Efforts, rewards and professional autonomy determine residents' experienced well-being.

The well-being of residents, our future medical specialists, is not only beneficial to the individual physician but also conditional for delivering high-quality patient care. Therefore, the authors further explored how residents experience their own well-being in relation to their professional and personal life. The authors conducted a qualitative study based on a phenomenological approach. From June to October 2013, 13 in-depth interviews were conducted with residents in various training programs using a semi-structured interview guide to explore participants' experience of their well-being in relation to their professional life. The data were collected and analyzed through an iterative process using the thematic network approach. Effort-reward balance and perceived autonomy were dominant overarching experiences in influencing residents' well-being. Experiencing sufficient autonomy was important in residents' roles as caregivers, as learners and in their personal lives. The experienced effort-reward balance could both positively and negatively influence well-being. We found two categories of ways that influence residents' experience of well-being; (1) professional lives: delivering patient care, participating in teamwork, learning at the workplace and dealing with the organization and (2) personal lives: dealing with personal characteristics and balancing work-life. In residents' well-being experiences, the effort-reward balance and perceived autonomy are crucial. Additionally, ways that influence residents' well-being are identified in both their professional and personal lives. These dominant experiences and ways that influence well-being could be key factors for interventions and residency training adaptations for enhancing residents' well-being.

[Supervisors being assessed]. / Supervisoren onder het vergrootglas.

OBJECTIVE: Since 2015, a permanent quality cycle is mandatory for medical residency specialist training. One aspect of this cycle is the System for Evaluation of Teaching Qualities (SETQ), which allows trainees to give feedback about their supervisor. We analysed how these quality evaluations are discussed within groups of supervisors. DESIGN: Questionnaire study amongst residency training program directors. METHOD: From September 2013 till February 2014, an online questionnaire was distributed amongst 255 program directors of medical residency specialist training in 54 teaching hospitals. The questionnaire assessed (a) if feedback was discussed, (b) the purpose of the feedback discussions, (c) their format, (d) the perceived outcomes and (e) any need for supervisor support in relation to any future feedback discussions. RESULTS: The response rate for the questionnaire was 61%. The majority of supervisor groups (86%) followed up on their individual SETQ feedback. Formats included individually between the program director and supervisor (34%), in a peer group of supervisors (69%), and in group format involving both trainees and supervisors (68%). Respondents listed the mutual learning process and devising improvement plans as aims of discussing feedback in a group format. There is considerable variation between groups of supervisors in terms of how the feedback is discussed. Over fifty percent of the group discussions resulted in concrete agreements for improvement plans. CONCLUSION: The feedback by trainees on the teaching performance of their supervisors is not wasted. The vast majority of supervisors follow up on their teaching performance feedback in peer group meetings.

Evaluating Mind Fitness Training and Its Potential Effects on Surgical Residents' Well-Being: A Mixed Methods Pilot Study.

BACKGROUND: Residents' well-being is essential for both the individual physician and the quality of patient care they deliver. Therefore, it is important to maintain or possibly enhance residents' well-being. We investigated (i) the influence of mind fitness training (MFT) on quality of care-related well-being characteristics: work engagement, empathy, work satisfaction and stress perception and explored (ii) residents' perceptions of MFT. METHODS: A multicenter study was conducted in eight Dutch teaching hospitals, from September 2012 to February 2014, using mixed methods­that is, quantitative and qualitative approaches to data collection and analysis. Eighty-nine surgical residents were invited to participate in pre- and post-intervention questionnaire surveys. Twenty-two residents participated in MFT and were additionally invited to evaluate the training by post-intervention interviews including open questions. RESULTS: At baseline 22 (100%) residents in intervention group and 47 (70.2%) residents in control group, and postintervention 20 (90.9 %) residents in intervention group and 41 (66.1%) residents in control group completed the questionnaires. In intervention-group, residents' specialty satisfaction increased by 0.23 point on 5-point Likert scale (95% CI 0.23­0.24, P < 0.001) while stress scores decreased by -0.94 point on 10-point scale (95% CI -1.77 to -0.12, P = 0.026). No substantial changes were observed in control group. Participation in MFT was positively associated with residents' empathy (b = 7.22; 95% CI 4.33­10.11; P < 0.001) and specialty satisfaction scores (b = 0.42; 95% CI 0.18­0.65; P = 0.001). Residents positively evaluated MFT with median scores of 6.80 for training design and 7.21 for outcome (10-point scale). Residents perceived improvement in focusing skills and reported being more aware of their own state of mind and feeling calmer and more in control. CONCLUSION: Mind fitness training could improve residents' empathy, specialty satisfaction, stress perception, and focusing skills, and was positively received by surgical residents.

A qualitative interview study on the positive well-being of medical school faculty in their teaching role: job demands, job resources and role interaction.

BACKGROUND: Attention for the well-being of medical school faculty is not only important for the prevention of attrition and burnout, but may also boost performance in their tasks in medical education. Positive well-being can be conceptualized as work engagement and this is associated with increased performance. In this study we explore how demands and resources from different tasks affect work engagement specifically for education. METHODS: Between June and September 2013, we conducted a multisite semi-structured interview study with a diverse group of medical school faculty and used an open-coding strategy within the Work Engagement Model on the transcribed interviews. RESULTS: We interviewed 16 faculty members whose teaching experience ranged from 7 to 38 years and whose professional tasks ranged from being solely an educator to being a physician, researcher, educator and administrator simultaneously. All participants were clear on the perceived demands and resources, although similar aspects of the work environment could be perceived oppositely between participants. Overarching themes were perceptions related to the organization or department, often described as a general and long-term effect and perceptions directly related to a task, often described as a direct and short-term effect on well-being. Furthermore, the demands and resources as resultant of fulfilling multiple tasks were described clearly by participants. CONCLUSIONS: The ambiguous nature of the work environment in terms of demands and resources requires an individualized approach to supporting work engagement. Furthermore, faculty members perceive many resources from fulfilling multiple tasks in relation to their tasks in education. Faculty developers and administrators alike could use these findings to apply the concept of work engagement to their daily support of faculty in medical education.

Immunization after renal transplantation: current clinical practice.

BACKGROUND: The use of potent immunosuppressive drugs and increased travel by renal transplant recipients (RTR) has augmented the risk for infectious complications. Immunizations and changes in lifestyle are protective. The Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group has developed guidelines on vaccination following solid organ transplantation. The degree of adherence to these guidelines is unknown, as is which barriers must be overcome to improve adherence. METHODS: We performed a cross-sectional national survey among Dutch nephrologists to assess vaccination policy and adherence to the KDIGO guidelines. In addition, to investigate awareness and attitude of RTR regarding their risk of infection, we performed a cross-sectional survey of RTR in our outpatient clinic. RESULTS: A total of 132 (63%) nephrologists completed the survey. Reported immunization rates were 90.8% for influenza and 27.3% for hepatitis B. However, pneumococcal, tetanus toxoid, and meningococcal immunization rates were low. Twenty-seven percent of respondents were familiar with the guideline contents. The most frequent perceived barrier to guideline adherence was expectation of low effectiveness. A total of 403 RTR (62%) completed the survey. Sixty-eight percent perceived more risk for complicated infection. A significant correlation was found between education level and variables concerning awareness and attitude toward risk of infection. CONCLUSIONS: Our results show that nephrologists' knowledge of and adherence to the recommendations regarding immunization after renal transplantation is suboptimal. Most Dutch RTR are aware of their increased risk and the possible seriousness of infectious complications. However, their behavior does not match their awareness. This disparity points to an important role for nephrologists in providing adequate counseling.

[Use of quality assessments by internists: added pressure to carry out assessments or an aid to improve quality?]. / Gebruik van kwaliteitsevaluaties door internisten: belastende evaluatiedruk of hulp bij kwaliteitsverbetering?

OBJECTIVE: To obtain an insight into how internists and residents use quality assessments and their opinions on these assessments. DESIGN: Questionnaire survey. METHOD: All 139 internists and residents who attended a national training day on internal medicine in 2012 were invited to answer questions anonymously on the actual use of various quality assessments and to give their opinion on these assessments. The questionnaire consisted of closed and free text questions. The answers were analysed using descriptive statistics. The qualitative information was analysed together by the investigators. RESULTS: In total 123 doctors (88% of the 139 attendants at the training day) from 45 training hospitals (74% of all internal medicine residency training programs) participated in this study. All respondents had recently participated as an individual or as a member of a group in one or more quality assessments. Medical departments and group practices carried out quality assessments more often than required in many cases. Respondents recognised and acknowledged the advantages of quality assessments. The disadvantages of quality assessments related to the methods, the ways assessments were used and undesirable effects. Most of the medical departments and group practices developed policies on how to follow up on the assessment results. Individual performance data was also discussed in the majority of cases. CONCLUSION: Internists (whether or not undergoing training) make extensive and intensive use of quality assessments. The benefits and the weaknesses of quality assessments are both acknowledged. Proactive efforts are required so that improvements can be made in addition to the assessments.

Residents' engagement and empathy associated with their perception of faculty's teaching performance.

BACKGROUND: Faculty members rely on residents' feedback about their teaching performance. The influence of residents' characteristics on evaluations of faculty is relatively unexplored. We aimed to evaluate the levels of work engagement and empathy among residents and the association of both characteristics with their evaluation of the faculty's teaching performance. METHODS: A multicenter questionnaire study among 271 surgery and gynecology residents was performed from September 2012 to February 2013. Residents' ratings of the faculty's teaching performance were collected using the system for evaluation of teaching quality (SETQ). Residents were also invited to fill out standardized measures of work engagement and empathy using the short Utrecht Work Engagement Scale and the Jefferson Scale of Physician Empathy, respectively. Linear regression analysis using generalized estimating equations to evaluate the association of residents' engagement and empathy with residents' evaluations of teaching performance. RESULTS: Overall, 204 (75.3 %) residents completed 1814 SETQ evaluations of 302 faculty, and 143 (52.8 %) and 140 (51.7 %) residents, respectively, completed the engagement and empathy measurements. The median scores of residents' engagement and empathy were 4.56 (scale 0-6) and 5.55 (scale 1-7), respectively. Higher levels of residents' engagement (regression coefficient b = 0.128; 95 % confidence interval (CI) 0.072-0.184; p < 0.001) and empathy (b = 0.113; 95 % CI 0.063-0.164; p < 0.001) were associated with higher faculty teaching performance scores. CONCLUSIONS: Residents' engagement and empathy appear to be positively associated with their evaluation of the faculty's performance. A possible explanation is that residents who are more engaged and can understand and share others' perspectives stimulate and experience faculty's teaching better than others.

[Concerns about residents' mental fitness: two possible strategies for a solution]. / Zorgen over de mentale fitheid van aiossen: 2 mogelijke oplossingsstrategieën.

A good level of physical and mental fitness is essential in order to function optimally as a resident. Concerns about residents' mental fitness have recently been raised, based on high percentages of residents suffering from burnout and depression and data on the experience of stress and anxiety. Lack of mental fitness has negative consequences for the individual doctor as well as for the quality of patient care delivered. This is expressed in loss of empathy, delivery of suboptimal care and increased medical errors. Finding solutions for the lack of, or deterioration in, mental fitness is crucial. We discuss two potential strategies: (1) the removal or reduction of obstacles to residents' mental fitness and (2) the provision of resources to improve mental fitness.

[Monitoring and improving the quality of residency training: the hospital's central teaching committee as director?]. / Het bewaken en verbeteren van de kwaliteit van de vervolgopleiding. De centrale opleidingscommissie als regisseur?

OBJECTIVE: The Central Teaching Committees (CTCs) of Dutch medical teaching institutions have, since January 1st 2011, the role of "director of medical residency training programmes" and as such are legally required to maintain and promote a positive and safe training environment. This study explores how CTCs are fulfilling their new role. DESIGN: Questionnaire study. METHODS: We developed a questionnaire to investigate the role of CTCs in assuring and improving the quality of the offered residency training. The questionnaire covered the general characteristics of the teaching institution and its CTC, the functioning of the CTCs including the attention given to quality management of residency training and the level of compliance with 6 quality standards. The first 2 parts contained mostly closed questions and questions concerning quality standards were scored on a 5-point scale. In the period December 2010-February 2011 the questionnaire was sent to 57 CTCs of academic and non-academic teaching hospitals in the Netherlands, addressed to the chair of the CTC; non-respondents were reminded up to 3 times. RESULTS: The response rate was 86%. In assuring and improving the quality of residency training CTCs fulfilled different roles, such as stimulating (77.1%), policy making (60.4%), enforcement (50.0%) and execution (27.1%). In 2010, all CTCs had considered quality management subjects during their meetings. Activities most often reported were peer review (61.0%), evaluating the learning climate (53.3%) and feedback to individual teaching faculty (36.7%). The level of compliance with the 6 quality standards varied from an average of 1.78 (creating an optimal learning climate) to 3.21 (enabling internal quality assessment). The top clinical teaching hospitals rated themselves highest. CONCLUSION: Quality assurance of residency training has the attention of CTCs, but systematic quality management is still in its infancy.

[Using the SETQ system to evaluate and improve teaching qualities of clinical teachers]. / Meten en verbeteren van opleiderskwaliteiten van klinisch opleiders met het SETQ-systeem.

OBJECTIVE: To determine (a) the feasibility of implementing a system for the evaluation of teaching qualities (SETQ) of faculty in an academic medical centre, (b) the psychometric qualities of the questionnaires that are used for the generation of feedback and (c) how residents evaluate the teaching qualities of faculty members and how faculty rated themselves. DESIGN: Questionnaire study. METHODS: Residents evaluated the teaching qualities of faculty members and faculty also evaluated themselves. Specialty specific questionnaires were developed for both evaluations. The psychometric qualities of the questionnaires were determined by using exploratory factor analysis and by calculating the reliability coefficients of scale constructs and item-total correlation. Mean, median and range were calculated for all teaching aspects per training programme. RESULTS: In the course of one year, 16 residency programmes in our academic medical centre implemented the SETQ system for the evaluation of teaching faculty. 398 faculty members and 314 residents were invited to (self-) evaluate; the response rates were 80.9% and 73.6% respectively. Residents conducted 2,520 evaluations in total. Factor analysis resulted in the definition of 5 teaching domains: 'learning climate', 'professional attitude towards residents', 'communication of learning goals', 'evaluation of residents' and 'feedback to residents'. Item-total correlation and reliability were high for both the residents' questionnaire and the self-evaluation questionnaire (Cronbach's alpha: > 0.70), except for the educational aspect 'learning climate' on the self-evaluation questionnaire (alpha: 0.67) Faculty members were rated positively, but the self-evaluation of faculty members was slightly less positive. For both groups 'professional attitude towards residents' was the highest scoring teaching domain and 'communication of learning goals' the lowest one. CONCLUSION: Implementing a system for the evaluation of teaching qualities (SETQ) of faculty in an academic hospital was proven feasible. The psychometric qualities of the underlying instruments was sufficient to good. Teaching faculty were evaluated positively, although interdepartmental variations existed.

Three methods of multi-source feedback compared: a plea for narrative comments and coworkers' perspectives.

BACKGROUND: Doctor performance assessments based on multi-source feedback (MSF) are increasingly central in professional self-regulation. Research has shown that simple MSF is often unproductive. It has been suggested that MSF should be delivered by a facilitator and combined with a portfolio. AIMS: To compare three methods of MSF for consultants in the Netherlands and evaluate the feasibility, topics addressed and perceived impact upon clinical practice. METHOD: In 2007, 38 facilitators and 109 consultants participated in the study. The performance assessment system was composed of (i) one of the three MSF methods, namely, Violato's Physician Achievement Review (PAR), the method developed by Ramsey et al. for the American Board of Internal Medicine (ABIM), or the Dutch Appraisal and Assessment Instrument (AAI), (ii) portfolio, (iii) assessment interview with a facilitator and (iv) personal development plan. The evaluation consisted of a postal survey for facilitators and consultants. Generalized estimating equations were used to assess the association between MSF method used and perceived impact. RESULTS: It takes on average 8 hours to conduct one assessment. The CanMEDS roles 'collaborator', 'communicator' and 'manager' were discussed in, respectively, 79, 74 and 71% of the assessment interviews. The 'health advocate role' was the subject of conversation in 35% of the interviews. Consultants are more satisfied with feedback that contains narrative comments. The perceived impact of MSF that includes coworkers' perspectives significantly exceeds the perceived impact of methods not including this perspective. CONCLUSIONS: Performance assessments based on MSF combined with a portfolio and a facilitator-led interview seem to be feasible in hospital settings. The perceived impact of MSF increases when it contains coworkers' perspectives.

Management of post-splenectomy patients in the Netherlands.

After splenectomy, patients are at increased risk of sepsis with considerable mortality. The risk of sepsis can be reduced by immunising these patients and by prescribing antibiotic prophylaxis. The purpose of our study was to determine compliance with the international standards for the management of splenectomised patients in the Netherlands by investigating: (i) vaccination rates, (ii) the prescription of antibiotics and (iii) information in discharge letters. A retrospective review of the medical records and discharge correspondence of 609 splenectomy patients from 1997 to 2008 was performed. Data were collected from 28 hospitals. Adherence to vaccination guidelines and the prescription of antibiotics were assessed. It was found that 85.4% of post-splenectomy patients received pneumococcal vaccination, 39.4% received Haemophilus influenzae type B and 32.3% received meningococcal group C vaccination. Also, 12.4% of patients were discharged on prophylactic antibiotics. In less than 25% of cases were adequate recommendations regarding post-splenectomy management given to the general practitioner (GP). In the Netherlands, compliance with recommendations for the management of patients after splenectomy is insufficient. Fifteen percent of patients do not receive vaccination against pneumococci and the majority of patients do not receive antibiotic prophylaxis. The development and implementation of a national guideline for splenectomised patients is urgently required.

Application of quality improvement strategies in 389 European hospitals: results of the MARQuIS project.

CONTEXT: This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project investigating the impact of quality improvement strategies on hospital care in various countries of the European Union (EU), in relation to specific needs of cross-border patients. AIM: This paper describes how EU hospitals have applied seven quality improvement strategies previously defined by the MARQuIS study: organisational quality management programmes; systems for obtaining patients' views; patient safety systems; audit and internal assessment of clinical standards; clinical and practice guidelines; performance indicators; and external assessment. METHODS: A web-based questionnaire was used to survey acute care hospitals in eight EU countries. The reported findings were later validated via on-site survey and site visits in a sample of the participating hospitals. Data collection took place from April to August 2006. RESULTS: 389 hospitals participated in the survey; response rates varied per country. All seven quality improvement strategies were widely used in European countries. Activities related to external assessment were the most broadly applied across Europe, and activities related to patient involvement were the least widely implemented. No one country implemented all quality strategies at all hospitals. There were no differences between participating hospitals in western and eastern European countries regarding the application of quality improvement strategies. CONCLUSIONS: Implementation varied per country and per quality improvement strategy, leaving considerable scope for progress in quality improvements. The results may contribute to benchmarking activities in European countries, and point to further areas of research to explore the relationship between the application of quality improvement strategies and actual hospital performance.

Differentiating between hospitals according to the "maturity" of quality improvement systems: a new classification scheme in a sample of European hospitals.

AIM: This study, part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project focusing on cross-border patients in Europe, investigated quality policies and improvement in healthcare systems across the European Union (EU). The aim was to develop a classification scheme for the level of quality improvement (maturity) in EU hospitals, in order to evaluate hospitals according to the maturity of their quality improvement activities. METHODS: A web-based questionnaire survey designed to measure quality improvement in EU hospitals was used as the basis for the classification scheme. Items included for the development of an evaluation tool--the maturity index--were considered important contributors to quality improvement. The four-stage quality cycle (plan, do, check and act) was used to determine the level of maturity of the various items. Psychometric properties of the classification scheme were assessed, and validation analyses were performed. RESULTS: A total of 389 hospitals participated in a questionnaire survey; response rates varied by country. For a final sample of 349 hospitals, it was possible to construct a quality improvement maturity index which consisted of seven domains and 113 items. The results of independent analyses sustained the validity of the index, which was useful in differentiating between hospitals in the research sample according to the maturity of their quality improvement system (defined as the total of all quality improvement activities). DISCUSSION: Further research is recommended to develop an instrument which for use in the future as a practical tool to evaluate the maturity of hospital quality improvement systems.

Is patient-centredness in European hospitals related to existing quality improvement strategies? Analysis of a cross-sectional survey (MARQuIS study).

BACKGROUND: There is growing recognition of patients' contributions to setting objectives for their own care, improving health outcomes and evaluating care. OBJECTIVE: To quantify the extent to which European hospitals have implemented strategies to promote a patient-centred approach, and to assess whether these strategies are associated with hospital characteristics and the development of the hospital's quality improvement system. DESIGN: Cross-sectional survey of 351 European hospital managers and professionals. MAIN OUTCOME MEASURES: Patients' rights, patient information and empowerment, patient involvement in quality management, learning from patients, and patient hotel services at the hospital and ward level were assessed. The hypothesis that the implementation of strategies to improve patient-centredness is associated with hospital characteristics, including maturity of the hospital's quality management system, was tested using binary logistic regression. RESULTS: In general, hospitals reported high implementation of policies for patients' rights (85.5%) and informed consent (93%), whereas strategies to involve patients (71%) and learn from their experience (66%) were less frequently implemented. For 13 out of 18 hospital strategies, institutions with a more developed quality improvement system consistently reported better results (percentage differences within maturity classification ranged from 12.4% to 46.6%). The strength of association between implementation of patient-centredness strategies and the quality improvement system, however, seemed lower at the ward than at the hospital level. Some associations (OR 2.1 to 5.1) disappeared or were weaker after adjustment for potential confounding variables (OR 2.2 to 3.7). CONCLUSIONS: Although quality improvement systems seem to be effective with regard to the implementation of selected patient-centredness strategies, they seem to be insufficient to ensure widespread implementation of patient-centredness throughout the organisation.

Impact of quality strategies on hospital outputs.

CONTEXT: This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project on patients crossing borders, a study to investigate quality improvement strategies in healthcare systems across the European Union (EU). AIM: To explore the association between the implementation of quality improvement strategies in hospitals and hospitals' success in meeting defined quality requirements that are considered intermediate outputs of the care process. METHODS: Data regarding the implementation of seven quality improvement strategies (accreditation, organisational quality management programmes, audit and internal assessment of clinical standards, patient safety systems, clinical practice guidelines, performance indicators and systems for obtaining patients' views) and four dimensions of outputs (clinical, safety, patient-centredness and cross-border patient-centredness) were collected from 389 acute care hospitals in eight EU countries using a web-based questionnaire. In a second phase, 89 of these hospitals participated in an on-site audit by independent surveyors. Pearson correlation and linear regression models were used to explore associations and relations between quality improvement strategies and achievement of outputs. RESULTS: Positive associations were found between six internal quality improvement strategies and hospital outputs. The quality improvement strategies could be reasonably subsumed under one latent index which explained about half of their variation. The analysis of outputs concluded that the outputs can also be considered part of a single construct. The findings indicate that the implementation of internal as well as external quality improvement strategies in hospitals has beneficial effects on the hospital outputs studied here. CONCLUSION: The implementation of internal quality improvement strategies as well as external assessment systems should be promoted.

Volume and diagnosis: an approach to cross-border care in eight European countries.

OBJECTIVES: Mobility of patients is a pertinent issue on the European Union's agenda. This study aimed to estimate the volume and main diagnoses of cross-border care in eight European countries, in order to provide policy makers with background information about the nature of patient mobility in Europe. METHODS: This article reports the combined findings from three independent studies that compiled self-reported information on admissions data and main diagnoses from more than 200 hospitals in eight European countries. RESULTS: The average volume of cross-border patients accounted for less than 1% of total admissions in the hospitals studied here. Diseases of the circulatory system (mainly acute myocardial infarction) and fractures were the most common reasons for hospitalisation of European patients abroad. Deliveries and other diagnoses related to pregnancy, pneumonia, appendicitis and other diseases of the digestive system, aftercare procedures, and disorders of the eye and adnexa were also common diagnoses for this population. CONCLUSIONS: Hospitals should reinforce their efforts to adapt the care provided to the needs of foreign patients in treatment areas that cover the most frequent pathologies identified in this population.

[An instrument for the assessment of the training qualities of clinician-educators]. / Een instrument voor de evaluatie van opleiderskwaliteiten van stafleden.

OBJECTIVE: The development and testing of a questionnaire to enable anesthesiology residents to assess the training qualities oftheir clinician-educators. DESIGN: Questionnaire. METHODS: The taskforce drafted a questionnaire based on the 26 item Stanford Faculty Development Program questionnaire (SFDP26) and adapted to the Dutch situation. Following its discussion in separate meetings ofanesthesiology residents and clinical staff, the questionnaire was further edited. The resulting instrument contained 6 teaching domains and 26 items. The questionnaire was made available electronically to anesthesiology residents only. Participation was voluntary, confidential and anonymous. Group results were presented at a plenary session. Anesthesiology staff received their individual scores by e-mail; results were confidential. RESULTS: 21 residents assessed 39 anesthesiologists. A total of 423 questionnaires were completed. Factor analysis resulted in the reduction and re-grouping of the teaching domains. The internal consistency ofthe teaching domains was high (Cronbach-alpha > or = 0.86). The assessment results of the teaching qualities of the anesthesiology faculty were positive. 'Communication of goals' was the lowest scoring (mean = 3.41) and 'Professional attitude towards residents' the highest scoring teaching domain (mean = 4.07). Gender did not correlate with the assessment scores of faculty. 'Year of training' was negatively correlated with most of the teaching domains. CONCLUSION: A feasible and reliable instrument for the evaluation of Dutch clinician-educators is now available.