The Dutch Case Developments in Medical Education in the Netherlands prof dr Herman JM van Rossum
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Transcript of The Dutch Case Developments in Medical Education in the Netherlands prof dr Herman JM van Rossum
The Dutch Case
Developments in Medical Education in the Netherlands
prof dr Herman JM van RossumFree University of Amsterdam
PortoFebruary 24th 2007
Groningen
Nijmegen
Maastricht
Rotterdam
UtrechtLeyden
Amsterdam AMCAmsterdam VU
Developments in Medical Education in the Netherlands
Medical education in the Netherlands: a continuum, many stakeholders
Undergraduate medical education
Postgraduate education
Conclusions
content Blueprint (8/8), competency based (5/8)process the Bologna process: restructuring the program (5/8)structure Integration of medical faculties and hospitals (8/8)
content Revising all programs; competencies, Teach the Teachersprocess shorter programs? new professions? pilot studystructure other umbrella: together with all health professions
IndependentLearning
Selection
Competencies
Medical education: a continuum
4 12 18-19 27 6530-33
Primary Secundary GP
Pub
Specialist
Undergrad
BolognaCompetenciesAccountabilityEfficiency
Quality Assurance
Medical Practice
IndependentLearning
Selection
Competencies
Medical education: a continuum
4 12 18-19 27 6530-33
Primary Secundary GP
Pub
Specialist
Undergrad
BolognaCompetenciesAccountabilityEfficiency
Quality Assurance
Medical Practice
Medical education and Health Care
4 12 18-19 27 6530-33
Primary Secundary GP
Pub
Specialist
Undergrad
Medical Practice
Education Health Care
1. Two Ministries are financing: Education and Health Care.2. Health Care: from individual doctor-patient health relation to Care ‘market’
• Providers Hospitals, homes, clinics• Brokers Insurance companies• Employees Doctors and other personnel
“Market”
Developments in Medical Education in the Netherlands
Medical education in the Netherlands: a continuum, many stakeholders
Undergraduate medical education
Postgraduate education
Conclusions
content Blueprint (8/8), competency based (5/8)process the Bologna process: restructuring the program (5/8)structure Integration of medical faculties and hospitals (8/8)
content Revising all programs; competencies, Teach the Teachersprocess shorter programs? new professions? pilot studystructure other umbrella: together with all health professions
Blueprint: Final Learning Outcomes
Basic curriculum
Blueprint
LAWFormats content
VUmc Compass CURRICULUM
Blueprintclinical conditions
competencies
VUmc
8 roles31 competencies
ConsultGive informationLiterature searchTeam work…
20 clusters188 conditions
Sore throat ShockProteinuriaDyingMisabusePreconception careEarly detection of …
17 domains> 150 concepts
Apoptosis Bio-psychosocial model DNA-repair StressHomeostasis EthicsAdaptation AutonomyFeedforward Laws …
concepts
CanMEDS
Calgary
Translation Blueprint into program
Tasks in practice
Curriculum
Professional field
Exercise tasksStudy tasks
Scientific field
Clinicalconditions
Competencies
Concepts
content
content
behaviour
behaviour
Concept of the translation
Rotterdam
Leyden
Amsterdam AMC
Groningen
Nijmegen
Maastricht
Utrecht
Amsterdam VU
Content of Dutch Curricula• Common learning outcomes• Eight different curricula• More electives (about 20%)• More research training (about 10%)
medical expert
professional scholar
collaborator communicator
healthadvocate
manager
self reflector
VUmc-CompassVU doctor:Competentwith passion.
MD
bachelor
Structure and characteristics new curriculum
1. grown-ups: similarities and differences
2. development of humans: man and wife
3. mechanisms of deseases
4. basic doctors skills
5. health care settings as working environment
6. choices in health care and in research
sem 1: 20 w sem 2: 20 w
MD
bachelor
Health care settings in new curriculum
MD
bachelor
Science in new curriculum
MD
bachelor
Assessment in new curriculum
MD
bachelor
Characteristics new VUmc-curriculum
sem 1: 20 w sem 2: 20 w
medical expert
professional scholar
collaborator communicator
healthadvocate
manager
reflector
Didactic learning environmentScientific settingHealth care settingFormal assessmentPortfolio assessment
Developments in Medical Education in the Netherlands
Medical education in the Netherlands: a continuum, many stakeholders
Undergraduate medical education
Postgraduate education
Conclusions
content Blueprint (8/8), competency based (5/8)process the Bologna process: restructuring the program (5/8)structure Integration of medical faculties and hospitals (8/8)
content Revising all programs; competencies, Teach the Teachersprocess shorter programs? new professions? pilot studystructure other umbrella: together with all health professions
Undergraduate Medical Education: process
The Bologna declaration process
- is a declaration, not a law, nor a treaty - countries are free to participate and to what degree - countries can make their own laws and regulations - the reasons for participation are varied, mainly political
Eastern-Europe: want to join the European ‘club’Denmark/Belgium: quick followersUK: medicine does not want to followFrance: what is Bologna?Netherlands: split response by deans, not a political item yet
History of the Bologna process
Year Place Topic # countries
1998 Sorbonne Harmonising of higher education in Europe 41999 Bologna One European Higher Education Area by 2010 292001 Prague Quality Assurance framework 332003 Berlin Peer review for Quality assurance 402005 Bergen Adoption of standards and guidelines ENQA 452007 London ??
Ten action lines of Bologna now1. System of comparable degrees2. 2 cycles:
- Bachelor: 3 jaar with possibility of outflow- Master
3. Creditsystem: ECTS4. Mobility of students and teachers5. Quality assurance: visitations and accreditation6. European dimension in the programmes
7. Third Cycle: the doctorate with PhD8. Acknowledgement of grades and study periods
/supplements of certificates9. “Learning Outcomes”, final goals? competencies?10. Longlive learning: national qualification structures,
European qualification framework
The Bologna process
The main question about the 2-cycle item is whether medical bachelors have relevant options to choose from other than the medical master program? If not, why should medical schools put so much effort in establishing two programs with the entire bureaucratic burden going along with it?
Here is the answer of the deans ...
But is this the most relevant item?What about quality assurance and learning outcomes?
Rotterdam
Leyden
Amsterdam AMC
Groningen
Nijmegen
Maastricht
Utrecht
Amsterdam VU
Bologna in the Netherlands
All Universities comply...but ... the 2-cycle!
Medical deans are split: 5-3
Unclear what will happen in 2010
Developments in Medical Education in the Netherlands
Medical education in the Netherlands: a continuum, many stakeholders
Undergraduate medical education
Postgraduate education
Conclusions
content Blueprint (8/8), competency based (5/8)process the Bologna process: restructuring the program (5/8)structure Integration of medical faculties and hospitals (8/8)
content Revising all programs; competencies, Teach the Teachersprocess shorter programs? new professions? pilot studystructure other umbrella: together with all health professions
Undergraduate Medical Education: structure
DEVELOPMENT in the LAST TWO DECADES
Merge of Medical Faculties and University Hospitals: all eight medical faculties now have been fused into University Medical Centers
The 8 Faculties of Medicine ...
- all have 350-400 new students a year
- are identically financed by the Ministry of Education
- all comply with the national Blueprint 2001
- work together: quality assessments of education and research
- each have their own type of program from complete problem-based to all kind
of mixed curricula; all have early patient contacts.
- all have one principal 800-1000 bed University Hospital.
Funding of the Medical Faculty
Ministry of Education
University
Faculty
Departments
number of Studentsnumber of Diplomasnumber of PhD’sand strategic research compartment
Model
28 M Euro/Year(40% Education - 60% Research)
Funding of the University Hospital
Ministry of Health
Routine Care BudgetAcademic Care Budget
Budget for the academicworkplace function:Clinical Education, Training, Clinical Research
Care sources
University Hospital
~ 260 M Euro~ 50 M Euro
Integral budget VUmc (2004)
• Ministry of Education 28• Ministry of Health 50• Care sources 260• Contract research 25• Various 8
_______ 370 M Euro
ADVANTAGES
One board of directorsOne employerOne management for the three main tasks: education, research and careMultidisciplinary research (preclinical combined with clinical)The use of common lab. facilities and specialised personnelMore flexibility because of larger budget
Merging: to do or not to do?
Merging: to do or not to do?
FEARS and possible DISADVANTAGES
Culture differences (democratic versus hierarchical)
David vs Goliath sentiments (‘Care will eat us all’)
Drifting away from the rest of the University
The loss of Academic character and status
A battle? ... or ...
... a (happy) marriage?
The development of UMC’s
The main question was whether the academic processes of research and education would survive, perish or flourish when they had to compete with the demands of health care. Would it be Academia or Health Care, David or Goliath?
Here is the answer of the deans ...
Conclusions of the deans
In the Netherlands the UMC is a success formula!- well organised education of high standard- productive research helped by the flexibility of bigger budgets- basic research not sacrificed at the altar of care- new forms of integrated management developed
Prerequisites and conditions- Most Deans have changed into professional executives!- Charter with a well defined relation of University and UMC- Clear and accepted role of the Dean in the Board of Directors of the
UMC i.e. responsible for Education and Research as well as for the selection of new academic staff
- Separate Budgets for Education and Research
Deans are happy about the marriageso far, but ...
what about the children? the student and the patient?
What should the dean take care of?
region
dean
secundaryschool
IN OUT
learn
teach
steer
patientstudent
Steering
Execution
organize
teacher
leaders
!UMC
+50%?
Staff / boards
Vocational programs
Now the dean has his basic structure.What about the primary educational process?
What should the dean take care of?
money alone ...or time of the doctors and their teaching qualities?
Health care system
in outpatient
doctor
patient
History takingPhysical examinationFirst consultation
operation
Patient care
Health care system
in outpatient
History takingPhysical examinationFirst consultation
operation
Patient care
TOO SIMPLE !management of care
doctor
patient
integrated management
Education and vocational trainingIn the health care system
in
doctor / teacher
assistant
clerk
Vocational training
education
outpatient
patient
History takingPhysical examinationFirst consultation
operation
Patient care
steering
support
Now the dean has his basic structureand the time for teachingand the organization?
What about the learning needsof the students and assistants?
STUDENT TEACHERTASK
Prepareshimself
LISTENSreflects
Gives JUDGMENT
DOES LOOKS
GivesFEEDBACK
The heart of clinical teaching
IN practiceTask descriptionOrganization of settingTeacher-training
Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7.
Knows
Shows how
Knows how
Does
Pro
fess
iona
l aut
hent
icity
Pro
fess
iona
l aut
hent
icity
Cognition
Behaviour
facts and concepts
problem solving
skills labs
practice
Training of competencies: Miller
Knows
Shows how
Knows how
Does
?
??
2007
Training of doctors should be on the top
Can deans use allies?
Yes, they need help of their colleagues.
How to mobilize the enthusiasm of the doctors, the professionals?
Developments in Medical Education in the Netherlands
Medical education in the Netherlands: a continuum, many stakeholders
Undergraduate medical education
Postgraduate education
Conclusions
content Blueprint (8/8), competency based (5/8)process the Bologna process: restructuring the program (5/8)structure Integration of medical faculties and hospitals (8/8)
content Revising all programs; competencies, Teach the Teachersprocess shorter programs? new professions? pilot studystructure other umbrella: together with all health professions
Royal Dutch Society for Medicine took the decision ...to innovate all 33 programs according to modern educational
principles: observation, feedback on behavior, varied assessment procedures ...
1. Competency based (CAN-meds)2. Portfolio mandatory3. Regular assessment sessions4. KPB’s (mini-CEX): 10 a year5. 360° Judgment on performance6. Knowledge tests7. Teach the Teachers programs
Postgraduate Medical Education: content
A nation-wide pilot-study has started this year by two disciplines (Pediatrics and Obstetrics / Gynecology) financed by Ministry of Health
OBJECTIVES- to develop prototypes for educational formats- to improve educational expertise of program directors- to increase support / analyze resistance- to develop a model for quality assurance
Postgraduate Medical Education: process
Postgraduate Medical Education: structure
UMC’s and the Professional societies are creating regional expertise centers for medical education
- linked to the eight University Medical Centers- serving all Health Professions- together serving all regions in the Netherlands
Rotterdam
Leyden
Amsterdam AMC
Groningen
Nijmegen
Maastricht
Utrecht
Amsterdam VU
The dream for the next decade
8 regions linked to the UMC’scovering all HC-professions
Conclusions
1. University Medical Centers are powerful structures in which care, research and education can be managed successfully. But what aboutthe primary educational process in the clinics?
2. The Medical professional organizations are creating a spirit of renewal and enthusiasm about education and training.
3. Regional centers for health care education should create the structure for clinical education of students and assistants AND to enable doctors to become competent clinical teachers.
‘Ο βίος βραχύς,
ή δε τέχνη μακρή,
We have to work together in educating the new generation of doctors
Ars longa, vita brevis
Hippocrates 450-370
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Thanks for your attention!
Let us work together in educating the new generation of doctors
Hippocrates 450-370
Conclusions
1. More tuning between undergraduate and postgraduate education- for educational methods: new spirits in postgraduate programs- improving educational skills of clinical teachers- quality assurance methodology
2. Tuning between education of doctors and other HC personnel- educational methods- organization and governance
3. Tuning between policy of department of Education and department of Health Care at the operational level
- merging medical faculties and University Hospitals- plans for eight regional medical education centers for all health care
personnel, each linked to one of the eight Universities
Questions for the future?
1. Bologna process and medicine: when will the politics decide?2. Will the marriage between University and Health Care last? 3. What will be the role of the doctor and the patient in the Health Care ‘market’ ?
Will the patient profit from all these development?
New programs, cooperations
18-19 27 6530-33
GP
Pub
Specialist
Undergrad
Medical PracticeUniversity
Prof. SchoolsP. Assist
Nurse P
Ministry of Health is stimulating...
shorter postgraduate medical training programs (eg hospital doctors)more physician assistant programsmore nurse practitioner programs
in order to ....make Health Care more efficient and cheaper.
Postgraduate Medical Education: process