboration between nurses and physicians – A qualitative study

In health care, optimal collaboration between nurses and physicians is crucial in the quality of the care process – but not self-generating. Little is known about how health-care professionals cope with conflicts within their collaboration. This qualitative study investigates the way nurses and physicians cope with conflict and clarifies the determinants of conflict management styles. All respondents formulate clear expectations which in their opinion are essential to collaboration. When collaboration leads to disagreement, physicians and nurses choose between ignoring the conflict or engaging in it. Choice is determined by five factors: the influence of oneself, the influence of the other, the nature of the conflict, the context of conflict, and personal motives.

Facilitators and barriers to a nationwide implementation of competency-based postgraduate medical curricula : A qualitative study

Background: Postgraduate medical education (PGME) curricula are being redesigned across the western world. Aim: This study examined the implementation process (what works where and why) of new competency-based PGME curricula and relevant factors influencing this process. Methods: In a nationwide project (2006–2010) in the Netherlands, competency-based PGME curricula were implemented for residents in Pediatrics and Obstetrics & Gynecology. The authors conducted 25 semi-structured interviews and used a multi-level theoretical framework to guide coding. Results: The implementation process proved to be highly dynamic, non-linear, and influenced by many factors. These could be divided into attributes of the innovations/adopters, the implementation process, and the organization. The context determined the speed, quality, and direction of the process and how a factor affected the process. Conclusions: We identified specific features of PGME innovation: the challenge of implementing other competencies than that of the medical expert; the importance of regional implementation strategies and educational support; the balance between training and patient care; and the need for regional inter-organizational networks of hospitals. The authors recommend: design the curriculum with the needs of the users in mind; facilitate knowledge sharing; organize educational support; translate the national curriculum to the local workplace; and promote regional inter-organizational networks between hospitals.

Preparedness for practice: a systematic cross-specialty evaluation of the alignment between postgraduate medical education and independent practice.

Abstract Background: Postgraduate medical education training programs strive to prepare their trainees optimally for independent practice. Several studies have shown, however, that new consultants feel inadequately prepared for practice, and that this increases the risk of stress and burnout. Aim: To analyze across specialties for which tasks and themes new consultants feel inadequately prepared. And, to identify themes that need improved attention in postgraduate medical education programs or after registration. Methods: 330 New consultants from all hospital specialities with accredited training programs who completed their training in the north-eastern educational region of The Netherlands between 2004 and 2010 received a questionnaire which was based on a previously validated generic task inventory. Results: 143 respondents (43%) returned the questionnaire. They felt excellently prepared for 40 tasks, well prepared for 25 tasks, marginally sufficiently prepared for 18 tasks and insufficiently prepared for 8 tasks. Preparedness scores were lowest for tasks concerning management administration and leadership, research, end-of-life care, and patient safety-related communication. Surgical specialists felt better prepared for practice than medical specialists, which could not be explained by differences in general self-efficacy. Conclusion: Although new consultants felt well prepared for medical tasks, the scores of more generic tasks indicate that the alignment between the different phases of the medical education continuum and independent practice needs improvement.

How Do Social Networks and Faculty Development Courses Affect Clinical Supervisors' Adoption of a Medical Education Innovation? An Exploratory Study

Purpose To examine the impact of social networks and a two-day faculty development course on clinical supervisors’ adoption of an educational innovation. Method During 2007–2010, 571 residents and 613 clinical supervisors in four specialties in the Netherlands were invited to complete a Web-based questionnaire. Residents rated their clinical supervisors’ adoption of an educational innovation, the use of structured and constructive (S&C) feedback. Clinical supervisors self-assessed their adoption of this innovation and rated their communication intensity with other clinical supervisors in their department. For each supervisor, a centrality score was calculated, representing the extent to which the supervisor was connected to departmental colleagues. The authors analyzed the effects of supervisor centrality and participation in a two-day Teach-the-Teacher course on the degree of innovation adoption using hierarchical linear modeling, adjusting for age, gender, and attitude toward the S&C feedback innovation. Results Respondents included 370 (60%) supervisors and 357 (63%) residents. Although Teach-the-Teacher course participation (n = 172; 46.5%) was significantly related to supervisors’ self-assessments of adoption (P = .001), it had no effect on residents’ assessments of supervisors’ adoption (P = .371). Supervisor centrality was significantly related to innovation adoption in both residents’ assessments (P = .023) and supervisors’ self-assessments (P = .024). Conclusions A clinical supervisor’s social network may be as important as faculty development course participation in determining whether the supervisor adopts an educational innovation. Faculty development initiatives should use faculty members’ social networks to improve the adoption of educational innovations and help build and maintain communities of practice.

Incidence of and sequels to medical problems discovered in medical students during study-related activities

Purpose  Students often act as subjects during practical and clinical skills training sessions. This routine seems to be quite acceptable for them but may present side‐effects. Disorders, sometimes of a serious nature, have been discovered in medical students during clinical skills training. Because the incidence of and sequels to medical problems discovered in medical students during study‐related activities are unknown, we carried out an explorative study.

How educational innovations and attention to competencies in postgraduate medical education relate to preparedness for practice: The key role of the learning environment

IntroductionMany training programmes in postgraduate medical education (PGME) have introduced competency frameworks, but the effects of this change on preparedness for practice are unknown. Therefore, we explored how elements of competency-based programmes in PGME (educational innovations, attention to competencies and learning environment) were related to perceived preparedness for practice among new consultants.MethodsA questionnaire was distributed among 330 new consultants. Respondents rated how well their PGME training programme prepared them for practice, the extent to which educational innovations (portfolio, Mini-CEX) were implemented, and how much attention was paid to CanMEDS competencies during feedback and coaching, and they answered questions on the learning environment and general self-efficacy. Multiple regression and mediation analyses were used to analyze data.ResultsThe response rate was 43 % (143/330). Controlling for self-efficacy and gender, the learning environment was the strongest predictor of preparedness for practice (B = 0.42, p < 0.001), followed by attention to competencies (B = 0.29, p < 0.01). Educational innovations were not directly related to preparedness for practice. The overall model explained 52 % of the variance in preparedness for practice. Attention to competencies mediated the relationship between educational innovations and preparedness for practice. This mediation became stronger at higher learning environment values.ConclusionsThe learning environment plays a key role in determining the degree to which competency-based PGME prepares trainees for independent practice.

What are we preparing them for? Development of an inventory of tasks for medical, surgical and supportive specialties

Background: Internationally, postgraduate medical education (PGME) has shifted to competency-based training. To evaluate the effects of this shift on the outcomes of PGME appropriate instruments are needed. Aim: To provide an inventory of tasks specialists perform in practice, which can be used as an instrument to evaluate the outcomes of PGME across disciplines. Methods: Following methodology from job analysis in human resource management, we used document analyses, observations, interviews and questionnaires. Two thousand seven hundred and twenty eight specialists were then asked to indicate how frequently they performed each task in the inventory, and to suggest additional tasks. Face and content validity was evaluated using interviews and the questionnaire. Tasks with similar content were combined in a total of 12 clusters. Internal consistency was evaluated by calculating Cronbachs alpha. Construct validity was determined by examining predefined differences in task performance between medical, surgical and supportive disciplines. Results: Seven hundred and six specialists (36%) returned the questionnaire. The resulting inventory of 91 tasks showed adequate face and content validity. Internal consistency of clusters of tasks was adequate. Significant differences in task performance between medical, surgical and supportive disciplines indicated construct validity. Conclusion: We established a comprehensive, generic and valid inventory of tasks of specialists which appears to be applicable across medical, surgical and supportive disciplines.

Unexpected pathological findings in skills training and assessing skills

This article draws attention to unexpected pathological findings encountered by students and teachers when examining one another and/or simulated patients in skills training and assessment sessions.Although no literature on the subject was found, it appears to be not uncommon for students and teachers to find abnormalities during skills training and assessment. It is important that both students and teachers should be aware of this possibility and students should be encouraged to disclose any unexpected findings. Teachers should be given guidelines on the appropriate course of action during teacher-training sessions and students should be informed of the possibility of finding abnormal pathology prior to their participation in skills training and assessment.

Hoe betrouwbaar en valide beoordelen studenten huisartsconsulten

Inleiding: Eerder werd onderzoek gedaan naar overeenkomsten en verschillen tussen consulten zoals studenten die in het onderwijs leren en consulten zoals die door huisartsen in de praktijk worden uitgevoerd. Daarbij werd een cohort studenten geneeskunde als onderzoeksassistent ingezet. De vraag rees hoe betrouwbaar en valide beoordelingen door studenten waren.