Implementation of workplace-based assessment in general practice.

Background: Workplace-based assessment (WPBA) is widely accepted, but few studies have investigated implementation issues during general practice (GP) placements. This study explored possible barriers and identified key elements for successful implementation of a WPBA-programme in Danish GP specialist training. Methods: Supervisors had attended a one-day course in WPBA and trainees had received a short introduction. Questionnaires on experiences with implementation of WPBA were distributed to 106 GP supervisors and 110 trainees after the rotation was finished. Results: The response rate was 61/96 (64%) for trainees and 67/94 (71%) for supervisors. Supervisors were generally more positive towards WPBA and saw fewer barriers than trainees. Lack of planning was most often reported as an impediment to WPBA. Supervisors did not identify trainees' uneasiness of being observed as a problem as often as trainees. A total of 34% of trainees reported uneasiness as an obstacle to WPBA. Conclusions: It seems that the education of supervisors positively influenced supervisors' perception and use of WPBA. Adequate planning of WPBA may be just as big a problem as assigning the time. Further investigations on the impact of education on trainees' perception of WPBA are needed.

Residents in difficulty--just slower learners? A case-control study.

BACKGROUND: Recent meta-analyses have found small-moderate positive associations between general performance in medical school and postgraduate medical education. In addition, a couple of studies have found an association between poor performance in medical school and disciplinary action against practicing doctors. The aim of this study was to examine if a sample of Danish residents in difficulty tended to struggle already in medical school, and to determine whether administratively observable performance indicators in medical school could predict difficulties in residency. METHODS: The study design was a cumulative incidence matched case-control study. The source population was all active specialist trainees, who were medical school graduates from Aarhus University, in 2010 to June 2013 in two Danish regions. Cases were doctors who decelerated, transferred, or dropped out of residency. Cases and controls were matched for graduation year. Medical school exam failures, grades, completion time, and academic dispensations as predictors of case status were examined with conditional logistic regression. RESULTS: In total 89 cases and 343 controls were identified. The total number of medical school re-examinations and the time it took to complete medical school were significant individual predictors of subsequent difficulties (deceleration, transferral or dropout) in residency whereas average medical school grades were not. CONCLUSIONS: Residents in difficulty eventually reached similar competence levels as controls during medical school; however, they needed more exam attempts and longer time to complete their studies, and so seemed to be slower learners. A change from "fixed-length variable-outcome programmes" to "fixed-outcome variable-length programmes" has been proposed as a way of dealing with the fact that not all learners reach the same level of competence for all activities at exactly the same time. This study seems to support the logic of such an approach to these residents in difficulty.

[Doctors in training for general practice profit from being employed in both orthopaedic and general surgery wards]. / Læger i hoveduddannelse til almen medicin profiterer af ophold på både organ- og ortopædkirurgisk afdeling.

In the statement of aims of the education for general practice in Denmark competences in orthopaedic as well as in internal general surgery are specified by the Danish Health and Medicines Authority. In the period 2008-2010 there were three different types of employment for the assessment of competences in surgery. We found that doctors in training who had been employed in both orthopaedic and general surgery wards to a greater extent felt confident about their required competences in orthopaedic surgery. A majority of the 27 doctors participating in this survey felt that this kind of employment would be the best way to ensure the achievement of surgical competences.