School of Health Professions Education Societal Impact in ... · Societal Impact in Narratives 2018...

School of Health Professions EducationSocietal Impact in Narratives

Designing Education with 4C/ID 03

Programmatic Assessment 06

Towards teaching residents in delivering high value, cost-conscious health care 08

Progress testing: Longitudinal assessment and feedback 10

Problem-based learning: Alive and kicking worldwide 12

Designing Multimedia Learning Materials: Managing the Load on a Learner’s Mind 14

Electronic Portfolio Assessment Support System (EPASS) 16

Pasemeco: Improving palliative care education for our future doctors 18

European Board of Medical Assessors: Promoting best assessment practice in 20

medical education in Europe

Developing excellence in patient safety in cross-border regions through standardized procedures, 22

policies and innovative tools: SafePAT

Contents

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Societal Impact in Narratives 2018 | School of Health Professions Education | Faculty of Health, Medicine and Life Sciences

The SHE’s Societal Impact in Narratives: 1

What is 4C/ID?Four-component instructional design (4C/ID) is a model for designing task-centred education, such as project-based, problem-based and case-based learning. It helps teachers and instructional designers to develop education aimed at the training of complex skills and professional competencies, with a special emphasis on transfer of what is learned to professional practice or real life. 4C/ID provides guidelines for the analysis of real-life tasks and the transition into a training blueprint for an educational program. It is typically used for designing and developing substantial learning and/or training programs ranging in length from several weeks to several years and/or that entail a substantial part of a curriculum. Its basic claim is that blueprints for complex learning can always be described by four basic components, namely (a) learning tasks, (b) supportive information, (c) procedural information, and (d) part-task practice. Learning tasks provide the backbone of the training program; they provide learning from varied experiences, are sequenced in simple-to-complex levels, and show a gradual decrease of learner support and guidance at each level of complexity. For more information, see www.tensteps.info.

Who is involved?At the SHE, 4C/ID is used as a theoretical framework for conducting research projects, as an object of study in courses offered by SHE (MHPE Unit 8 on Designing Learning Environments, the short course Curriculum and Course Design in Health Professions Education, and the new online course Research on Task Centred Learning Environments), and as a practical tool for running educational innovation projects. Lectures and workshops on the model are given by SHE researchers all over the world. People most heavily involved in developing and/or teaching and/or using 4C/ID are prof. dr. Diana Dolmans, dr. Greet Fastré, dr. Jimmy Frerejean, Jacqueline Hu MSc, drs. Wilma Huveneers, dr. Wendy Kicken, dr. Karen Konings, dr. Herma Roebertsen, Sanne Rovers MSc, prof. dr. Jeroen van Merrienboer (founder of the 4C/ID model), dr. Peter van Rosmalen, dr. Danielle Verstegen, and dr. Trynke Keuning.

Collaborations and UsersThe SHE is using 4C/ID as an approach to designing education in collaborative projects such as: Pasemeco where medical schools integrate education on palliative care in their curriculums. See www.pasemeco.nl/ (with all eight medical schools in the Netherlands).

Safepat where partners in the Euregion Maas-Rijn develop education on cross-border patient transfers. See www.safepat.eu/en (with OUNL, RWTH Aachen, Hospital Genk, University Hasselt and University Liege). Indicators in Game-based learning, where a medical simulation game for acute care is re-designed and evaluated. See https://virtualmedschool.com/abcdesim (with VirtualMedSchool, Erasmus MC, and IJsfontein).

MATCH where primary school teachers are trained to differentiate between pupils in their classrooms (www.matchproject.nl; with the University of Twente, the Katholieke PABO Zwolle, and the Christelijke Hogeschool Ede). In the Netherlands, 4C/ID is probably the most popular model for designing education in schools for senior vocational education, universities of applied sciences, and professions-oriented university programs. Some institutes, such as MBO Rijnland, design all their educational programs with 4C/ID. It is also used by many educational consultancy firms as well as not-for profit organizations (e.g., Stichting Leerplan-ontwikkeling, Consortium Beroepsonderwijs, www.basa.casa). Together with the Open University of the Netherlands, the SHE organizes an annual 4C/ID User Day where users can participate in inter-vision sessions, follow crash courses in specific 4C/ID-related topics, and visit workshops in which practical

Designing Education with 4C/ID

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4C/ID applications are discussed. The user days typically attract between 100-150 participants. In 2017 and 2018, the 7th and 8th Annual 4C/ID User Days were organized at the University of Nijmegen.

Apart from the Netherlands, 4C/ID is taught and used around the world. The book Ten Steps to Complex Learning and several articles describing the model have been translated in Spanish, Portuguese, Korean and Chinese and there are plans for other translations (Iranian, Russian); this book is used as a study book in educational science programs around the world. In the medical domain, the Faculty of Medicine at the University of Leuven in Belgium provides a good illustration of the use of 4C/ID. They developed a series of courses under the name “Levensecht Leren” (lifelike learning; see https://med.kuleuven.be/nl/levensechtleren ). 4C/ID is also used to develop educational programs in the health professions at, amongst others, the University of Pretoria, University of Surabaya, University of Recife, and New York University. But the model is also widely used outside the field of health professions education.

Interviews• Educational Technology Magazine (January-February, 2012). Questions and answers with EdTech leaders. Interview with

Jeroen J. G. van Merrienboer by Michael Shaughnessy and Susan Fulgham. Educational Technology Magazine, 52(1), 49-51.• Open Education Research (August, 2012). 10 steps to 10 questions: interview with the authors of ten steps to complex

learning. Interview with Jeroen J. G. van Merrienboer and Paul A. Kirschner by Sheng Qunli, Wang Wenzhi, & Wei Zhihui (in Chinese). Open Education Research, 18(4), 4-11.

• Na-apen moet. Interview met Jeroen van Merrienboer door Olmo Linthorst, ten behoeve van het blad Profielen – onafhankelijk blad van de Hogeschool Rotterdam (2016).

• Van Merrienboer, J. J. G. (2017). Breng het beroep de klas in. In Onderzoeksconferentie Kennisnet/NRO 2017 (pp. 33-34). Den Haag: NWO/NRO.

Entrees in EncyclopaediasVan Merrienboer, J. J. G. (2012). Four-component instructional design. In N. M. Seel (Ed.), Encyclopedia of the Sciences of Learning

(pp. 1320-1322). New York: Springer.Van Merrienboer, J. J. G. (2015). Four-component instructional design (4C/ID). In J. M. Spector (Ed.), The Sage encyclopedia of

educational technology (pp. 294-296). Thousand Oaks, CA: Sage Publications.

English BookVan Merrienboer, J. J. G., & Kirschner, P. A. (2013). Ten steps to complex learning (Second Revised Edition).

New York: Routledge. [The third revised edition was published in 2018]

Dutch BookHoogveld, B., Janssen-Noordman, A., & van Merrienboer, J. (2017). Innovatief onderwijs ontwerpen

- de ontwerpprincipes van het 4CID-model. Groningen: Noordhoff.

Translated/non-English booksVan Merrienboer, J. J. G. (2017). Training complex cognitive skills: A four-component

instructional design model for technical training (Chinese Translation). Fuzhou, China: Fujian Education Press

Van Merrienboer, J. J. G., Correia, S., & Paiva, J. (Eds.). (2012). As novas tecnologias (in Portugese). Lisboa, Portugal: Fundacao Francisco Manuel Dos Santos.

Van Merrienboer, J. J. G., & Kirschner, P. A. (2012). Ten steps to complex learning: A systematic approach to four-component instructional design (Chinese translation). Fuzhou, China: Fujian Education Press.

Van Merrienboer, J. J. G., & Kirschner, P. A. (2015). Ten steps to complex learning: A systematic approach to four-component instructional design (Chinese translation of the second revised edition). Fuzhou, China: Fujian Education Press.

Other translationsIn the period 2012-2017, about 12 journal articles and book chapters on 4C/ID have been translated to other languages, especially Chinese.

Scientific quality (selection of publications)Clarebout, G., Goanta, C., Hardt, S., Hazen, H., Hommels, A., Kicken, W., van Merrienboer, J., & Reithler, M. (2017). Integrating skills

in curricula: An analysis based on the 4C/ID model. In The UM Handbook for PBL & Research Skills (pp. 32-43). Maastricht, the Netherlands: EdLab Maastricht University.

Susilo, A. P., van Merrienboer, J. J. G., van Dalen, J., Claramita, M., & Scherpbier, A. (2013). From lecture to learning tasks: Use of the 4C/ID model in a communication skills course in a continuing professional education context. The Journal of Continuing Education in Nursing, 44(6), 278-284.

Tjiam, I., Schout, B., Hendrikx, A., Scherpbier, A., Witjes, J., & van Merrienboer, J. J. G. (2012). Designing simulator-based training: An approach integrating cognitive task analysis and four-component instructional design. Medical Teacher, 34, e698-e707.

Van Merrienboer, J. J. G., & Kester, L. (2014). The four-component instructional design model: Multimedia principles in environments for complex learning. In R. E. Mayer (Ed.), The Cambridge handbook of multimedia learning (2nd Ed.) (pp. 104-148). New York: Cambridge University Press.

Vandewaetere, M., Manhaeve, D., Aertgeerts, B., Clarebout, G., van Merrienboer, J. J. G., & Roex, A. (2015). 4C/ID in medical education: How to design an educational program based on whole-task learning: AMEE Guide No. 93. Medical Teacher, 37(1), 4-20.

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What is programmatic assessment?Programmatic assessment is an assessment theory that optimizes an assessment program as a whole. It is an integral answer to an assessment-for-learning strategy relevant to constructivist learning programs. Programmatic assessment can be used for learning in school or in the workplace. In programmatic assessment both learning and promotion decision-making is optimized. There are five basic ground rules in this assessment approach.

1 Single assessments are data points to inform learning not to pass or fail a learnerAn individual assessment is considered to be a data point in programmatic assessment. A single data point should provide meaningful information to the learner either in quantitative or qualitative form. It is feedback oriented, not decision oriented. In essence there is too little information in a single data point to make a high-stake decision. For the evaluation of complex skills and behaviours narrative information is desired.

2 The program involves a deliberate mix of different methodsMethods of assessment are deliberately chosen based on their alignment with the goal of education. Any method may be useful, modern or traditional, objective or subjective. The utility of a method comprising a single data point lies in the educational justification for using that method in that moment in time in the learning program. Often there is a mix of modular and longitudinal assessment.

3 Feedback use and self-directed learning is promoted through a continuous dialogue with the learnerThe use of feedback by the learner is educationally scaffolded in a dialogue around feedback in a mentoring system. By creating a relationship with a trusted person, reflection and feedback use is promoted. The mentor has access to all assessment information (and other learning data) and periodically discusses this with the learner. The learner is stimulated to reflect on the assessment feedback and to plan study actions accordingly.

4 The number of data-points needed is proportionally related to the stakes of the assessment decision At some point in time pass/fail or promotion decisions need to be taken in a program. In programmatic assessment the conventional summative and formative distinction is replaced by a continuum of stakes. A single data point is low stake since no pass/fail consequences are connected to it. It is not of “no stake”, since the information from the assessment may feed into higher stake decisions at a later moment of time. In general, the higher the stake of the decision-making involved, the more data points are needed. Intermediate decisions are of higher stake and need less data points then very high-stake decisions.

5 High-stake decisions are professional judgments made in a committee of assessorsGiven the quantitative and qualitative nature of the assessment information high-stake decisions require a professional judgement. To harness that judgment, this high-stake decision is taken in a group of (independent) assessors. All assessment (and other learning) information, usually in the form of an electronic portfolio, is held against performance standards relevant to the phase of training and a decision is made.

Based on these ground rules teachers and curriculum developers create local implementations of programmatic assessment. Often very different approaches are taken. Implementation requires central governance on education and a different mind-set to the role of assessment.

Programmatic Assessment

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Who is using programmatic assessment?The first publication on programmatic assessment was in 2011. Since that time numerous schools and organizations have adopted it. Maastricht University, where this assessment model was conceptualized, has been among the first to implement it in several bachelor and master programs. A number of Universities of Applied Sciences in The Netherlands are implementing the program. Internationally programmatic assessment is adopted in training programs in the United States, Canada, Australia and New Zealand. A special interest group has been started under the umbrella of the European Board of Medical Assessors (EBMA) and regular meetings are being held. Programmatic assessment is also popular in postgraduate medical training programs, both in The Netherlands and internationally.

Scientific quality (selection of publications)Driessen, E. W., Van Tartwijk, J., Govaerts, M., Teunissen, P., & van der Vleuten, C. P. (2012). The use of programmatic assessment in

the clinical workplace: a Maastricht case report. Medical Teacher, 34(3), 226-231.Schuwirth, L. W., & Van der Vleuten, C. P. (2011). Programmatic assessment: from assessment of learning to assessment for

learning. Medical Teacher, 33(6), 478-485.Schuwirth, L. W., & van der Vleuten, C. P. (2012). Programmatic assessment and Kane’s validity perspective. Medical

Education, 46(1), 38-48.Van der Vleuten, C. P., Schuwirth, L. W. T., Driessen, E. W., Dijkstra, J., Tigelaar, D., Baartman, L. K. J., & van Tartwijk, J. (2012). A model

for programmatic assessment fit for purpose. Medical Teacher, 34(3), 205-214.Van Der Vleuten, C. P., Schuwirth, L. W. T., Driessen, E. W., Govaerts, M. J. B., & Heeneman, S. (2015). Twelve tips for programmatic

assessment. Medical Teacher, 37(7), 641-646.Van der Vleuten C, S. D., Joosten-ten Brinke D. (2017). Competence Assessment as Learner Support in Education. In M. Mulder

(Ed.), Competence-based Vocational and Professional Education, Technical and Vocational Education and Training: Issues, Concerns and Prospects (Vol. 23, pp. 607-630): Springer International Publishing Switzerland.

Research Program 2018-2023 | School of Health Professions Education | Faculty of Health, Medicine and Life SciencesSocietal Impact in Narratives 2018 | School of Health Professions Education | Faculty of Health, Medicine and Life Sciences

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What is high value, cost-conscious health care?Healthcare in the Netherlands has a high quality, but is also expensive. In order to keep a high quality of care, while making sure to control healthcare costs, high value cost-conscious care (HVCCC) is essential. It is nationally recognized that this topic needs to be embedded in postgraduate medical training. The project “Towards high-value, cost-conscious health care”, or in Dutch ‘‘Bewustzijnsproject’’, is a three-year project that started December 1st, 2015. The College Medical Specialties (CGS), which is part of the Royal Dutch Medical Association (KNMG), has commissioned this project. Maastricht University/SHE is responsible for putting the project plan into effect, because pioneering work on this theme was already done in Maastricht. The Dutch Ministry of Health, Welfare and Sport (VWS) finances the project. Scientifically, this project aims for a deeper understanding of how to best train residents regarding providing high-value, cost-conscious health care (HVCCC). We want to know how the training context and work environment serve as preconditions for effectively supporting residents in their development towards cost-conscious doctors. Therefore, research focuses on what attitudes medical residents, supervisors, managers and patients have concerning HVCCC.

Who is involved?Main researchers are Serge Mordang (PhD student), Karen Könings (associate professor), and Laurents Stassen and Frank Smeenk (project directors, professors). Corry den Rooyen and Angelique van Bijsterveld are the national daily project leaders.

Users and collaborationsThe practical aim of the project is to develop tools for residents and practicing physicians to include HVCCC in the residency-training program. These tools contain a wide range of topics, clustered around three themes: (1) organizing cost-consciousness and effectiveness, (2) choosing wisely to prevent excessive use of diagnostic tests and overtreatment, and (3) risk management and ethics. Another goal is to develop a community of learners, in which knowledge and experiences are shared between all those who are involved in the project. At a national level, all training regions are invited to actively participate. The project will result in a range of materials and activities to inspire and inform medical education practice in all regions in the Netherlands:Elaborated online sources: www.bewustzijnsproject.nl • Annual HVCCC symposium in Eindhoven (2017) and Leiden (2018).• Masterclass HVCCC for educationalists. • Workshop about HVCCC for residents and physicians in several hospitals throughout the Netherlands• Workshop Teach the teacher: HVCCC for medical trainers• Online course on knowledge of healthcare costs for residents• Serious game ‘‘Doctor Flow’’ (an application for residents to playfully think about efficient care) developed.

Towards teaching residents in delivering high value, cost-conscious health care

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In collaboration with the Choosing Wisely campaign and the Royal College of Physicians in Canada an initiative has been started to also involve students in disseminating the theme of HVCCC in the general medical training curriculum. As a result, this Dutch STARS initiative has inspired other countries to do the same. Furthermore, the project is invited to share its knowledge and ideas with the European Union of Medical Specialists (EUMS) and more specifically the Young European Academy of Pediatrics (YEAP). A webinar has been given, contribution to the Pediatric European congress will be given, and the ideas will be used in the update of the European training directives.

Societal impactThe research is explicitly focused on multiple stakeholders, including patients. By including this group, the research is likely to have a larger societal impact. Furthermore, research and practical tools are developed in collaboration with all eight academic training regions in The Netherlands, expanding the impact of the project to a national level. Moreover, project results are and will be presented at national and international conferences on medical education and will be published in national and international scientific journals, as well as journals for professionals, like Medisch Contact which is the official journal of the KNMG, weekly sent to all Dutch physicians.

Scientific quality (selection of publications)Könings, K. D., Bloemen, A., Hageman, M., & Schlatmann, F. (2018). Ook doelmatigheid is jong geleerd, oud gedaan. Medisch

Contact, 4, 28-31.Mordang, S. B. R., Vanassche, E., Smeenk, F. W. J. M., Stassen, L. P. S., & Könings, K. D. (2018). How peers, supervisors and patients

support reflection of residents, but also hinder it. Manuscript submitted for publication.Mordang, S. B. R., Vanassche, E., Smeenk, F. W. J. M., Stassen, L. P. S., & Könings, K. D. (2017, November). Reflectie van AIOS op de

werkplek: een behoefte aan organisatorische ondersteuning bij het introduceren van nieuwe thema’s, zoals doelmatigheid. Paper presented at the meeting of the Dutch Association of Medical Education, Egmond aan Zee.

Mordang, S. B. R., Vanassche, E., Smeenk, F. W. J. M., Stassen, L. P. S., & Könings, K. D. (2018, August). How peers, supervisors and patients support reflection of residents, but also hinder it. Paper to be presented at the meeting of the Association for Medical Education in Europe, Basel, Switzerland.

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What is progress testing?Often, students are only tested right after a course has ended on the topic of that course. In some cases a national exam takes place at the end of the program. But what is in between? How do we know that the student is at the required level in each subdomain at the moment of graduation? Here progress testing comes in. In this form of testing, each student is tested at regular intervals on all relevant subdomains during the whole education program. If all goes well, a student should show a steady development in all subdomains up to the graduation level. If not, the progress test results can tell what subdomains are underdeveloped and need extra attention. This information is available at the individual level, allowing a student to be helped with remediation but also at the cohort level so that teachers and program developers can evaluate and improve the education. When a progress test is administered in multiple schools simultaneously, it can also form a perfect benchmark. Since it prevents strategic study behavior and provides the students with rich longitudinal feedback, progress testing fits perfectly in the concept of assessment for learning.

Longitudinal feedbackTo disclose the information that the progress tests produces on individual and group progress to students and staff, an online dashboard system has been developed (ProF: progress test feedback). The ProF system allows students to view their progress on all subdomains and to compare their development with that of their peers within the own school or nationally. It allows the students to zoom in on several details and by doing so discover their stronger and weaker areas. The result of this analysis is the start of a new action plan for individual improvement.

The future: Computer adaptive progress testingThe current practice of paper-based progress test in six medical schools (involving almost 9,000 students sitting simultaneously per test) is a logistical challenge. Moreover, the psychometrical properties of the test are not optimal for first-year students since they only answer few questions. A computerized version of the test that allows students to do the test in batches and that is tailored to the level of each student would be an improvement of the progress test. We therefor are investigating the use of computer adaptive testing for the progress test. In this type of testing, an algorithm selects the questions from an item bank based on the answers that the student gave on previous questions in the test. In doing so, the algorithm estimates the level of the student based on the difficulty of each question the student answered correctly or incorrectly. We applied the computer adaptive progress test in the international track of the medicine program at Maastricht University and in the Al Rajhi University in Saudi Arabia, involving about 300 students. The questions used and their difficulty parameters were derived from the classical progress test. Current research is focused on scaling the computer adaptive progress test to the national level.

Who is involved?Within SHE, Prof. dr. Cees van der Vleuten, dr. Arno Muijtjens, dr. Jeroen Donkers, and dr. Carlos Collares are involved in scientific research and development of progress testing as well as in the daily application of progress testing at a national and international level.

Collaborations and usersThe medical program at Maastricht University has a longstanding tradition with progress testing. The particular form in which it takes place here is that 4 times each year all medical students take a written test of 200 multiple choice questions with question mark option. The test is summative, and 4 subsequent tests are taken together to decide on sufficient progress. The standards are

Progress testing: Longitudinal assessment and feedback

determined relative to each year group. It is developed and administered in six (out of eight) Dutch medical schools. To realize this joint progress test an elaborate item production and review process has been put in place, supported by an item bank system.

The progress test for the Dutch medical schools is organized in the iVTG (interuniversity progress test medicine, see: ivtg.nl) a consortium of Maastricht University, UMCG Groningen, LUMC Leiden, UMCN Nijmegen, VUmc and AMC Amsterdam. The test items are developed by all partners but Maastricht University takes care of central processing and analysis and provides all IT support. The iVTG collaboration has been a model and example for progress testing in many places, for instance the Dutch family medicine resident program and the Dutch gynecology resident program use a similar progress test. Many presentations, invited talks and workshops have been provided by SHE on progress testing worldwide. Within EBMA (see narrative 4) the model inspired the start of a European progress test.

The ProF system has been developed to be used generically, i.e. independent from a specific type of progress test and is now supported by SHE in use for several other organizations.

Scientific quality (selection of publications)Heeneman, S., Schut, S., Donkers, J., van der Vleuten, C., & Muijtjens, A. (2017). Embedding of the progress test in an assessment

program designed according to the principles of programmatic assessment. Medical Tacher, 39(1), 44-52.Muijtjens, A. M., Timmermans, I., Donkers, J., Peperkamp, R., Medema, H., Cohen-Schotanus, J., Thoben. A., Wenink, A.C.G. & Van

der Vleuten, C. P. (2010). Flexible electronic feedback using the virtues of progress testing. Medical Teacher, 32(6), 491-495.Van der Vleuten, C. P. M., Schuwirth, L. W. T., Muijtjens, A. M. M., Thoben, A. J. N. M., Cohen-Schotanus, J., & Van Boven, C. P. A.

(2004). Cross institutional collaboration in assessment: a case on progress testing. Medical Teacher, 26(8), 719-725.Wrigley, W., Van Der Vleuten, C. P., Freeman, A., & Muijtjens, A. (2012). A systemic framework for the progress test: strengths,

constraints and issues: AMEE Guide No. 71. Medical Tacher, 34(9), 683-697.

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What is problem-based learning?Problem-based learning (PBL) is an instructional design. Within PBL students discuss professionally relevant problems in small groups. The problems are first discussed to activate students’ prior knowledge. Based on this discussion, questions are formulated for further individual self-study. After this individual self-study, students meet again and discuss what they have learned in the small group. The small group discussion is facilitated by a teacher, a so-called tutor. PBL is well aligned with current instructional design approaches that emphasize the importance of learning by means of professionally relevant problems in order to encourage integration of knowledge, skills, and attitudes and to better prepare learners for their future profession.

Who is involved?Problem-based learning is used in many curricula all over the world. Maastricht University is known for its Problem-Based Learning approach and its international orientation and multidisciplinary approach to research and education. PBL is continuously being innovated within the Maastricht curricula which provide a rich and unique context to investigate PBL and its underlying theorebtical principles. Workshops on PBL are given by many SHE researchers all over the world. Researchers who are strongly involved are dr. Daniëlle Verstegen, dr. Janneke Frambach, dr. Dominique Waterval, prof. dr. Hans Savelberg, dr. Nynke de Jong, Emmaline Brouwer MSc, dr. Herma Roebertsen, Sanne Rovers MSc, Prof. dr. Jeroen van Merrienboer and prof. dr. Diana Dolmans.

Users and CollaborationsEDview is a research project that investigates the current state and the future of education at Maastricht University. Within this project the current merits and challenges of PBL are being investigated as well the vision of education at UM for the future (https://edlab.nl/edview).

VR Glasses in the PBL classroom. In cooperation with the Living Lab in Ageing and Long-term Care (Academische Werkplaats Ouderenzorg), the students “join” a homecare visit of real employees of the MeanderGroep Zuid-Limburg by watching a 360 video (a video in which all directions are recorded simultaneously) through virtual reality glasses, and thereby getting the feeling of what such a visit consist of in reality. This in turn is used as a basis for discussions in the problem-based classroom. See https://edlab.nl/bringing-reality-into-the-classroom

Massive Open Online Course (MOOC): Problem-Based Learning. Principles and design. Students at the centre! Massive Open Online Courses (MOOCs) aim at large-scale learning with relatively little teacher support. Maastricht University aims to contribute to the development of educationally sound MOOC designs by developing a MOOC about Problem-Based Learning (PBL) following -as far as possible- the principles of PBL. The PBL MOOC has run twice and 4000 participants from all over the world have learned about PBL by studying authentic problems collaborating in a group, online and without a tutor.

Standing tutorials: Education that moves you. This project aims to turn the classroom into a more dynamic space to improve the learning experiences of students during tutorials. Within this project it is investigated how standing could be beneficial in creating a more active environment where discussions become more lively and inspiring. So far standing tutorials have been implemented at University College Maastricht and the Maastricht Science Programme (https://edlab.nl/the-dynamics-of-standing)

New Medical Education Initiative (NMEI) in Ethiopia. This initiative works on planning medical doctor training, supporting the medical schools in Ethiopia focusing on the new medical schools and developing standards for the medical doctors training. Ethiopia has intensified the pre-service education through increased number and expansion of medical schools from 14 to 27,

Problem-based learning: Alive and kicking worldwide

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building capacity and increase in the number of enrollees in the existing schools. SHE is offering support in innovating the curricula and offers training to local teachers on PBL. www.youtube.com/watch?v=--bKvnXUitQ&t=12s OR www.moh.gov.et/nmei

PAN-PBL Association of Problem-Based Learning and Active Learning Methodologies. This association aims to promote educational forums for professionals representing a wide variety of positions and knowledge on Problem-Based Learning and Active Learning Methodologies, as well as communication, cooperation and scientific research for individuals and institutions (www.panbpl.org). SHE researchers have presented their work at the PAN-PBL conferences e.g. in Santa Clara (USA) in 2018 and Sao Paolo in 2016.

Media exposure

Scientific quality (selection of publications)De Jong, N., Savin-Baden, M., Cunningham, A. M., & Verstegen, D. M. (2014). Blended learning in health education: three case studies. Perspectives on Medical Education, 3(4), 278-288.

Frambach, J. M., Manuel, B. A., Fumo, A. M., Groosjohan, B., Van Der Vleuten, C. P., & Driessen, E. W. (2017). How innovative and conventional curricula prepare medical students for practice in Sub-Saharan Africa: A comparative study from Mozambique. Education for Health, 30(1), 3.

Mogre, V., Amalba, A., Saaka, M., & Kyei-Aboagye, K. (2014). Medical students’ achievement on the Bachelor of Medicine, Bachelor of Surgery/Chirurgery Final Part I and II licensing examination: a comparison of students in problem-based learning, community-based education and service, and conventional curricula in Ghana. Journal of Educational Evaluation for Health Professions, 11.

Verstegen, D.M.L., & Fonteijn, H. (2018). Problem-Based Learning in a MOOC. Paper presented at the PAN-PBL 2018, February 16-19, Santa Clara, California, USA.

Verstegen, D.M.L., Clarebout, G., Spruijt, A., Dailey-Hebert, A., & Fonteijn, H. (2017). How do virtual teams collaborate in online learning tasks without a tutor? Paper presented at the AMEE Conference 2017, August 26-30, Helsinki, Finland.

Waterval, D. G., Frambach, J. M., Oudkerk Pool, A., Driessen, E. W., & Scherpbier, A. J. (2016). An exploration of crossborder medical curriculum partnerships: Balancing curriculum equivalence and local adaptation. Medical Teacher, 38(3), 255-262.

Source Title Lead researcher(s)

Observant, November 26, 2016 PBL at standing table. Met z’n allen aan de stehtisch. Door Wendy Degens Hans Savelberg

Observant, September 27, 2017 VR glasses in the tutorial group. VR Bril in de onderwijsgroep. Leuke gadget of waardevolle toevoeging. Door Cleo Freriks.

Nynke de Jong

Observant, April 23, 2015 First UM MOOC: Learning about Problem-Based Learning in the style of Problem-Based Learning

Danielle Verstegen

UMagazine, February, 2016 First UM MOOC is a hit. Interview in UMagazine, pages 4-6. Danielle Verstegen

PANPBL Association, Webinar, Dec 5, 2017

Does problem-based learning enhance deep learning? www.youtube.com/watch?v=WxuEP0wJ8mo

Diana Dolmans

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What is cognitive load theory?Throughout their curriculum, learners in domains like medicine encounter situations in which they must deal with a heavy information-processing load. CLT states that learning, which is defined as the construction and automation of cognitive schemas about a given topic or procedure, can only occur if the narrow limits of working memory are respected. Moreover, education must be designed with specific learning goals in mind; some cognitive activities are essential while other cognitive activities are nonessential for achieving these learning goals. Given that essential and nonessential cognitive activities together constitute the total cognitive load, to avoid cognitive overload (i.e., respect the narrow limits of working memory) and to stimulate learning (i.e., successful engagement in essential cognitive activities), education ought to be designed such that learners have to invest only a minimum of effort in nonessential cognitive activities and are stimulated to optimally engage in essential cognitive activities. To achieve this, it is of paramount importance that education and training be designed around specific and carefully timed learning goals. These learning goals can help educators to distinguish between essential and nonessential cognitive activities and can facilitate the design of assessments that monitor past and current learning, that inform subsequent learning, and that may - at some point - start to foster the development of monitoring and study activity selection skills on the part of the learner.

Who is involved?CLT is used as a theoretical framework for conducting research projects and as a set of guidelines for developing (multimedia) learning materials. Lectures and workshops on the theory have been given at a variety of conferences, including in keynote lectures in 2016 (International Cognitive Load Theory Conference, Bochum, Germany) and 2017 (International Association of Medical Science Educators, Burlington VT, United States). People currently involved in research involving CLT are prof. dr. Jeroen van Merriënboer, prof. dr. Diana Dolmans, prof. dr. Jan-Joost Rethans, dr. Jimmie Leppink, dr. Anique de Bruin, dr. Jeroen Donkers, Joy Lee MSc, Marie-Laurence Tremblay MSc, and Adam Szulewski MSc. Dr. Anique de Bruin is working on the integration of CLT with theories of self-regulated learning. Dr. Jeroen Donkers and Joy Lee apply CLT guidelines in the design of simulation-based games for learning emergency skills. Mrs. Laurence Tremblay and Mr. Adam Szulewski are currently doing their PhD projects on CLT, cognitive load measurement, and instructional design in emergency medicine contexts.

Users and collaborationsCLT is widely used by educational practitioners (professional designers and teachers) for the design of multimedia learning materials. One of the reasons why our work involving CLT has received renewed attention across the world is because of the development of a multidimensional psychometric instrument for the measurement of cognitive load. The instrument, originally developed and published in English, has been translated for research and education purposes in a variety of languages, including Dutch, German, French, Spanish, Russian, and Mandarin. There is a lively CLT community and association in which the SHE plays and active role. In June 2019, the SHE will organize the 12th International Cognitive Load Theory Conference (ILCTC) in Maastricht. At this conference, 100-150 scholars doing research inspired by or who are interested in cognitive load theory are expected to participate. Main theme of this 12th ICLTC edition will be education and training in the health professions.

Designing Multimedia Learning Materials: Managing the Load on a Learner’s Mind

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Scientific quality (selection of publications)De Bruin, A. B. H., & van Merrienboer, J. J. G. (2017). Bridging cognitive load and self-regulated learning research:

A complementary approach to contemporary issues in educational research. Learning and Instruction, 51, 1-9.Kester, L., & van Merrienboer, J. J. G. (2013). Effectief leren van multimediale leerbronnen. 4W: Weten wat werkt en waarom, 2(4), 14-51.

Leppink, J., Paas, F., Van der Vleuten, C. P. M., Van Gog, T., & Van Merriënboer, J. J. G. (2013). Development of an instrument for measuring different types of cognitive load. Behavior Research Methods, 45(4), 1058-1072.

Leppink, J., Paas, F., Van Gog, T., Van der Vleuten, C. P. M., & Van Merriënboer, J. J. G. (2014). Effects of pairs of problems and examples on task performance and different types of cognitive load. Learning and Instruction, 30, 32-42.

Leppink, J. & Van den Heuvel, A. (2015). The evolution of cognitive load theory and its application to medical education. Perspectives on Medical Education, 4(3), 119-127.

Leppink, J., Van Gog, T., Paas, F., & Sweller, J. (2015). Cognitive load theory: researching and planning to maximise learning. In: Cleland, J., & Durning, S. J. (Eds.), Researching Medical Education (Chapter 18, pp. 207-218).

Leppink, J., & Duvivier, R. (2016). Twelve tips for medical curriculum design from a cognitive load theory perspective. Medical Teacher, 38(7), 669-674.

Spanjers, I., Leppink, J., van Merrienboer, J. J. G., & van Gog, T. (2014). Waarom leren leerlingen meer van animaties met pauzes? Weten Wat Werkt en Waarom (4W), 3(3), 14-21.

Tremblay, M. L., Lafleur, A., Leppink, J., & Dolmans, D. H. J. M. (2017). The simulated clinical environment: cognitive and emotional impact among undergraduates. Medical Teacher, 39(2), 181-187.

Young, J. Q., van Merrienboer, J. J. G., Durning, S., & ten Cate, O. (2014). Cognitive load theory: Implications for medical education: AMEE Guide No. 86.


What is EPASS?Competency-based education has become central to training and assessment in higher education. In competency-based education, there is a strong focus on outcomes and professional performance. Typically, holistic tasks are used to train, practice and assess the defined outcomes or competencies. The performance of learners on these tasks needs to be captured and stored. A portfolio is often used as an instrument for storage and collection of assessment results and feedback. A portfolio can serve or be used for a variety of purposes, such as (i) the collection of work samples, assessment, feedback and evaluations, (ii) self-direction of learning by the learner, under the guidance of a mentor, and (iii) as an assessment instrument to make high-stake decisions about progress or promotion. Portfolios quickly evolved from paper-based formats to electronic formats, to enable quick overview by the learner and mentor, self-regulation of learning and reflective activities, automated depository of assessment results, online completion of feedback forms, aggregation of assessment and feedback information to take high-stake decisions and connection to mobile devices.

Who is involved?The following researchers are involved: J. van Berlo, Msc (UM) - ICT coordinator, J. Donkers, PhD (UM) - System architect, M. Govaerts, PhD (UM) - Educational expert, S. Heeneman, PhD (UM) - Educational expert, J. Moonen-van Loon, PhD (UM) - ICT developer, Management-team Mateum, C. van de Vleuten, PhD (UM) - Educational expert, Management-team Mateum, M. Holthuijsen, MSc (Mateum) - Head of Management Team Mateum, V. Kerkhofs, MSc (Mateum) - Technical consultant, product manager, Team of ICT developers (Mateum).

Users and collaborationsMaastricht University first implemented the use of a portfolio in the undergraduate Medical curriculum. In parallel, an e-portfolio platform was designed by the department of Educational Development and -Research. Insights from educational practice and research were used to design an evidence-based and fit-for-purpose portfolio platform. In 2008, EPASS (Electronic Portfolio Assessment Support System) was launched. Within the framework of an IN VIVO project, the construction of an e- portfolio for residents within the medical specialties Gynaecology and Pediatric Medicine was set up. In 2009, the collaboration with Mateum started, and the Mateum/ UM team expanded on diverse domains. EPASS was further developed and currently many educational programmes/ institutes (undergraduate, postgraduate) have implemented EPASS (see www.epass.eu/en/portfolios). In these contexts, EPASS is adapted to the specific requirements and features of the specific programme, whereby an educational fit-for purpose design and use of evidence-based methods are used. As an example: EPASS has also developed an App (RAPP-IT)) to support reflection and learning processes. Reflecting on workplace-based experiences is necessary for professional development. The RAPP-IT app, in combination with coaching/mentoring, can make learners more aware of learning moments, support and stimulate reflection of professional performance and development. In addition, EPASS is used to support educational developments and innovations, such as programmatic assessment, entrustable professional activities (EPAs) and a concept map approach to reflective activities (see www.epass.eu/en/innovation/academic-research). In 2014, the European project called WATCHME started, in which EPASS was used to improve workplace-based feedback and assessment and professional development by means of learning analytics. The further development and use of learning analytics is envisioned as the next step in the use of portfolios for the benefit of learning from feedback and assessment. As of November 2015, Intaka Learning is an official partner of Mateum involved with the marketing and the implementation of EPASS in South-Africa. Relevant website: The WatchMe project: www.project-watchme.eu and EPASS (Electronic Portfolio and Assessment Support System): www.epass.eu.

Electronic Portfolio Assessment Support System (EPASS)

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Societal impactIn a policy report (Ham, R, van Elk L. 2018. Inventarisatie e-portfolio-s in hoger onderwijs - een stand van zaken. www.surf.nl/digitale-leeromgeving ), the use and implementation of e-portfolio in higher education is summarised and discussed. It is emphasized that educational embedding is important, as is ownership by the learner, attainment to legal requirements and the possibility to export the data. These are features that EPASS has taken into account in the design and implementation of its e-portfolios.

Scientific quality (selection of publications) van Berlo, J., Heeneman, S., Verhoeven, B., & van der Vleuten, C. (2015). Een Mindmap-gebaseerd Portfolio ter Ondersteuning

van Reflectie in een Competentiegericht Onderwijsprogramma. Tijdschrift voor Hoger Onderwijs, 34-54.Könings, K. D., van Berlo, J., Koopmans, R., Hoogland, H., Spanjers, I. A., Jeroen, A., ... & van Merriënboer, J. J. (2016). Using a

smartphone app and coaching group sessions to promote residents’ reflection in the workplace. Academic Medicine, 91(3), 365-370.

Moonen-van Loon, J. M. W., Overeem, K., Donkers, H. H. L. M., Van der Vleuten, C. P. M., & Driessen, E. W. (2013). Composite reliability of a workplace-based assessment toolbox for postgraduate medical education. Advances in Health Sciences Education, 18(5), 1087-1102.

Moonen–van Loon, J. M., Overeem, K., Govaerts, M. J., Verhoeven, B. H., van der Vleuten, C. P., & Driessen, E. W. (2015). The reliability of multisource feedback in competency-based assessment programs: the effects of multiple occasions and assessor groups. Academic Medicine, 90(8), 1093-1099.

Pool, A. O., Govaerts, M. J., Jaarsma, D. A., & Driessen, E. W. (2018). From aggregation to interpretation: how assessors judge complex data in a competency-based portfolio. Advances in Health Sciences Education, 23(2), 275-287.

Van der Schaaf, M., Donkers, J., Slof, B., Moonen-van Loon, J., van Tartwijk, J., Driessen, E., Badii Serban, O., & Ten Cate, O. (2017). Improving workplace-based assessment and feedback by an E-portfolio enhanced with learning analytics. Educational Technology Research and Development, 65(2), 359-380.

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What is palliative care?Palliative care is an approach that improves the quality of life of patients and their families facing a life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, of a physical, psychosocial and/or spiritual nature (From: WHO definition of palliative care).

The need for palliative care is increasing due to the expanding aging population and the growing number of people with chronic diseases such as cancer, heart failure, COPD, and dementia. However, providing palliative care can be challenging, due to the multidimensional and multidisciplinary aspects. To be able to deliver quality palliative care, doctors need to be educated accordingly. International organisations such as the World Health Organization (WHO, 2014) and The European Association for Palliative Care (EAPC, 2015) underline the importance of palliative care education. Nonetheless, in the EAPC expert committee’s assessment of palliative care education in undergraduate curricula, the Netherlands scored in the bottom five of all European countries. Many initiatives have been launched with the aim of improving palliative care in the Netherlands. One of these is the Pasemeco project, part of the National Programme Palliative Care.

Pasemeco is a national project with the aim to improve palliative care education for Dutch medical students by developing and evaluating a program for palliative care in medical education. It started in 2016 and is funded by ZonMw, a Dutch organisation for health research and development. All eight universities in the Netherlands that offer undergraduate medical curricula have committed to this project. The Pasemeco project aims to have a direct impact on the medical undergraduate education in the Netherlands by developing education on palliative care in a design based research project. We use existing successful projects on palliative care education, adapt them when needed, and we create new educational material. We implement both existing and new material in the current and future medical curricula in the Netherlands. To this end, we are developing and evaluating a multi-purpose toolbox offering an integrated programme with authentic learning for palliative care.

Who are involved?All eight medical schools in the Netherlands have signed an intention letter to participate in this project and have been involved in the first two phases of the project. At the moment Pasemeco is actively involved in implementing toolbox material in four faculties: UMCG Groningen, ErasmusMC Rotterdam, Radboudumc Nijmegen and MUMC Maastricht, and in contact about future plans with the other medical schools in the Netherlands.

Users and collaborationsAs part of the Pasemeco project, students of four Dutch medical schools have been asked about their views on the importance of, their confidence in, and knowledge of palliative care. The 222 students in this study are soon-to-be junior doctors who will have to take care of palliative patients. These findings stress the importance of improving palliative care in the medical curriculum.

Patients who receive palliative care and informal caregivers have been interviewed. These interviews have been analysed and text fragments have been coded. Many comments of patients and relatives concerned the way that professional caregivers

Pasemeco: Improving palliative care education for our future doctors

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communicated and collaborated. From the interviews, many ‘do’s and don’ts’ for interactions between patients (and/or relatives) and medical professionals were distilled. Among these were: showing compassion and a healthy involvement with the patient in terms of attention and interest, listening carefully, taking time, not sticking to routines and following rules too strictly, avoiding administrative burden for patients, and refraining from using diminutive language.

To define what our future doctors should be capable of, regarding palliative care, an entrustable professional activity (EPA) list has been developed based on the EAPC guidelines and national initiatives on education in palliative care (Onderwijsraamwerk 1.0 and the recently published Kwaliteitskader). The list also gives direction to the contents of the Pasemeco toolbox and its implementation in the medical curricula.

Scientific quality (selection of publications)Pieters, J., Warmenhoven, F., Verstegen, D., Beuken-van Everdingen, M.H.J., van den, Courtens, A., & Dolmans, D.H.J.M. (2017).

Palliatieve zorg in het medisch basis curriculum: perspectief van de studenten [Palliative care in the undergraduate medical curriculum: perspective of the students]. Poster presented at NVMO congres 2017, November 16-17, Egmond aan zee, The Netherlands (in Dutch).

Westen, J.H., Jaarsma, A.D.C., Pols, J., Warmenhoven, F., & Van Dijken, P.(2017), Integratie van nieuwe onderwerpen in het medisch curriculum: Samen in gesprek [Integration of new topics in the medical curriculum], Round table organized at NVMO congres 2017, November 16-17, Egmond aan zee, The Netherlands (in Dutch).

Westen, J.H., Warmenhoven, F.C., & Pieters, J.(2017), Palliatieve zorg als casus in het medisch onderwijs [Palliative care as case in the medical curriculm], Workshop presented at NVMO congres 2017, November 16-17, Egmond aan zee, The Netherlands (in Dutch).

Pieters, J., Warmenhoven, F., Westen, J., Verstegen, D., van den Beuken-van Everdingen, M.H.J., Courtens, A. & Dolmans,D.H.J.M., Pasemeco-Palliatieve zorg in medisch onderwijs [Pasemeco-Palliative care in medical education], Poster presented at Eerste Nederlands-Vlaamse wetenschapsdagen palliatieve zorg 2017, November 30-December 1, Amsterdam, The Netherlands (in Dutch).

Pieters, J.(2017), Palliatieve zorg in het medisch basis curriculum: perspectief van de studenten [Mend the gap - Palliative care education: Students’ perspectives on palliative care education], Paper presented at Eerste Nederlands-Vlaamse wetenschapsdagen palliatieve zorg 2017, November 30-December 1, Amsterdam, The Netherlands.

Westen, J.H., Warmenhoven, F.C., Pieters, J.(2017) Het gebruik van palliatieve casuïstiek uit de praktijk in het medisch onderwijs [The use of palliative care cases from practice for medical education], Workshop presented at Eerste Nederlands-Vlaamse wetenschapsdagen palliatieve zorg 2017, November 30-December 1, Amsterdam, The Netherlands (in Dutch)

Pieters, J., Warmenhoven, F., Verstegen, D., van den Beuken-Everdingen, M.H.J., Courtens, A., & Dolmans, D. (2017). Palliative care in undergraduate medical education: Students’ perspective. Paper presented at the AMEE Conference 2017, August 26-30, Helsinki, Finland.

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What is EBMA?EBMA is a non-profit foundation which was created by assessment experts from European medical schools in 2009 as a result from the recognition of the phenomenon of globalization of medicine and the recommendations of the Bologna Accord for the creation of a European Higher Education Area. This community of assessment specialists understood there is a need to have common standards in assessing medical knowledge and clinical competence in order to establish a quality assurance framework throughout Europe, particularly considering the freedom of movement of patients and doctors in a multicultural Europe. EBMA is not, and cannot be, a licensing body. That is the function of regulatory bodies and universities in the different European countries. EBMA will always act within the legal provisions that ensure free movement of the medical workforce. Neither do we promote a pan European licensing examination. Rather, we will eventually provide a range of assessment products that will be relevant to Europe. EBMA is aimed at promoting best assessment practice for medical education in Europe and enables medical schools and other institutions, active in medical education and training, to develop and implement the strategic use of assessment for learning. To stay on top of quality levels and European standards and to make sure that medical students have the appropriate level of knowledge and skills to work across Europe, medical schools are increasingly looking for cooperation to ensure the quality of their medical education and assessment methods. Therefore, EBMA supports schools, individuals and other institutions by offering assessment products, trainings, conferences, workshops and services.

Who is involved?EBMA is a community consisted of individual and institutional members, who share expertise in assessment practice and research. In the recent years our community has been extensively grown with members all over Europe and beyond. There are several bodies (i.e. Board, Council of Audit & Goverance, Council of Participants, Scientific Committee) who are concerned with the strategic policy and operational matters of EBMA.

Users and collaborationsEuropean Knowledge Test (EKT). The EKT covers all relevant aspects of basic and clinical sciences as well as behavioural sciences and statistics. The EKT is currently available in English and consists of 200 multiple-choice questions, each with one best answer accepted as correct. The difficulty of the test and cut scoring are tailored to the knowledge level European students should have at the time just prior to receiving their Doctor of Medicine(or equivalent) degree. The objective of the EKT is to provide schools with a benchmarking tool with a high degree of reliability and validity for cross-cultural comparisons. Students with a good performance on the EKT can include their achievement in their curricula vitae and use such credential in residency selection processes or job applications.

International Progress Test (IPT). Progress testing is a way of cognitive testing that promotes long-lasting, deep learning strategies. It consists of a longitudinal assessment strategy covering the complete domain of medical knowledge and is administered periodically to students of all academic years. Progress tests can be used at the undergraduate and postgraduate level. Under the EBMA umbrella, participating medical schools will benefit from sharing quality testing materials and robust benchmarking. EBMA currently supports several schools with Progress Testing, which are Maastricht University (the Netherlands), Monterrey Tec University (Mexico), David Tvildiani Medical University (Georgia), University of Helsinki (Finland) and University of Algarve (Portugal).

European Board of Medical Assessors: Promoting best assessment practice in medical education in Europe

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EBMA Conferences and Trainings. Yearly, EBMA organises a conference on Assessment which will be hosted at one of EBMA’s institutional members. In 2017, about 150 professionals from 25 countries came together for the 2nd EBMA conference in the Netherlands to share knowledge on the latest trends of assessment in medical education. The main subject was Transformative Assessment. The EBMA conference 2018 will take place at the University of Minho, Braga, Portugal on November 22 -24 and the subject which will be addressed is ‘ Technology enabled Assessment. More information can be found here: www.ebma.eu/conference

EBMA training Psychometrics & Introduction to Assessment. EBMA has noticed a growing demand for more practical, hands-on activities involving Psychometrics. Many members wanted not only to interpret evidence on validity and reliability, but also to carry out adequate analyses themselves. This year the second training on Psychometrics was organised. Moreover, there was a need to set up a training on the general principles of assessment and practical aspects of assessment which resulted in the training ‘Introduction to Assessment for Healthcare Professions Education’ which will be held in October 2018.

Conference looking ahead in progress Testing. EBMA organizes in collaboration with University of Exeter Medical School a one-day conference titled ‘Looking ahead in progress testing’ on June 22th 2018 in Exeter, UK. This conference is open to all and those experienced with Progress Testing (PT) can come and present academic findings; and those new to PT can learn more about it and present their academic questions.

Scientific quality (selection of publications)Chang, H. H. (2015). Psychometrics behind computerized adaptive testing. Psychometrika, 80(1), 1-20.Dijkstra, J., Galbraith, R., Hodges, B. D., McAvoy, P. A., McCrorie, P., Southgate, L. J., Vleuten, C.P.M, Wass, V & Schuwirth, L. W. (2012).

Expert validation of fit-for-purpose guidelines for designing programmes of assessment. BMC medical education, 12(1), 20.Martin, A. J., & Lazendic, G. (2018). Computer-adaptive testing: Implications for students’ achievement, motivation, engagement,

and subjective test experience. Journal of Educational Psychology, 110(1), 27.van der Vleuten, C., Freeman, A., & Collares, C. F. (2018). Progress test utopia. Perspectives on medical education, 7(2), 136-138.

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Developing excellence in patient safety in cross-border regions through standardized procedures, policies and innovative tools: SafePATThe SHE’s Societal Impact in Narratives: 10

What is SafePAT?SafePAT is a European-financed project that aims to better understand and support international collaboration in the Euregion Meuse-Rhine (EMR). A total of six hospitals and educational institutions in the region form the SafePAT consortium. The consortium is supported by Interreg V-A, and co-financed by the regional provinces and all partner institutions. Typical for a border-region in the European Union, is that patients as well as healthcare providers are additionally challenged by fragmented and unconnected healthcare systems amplifying patient safety risks. Highly critical moments in the chain of patient safety, especially on an international level, are the patient’s admission to hospital, transfer within or between hospitals, and discharge from the hospital to other healthcare providers like general practitioners, also known as handovers. Handover is a risky event. It is associated with medication errors, increased length of stay, increased in-hospital complications and decreased patient satisfaction.

Support

Previous studies have shown that, on average, over 80,000 Dutch patients cross the border for planned and unplanned treatment in another country each year. This results in international patient handover (or handoff). Additional to the previously mentioned risks of handover, international handover is associated with language barriers, cultural barriers, differences in healthcare systems and unfamiliarity with other teams. It is therefore necessary to gain a better understanding of international patient handover and how to support these presumably risky situations by means of training. The EMR is characterized by a multitude of patient safety guidelines and standards with differences between countries and between hospitals. The guidelines and standards on patient safety are not always coherent and lack interoperability. Standardization and harmonization of local patient safety initiatives stimulate uniformity among regional healthcare institutions, ultimately increasing patient safety in the entire region. Two main research questions arose: (1) “What are requirements to improve international patient handover from the perspective of healthcare professionals and patients?”, and (2) “How can these requirements be supported with training interventions?”. The EMR is well positioned to address this challenge with some highly innovative institutions and approaches towards patient safety that are combined in the SafePAT consortium. For more info visit our website www.safepat.eu

Who is involved?The SafePAT consortium consists of six partner institutions that are all based in the Euregion Meuse-Rhine: Uniklinik RWTH Aachen, Ziekenhuis Oost-Limburg Genk, CHR de la Citadelle Liège, Universiteit Hasselt, Open Universiteit Heerlen, and Universiteit Maastricht. At Maastricht, Mara Bouwmans (PhD), Juliët Beuken, Daniëlle Verstegen (PhD), and Diana Dolmans (PhD), are involved in the project.

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Users and collaborationsMaastricht University recently completed an exploratory study about the current patient safety status quo among >1000 healthcare professionals in the EMR, and is working on a study to identify patient needs during international handovers. Results will be presented during the International Conference on Communication in Healthcare in Porto (September). In the meantime Maastricht is busy with ongoing case studies, aiming to further explore the exact needs of healthcare professionals in regional settings where international handover occurs on a regular basis. Further, Maastricht University together with University of Hasselt will provide a round table to discuss training possibilities of international collaboration in the region at the yearly conference of the NVMO in Egmond aan Zee (November).

Partners

The SafePAT colleagues at Open Universiteit (Heerlen) and CHR de la Citadelle (Liège) are cooperating in adapting the SimHand App into French language. The SimHand App is an augmented reality application running on mobile clients that enables to design medical role games and use them in medical simulation settings. The app will be adapted for training scenarios for medical professionals in CHR de la Citadelle. Our SafePAT colleagues at Ziekenhuis Oost-Limburg (Genk) have started a patient safety study this month. They developed a tool to empower patients who visited the emergency department to take their medication after discharge. Results will become available by the end of 2018. Within the framework of its quality accreditation by the JCI, CHR de la Citadelle (Liège) set up numerous strategies to improve patient safety. One of the main goals is the ongoing education of medical and nursing staff. This education is particularly focused on professional communication. In association with the SafePAT partners, an original thirty minutes e-learning was built, that is in its validation phase by now. The e-learning is part of a training program that will be assessed by and available for all the project partners. The SafePAT project received international attention when it was presented last month (March) at the Ottawa-ICME conference in Abu Dhabi. This has been the largest conference on medical education that attracted more than 2,000 influential leaders and decision-makers in medical education, health policy, medical practice and healthcare professionals from around the world. In October 2018, the SafePAT consortium organizes their first symposium “SafePAT: Joining forces across borders”. The symposium will contain of interesting lectures, workshops, and network possibilities with the aim to get to know involved professionals in the region and strengthen collaboration among them.

Scientific quality (selection of publications)Beuken, J., Bergs, J., Ulenaers, D., & Bouwmans, M.E.J. (2018). Krachten bundelen over de grens: training van internationale

samenwerkingsvaardigheden. Workshop, Nederlandse Vereniging voor Medisch Onderwijs Congres, Egmond aan Zee, 15-16 November 2018.

Beuken, J., Bouwmans, M.E.J., Verstegen, D., & Dolmans, D. (2018). Exploring risks of international handover and training needs of healthcare professionals in a European border region. Poster presentation, International Association for Medical Education Conference, Basel, 26-29 August 2018.

Beuken, J., Bouwmans, M.E.J., Verstegen, D., Dolmans, D. (2018). Exploring training needs of healthcare professionals in a European border region. Poster presentation, 16th International Conference on Communication in Healthcare, Porto, 1-4 September 2018.

Beuken, J., Bouwmans, M.E.J., Verstegen, D., Dolmans, D. (2018). How to train healthcare professionals in border areas to collaborate internationally? Work in progress session, 16th International Conference on Communication in Healthcare, Porto, 1-4 September 2018.

Bouwmans, M.E.J., Beuken, J., & Verstegen, D. (2018). Internationale zorgoverdrachten in de Euregio Maas-Rijn: wat zijn de behoeften van zorgprofessionals? Poster presentation, Nederlandse Vereniging voor Medisch Onderwijs Congres, Egmond aan Zee, 15-16 November 2018.

Bouwmans, M.E.J., Beuken, J., Verstegen, D., Dolmans, D. (2018). Hoe betrek je de klinische praktijk bij onderzoek naar medisch vervolgonderwijs? Poster presentation, Symposium Onderzoek naar onderwijs in de kliniek, Maastricht, 7 June 2018.

Bouwmans, M.E.J., Beuken, J., & Verstegen, D. (2018). International collaboration in a European border region: patient safety risks and solutions. Poster presentation, 16th International Conference on Communication in Healthcare, Porto, 1-4 September 2018.

Maastricht University / Maastricht UMC+School of Health Professions EducationFaculty of Health, Medicine and Life SciencesP.O. Box 616, 6200 MD Maastricht, The NetherlandsE: [email protected]

www.maastrichtuniversity.nl/she

Based in Europe, focused on the world. Maastricht University is a stimulating environment. Where research and teaching are complementary. Where innovation is our focus. Where talent can flourish. A truly student oriented research university.

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