Change Management Support in Postgraduate Medical Education: A Change for the Better

Curriculum change is inevitably a part of postgraduate medical education (PGME) due to a necessity to rapidly adapt to changes in societal needs, educational philosophy and technological advances. Initiating, adopting as well as sustaining successful change can be very challenging especially in complex and time-constrained environments such as healthcare and PGME. Indeed, research has shown that educational changes do not always lead to the desired adjustments in practice. Surprisingly, implementation processes in healthcare and, more particularly, those in medical education are rarely supported by change management principles despite the scale and implications of curriculum reforms that justify guidance of such implementation processes. Insights from a change management perspective could help to smoothen the transition from theory to practice by guiding implementation processes and provide support in routinizing innovations in standard practice. A thorough description about change from an educational as well as a change management perspective is made, followed by the experiences with introducing change management principles into PGME. Lastly, the potential of change management principles for future changes in medical education, and their practical implications, is presented

Working in preventive medicine or not? Flawed perceptions decrease chance of retaining students for the profession

Background: Recruiting and retaining students in preventive medical (PM) specialties has never been easy; one main challenge is how to select appropriate students with proper motivation. Understanding how students perceive PM practice differently from practicing doctors is necessary to guide students, especially for those for whom PM is only a substitute for medicine as their first study preference, properly during their study and, later, the practice of PM. Methods: One thousand three hundred eighty-six PM students in four Vietnamese medical schools and 101 PM doctors filled out a questionnaire about the relevance of 44 characteristics of working in PM. ANOVAs were conducted to define the relationship between students' interest, year of study, willingness to work in PM, and the degree to which students had realistic perceptions of PM practice, compared to doctors' perceptions. Results: Overall, compared to doctors' perceptions, students overestimated the importance of most of the investigated PM practice's characteristics. Moreover, students' perception related to their preference and willing to pursue a career in PM after graduation. In particular, students for whom PM was their first choice had more realistic perceptions of community practice than those who chose PM as their second choice. And, second-choice students had more realistic perceptions than first-choice students in their final years of study, but expected higher work stress in PM practice. Students who were willing to pursue a career in PM rated the importance of community practice higher than those who were not. We also found that students' perception changed during training as senior students had more realistic perceptions of clinical aspects and working stress than junior students, even though they overemphasized the importance of the community aspects of PM practice. Conclusions: To increase the number of students actually entering the PM field after graduation, the flawed perceptions of students about the real working environment of PM doctors should be addressed through vocation-oriented activities in the curriculum targeted on groups of students who are most likely to have unrealistic perceptions. Our findings also have implications for other less attractive primary health care specialties that experience problems with recruiting and retaining students

Nutrition in Medicine: Medical Students׳ Satisfaction, Perceived Relevance and Preparedness for Practice

Purpose Doctors play a critical role in providing nutrition care and supporting patients to adopt healthy dietary habits. Improving the quality of nutrition education in medical schools is necessary to build the capacity of doctors to deliver effective nutrition care to help reduce malnutrition especially for sub-Saharan Africa. This study investigated Ghanaian undergraduate clinical level medical students’ satisfaction with their current nutrition education, preparedness to provide nutrition care, perceived relevance of nutrition education to their future practice and their relationships. Method A survey among 207 clinical level medical students was conducted. An 11-item questionnaire with subscales was used to assess students’ demographic characteristics, satisfaction with current nutrition education, preparedness to provide nutrition care and perceived relevance of nutrition education to their future practice. Results Ninety-two percent (n=187) of the students considered nutrition education to be relevant to their future practice. However, the majority of the students (70%) were dissatisfied with the amount of time dedicated to nutrition education in their curriculum; integration of nutrition into organ-system based modules (62.0%); inclusion of nutrition materials to promote independent study (62.8%) and nutrition course content (59.0%). Only 22.2% felt adequately prepared by their current nutrition education to provide nutrition care in the general practice setting. Satisfaction with current education in nutrition was positively related to students’ preparedness to provide nutrition care in the general practice setting. Discussion Students were dissatisfied with their current education in nutrition, felt inadequately prepared to provide nutrition care and considered nutrition education to be highly relevant to their future practice. The findings of this study provide additional evidence that suggests changes in the current format and content of nutrition education in medical education

Reliability of clinical oral examinations re-examined

Many medical schools still use oral examinations for the evaluation of clinical competence of students in their clerkship, although it has been proven that orals have poor reliability. This study investigates the feasibility and reliability of multiple oral examinations. Students in the last week of their Internal Medicine clerkship in an outpatient clinic were given several patient-based oral examinations. The student's performance was rated on a list of items reflecting clinical competence. A global judgement of the student's performance was also given. The results indicate that it is possible to increase the number of orals and the number of examiners in the day-to-day practice of an outpatient clinic moderately. The reliability when using a number of orals is better than the reliability of the common single oral examination. The reliability using global judgements appeared to be better than the reliability of averaged item scores

Learn laparoscopic surgery without a patient

Traditionally, trainee surgeons have learnt many surgical procedures in the operating theatre directly on the patient, under the supervision of an experienced surgeon. However, for ethical, practical and legal reasons, there is a need to create training programs outside the operating theatre. The Netherlands Healthcare Inspectorate (IGZ) requires that measures be taken to improve training in laparoscopic skills by January 2009. The relevant surgical specialties need to collaborate on the development of uniform guidelines. It is time-consuming and costly to validate simulators and training programs. The ‘Fundamentals of Laparoscopic Surgery’ program is a training program developed in the United States of America which consists of theoretical and practical modules. It has been validated in various stages. Aspects of this program could be applied in Dutch training programs for basic laparoscopic skills.<br/

Zonder patiënt laparoscopisch leren opereren

Traditionally, trainee surgeons have learnt many surgical procedures in the operating theatre directly on the patient, under the supervision of an experienced surgeon. However, for ethical, practical and legal reasons, there is a need to create training programs outside the operating theatre. The Netherlands Healthcare Inspectorate (IGZ) requires that measures be taken to improve training in laparoscopic skills by January 2009. The relevant surgical specialties need to collaborate on the development of uniform guidelines. It is time-consuming and costly to validate simulators and training programs. The ‘Fundamentals of Laparoscopic Surgery’ program is a training program developed in the United States of America which consists of theoretical and practical modules. It has been validated in various stages. Aspects of this program could be applied in Dutch training programs for basic laparoscopic skills

Revisiting the D-RECT tool: Validation of an instrument measuring residents’ learning climate perceptions

<div><p></p><p><b>Introduction:</b> Credible evaluation of the learning climate requires valid and reliable instruments in order to inform quality improvement activities. Since its initial validation the Dutch Residency Educational Climate Test (D-RECT) has been increasingly used to evaluate the learning climate, yet it has not been tested in its final form and on the actual level of use – the department.</p><p><b>Aim:</b> Our aim was to re-investigate the internal validity and reliability of the D-RECT at the resident and department levels.</p><p><b>Methods:</b> D-RECT evaluations collected during 2012–2013 were included. Internal validity was assessed using exploratory and confirmatory factor analyses. Reliability was assessed using generalizability theory.</p><p><b>Results:</b> In total, 2306 evaluations and 291 departments were included. Exploratory factor analysis showed a 9-factor structure containing 35 items: teamwork, role of specialty tutor, coaching and assessment, formal education, resident peer collaboration, work is adapted to residents’ competence, patient sign-out, educational atmosphere, and accessibility of supervisors. Confirmatory factor analysis indicated acceptable to good fit. Three resident evaluations were needed to assess the overall learning climate reliably and eight residents to assess the subscales.</p><p><b>Conclusion:</b> This study reaffirms the reliability and internal validity of the D-RECT in measuring residency training learning climate. Ongoing evaluation of the instrument remains important.</p></div