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

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

Assessing the market opportunities of landfill mining.

Long-term estimates make clear that the amount of solid waste to be processed at landfills in the Netherlands will sharply decline in coming years. Major reasons can be found in the availability of improved technologies for waste recycling and government regulations aiming at waste reduction. Consequently, market size for companies operating landfills shrinks. Among the companies facing the problem is the Dutch company Essent. Given the expected market conditions, it looks for alternative business opportunities. Landfill mining, i.e., the recycling of existing landfills, is considered one of them. Proceeds of landfill mining are related to, for example, recycled materials available for re-use, regained land, and possibilities for a more efficient operation of a landfill. The market for landfill mining is of a considerable size--there are about 3800 landfills located in the Netherlands. Given market size the company faces the dilemma of how to explore this market, i.e., select the most profitable landfills in a fast and efficient way. No existing methods or tools could be found to do so. Therefore, to answer to the problem posed, we propose a step-wise research method for market exploration. The basic idea behind the method is to provide an adequate, cost-saving and timely answer by relying on a series of quick scans. Relevant aspects of a mining project concern the proceeds of regained land and recyclables, the costs of the mining operation and the associated business and environmental risks. The method has been tested for its practical use in a pilot study. The pilot study addressed 147 landfills located in the Dutch Province of Noord-Brabant. The study made clear how method application resulted in the selection of a limited number of high potential landfills in a few weeks, involving minimal research costs.