[CanMEDS 2015: better doctors?]. / CanMEDS 2015: nog betere dokters?

Recently, the CanMEDS model, which forms the basis for competency-based learning in both undergraduate and postgraduate training, has been renewed by the introduction of CanMEDS 2015. The most prominent change is the emphasis on leadership skills, which is also reflected by the name change for the role of 'manager' to 'leader'. The addition of milestones provides clearly defined targets for learning and assessment, which facilitates the monitoring of the progression in competence. Furthermore, CanMEDS 2015 strongly focusses on the overall coherence of the separate competencies. CanMEDS, designed as a model that helps to train young doctors to become good doctors, also helps us - the trainers - to become better doctors ourselves.

Faculty and student perceptions of the feasibility of individual student-faculty meetings.

The extent to which students feel involved in their education positively influences academic achievement. Individual student-faculty meetings can foster student involvement. To be effective, faculty acknowledgement of the benefit of these meetings is a prerequisite. The aim of this study was to explore faculty perceptions of individual student-faculty meetings. In addition we investigated students' perceptions. As part of the undergraduate programme, mandatory individual intake and follow-up meetings between first-year medical students (n = 425) and senior faculty members (n = 34) have been implemented from 2009 onwards. We administered a questionnaire on faculty perceptions of the benefit and impact of intake meetings. Subsequently, after both meetings had been held, strong and weak points of the mandatory programme were explored using open-ended questions. Students' perceptions were investigated by open-ended questions as a part of the curriculum evaluation process. Faculty enjoyed the meetings (90 %), perceived the meetings to be beneficial (74 %) and expected a positive effect on student involvement (74 %). Faculty appreciated the opportunity to give advice tailored to students' personal needs and levels of performance. The students appreciated the meetings and the attention given to their personal situation and study progress. Faculty and student appreciation of the meetings seems to support the assumption that the individual meetings increase students' social and academic involvement. Further research should focus on the impact of individual student-faculty meetings on students' learning behaviours.

[Pro and contra discussion about medical education]. / Pro-contradiscussie over medisch onderwijs.

Since the end of the last century, medical education is being renewed in many countries. There is a tendency toward integration of clinical and preclinical knowledge, presentation of basic science topics as themes of organ systems in conjunction with clinical cases, emphasis on professional attitude, context-related and small-scale learning and the own responsibility of the student. As a contribution to the discussion, the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine) and the Tijdschrift voor Medisch Onderwijs (Dutch Journal of Medical Education) have decided to publish articles in a pro and contra format.

Comparison of two once-daily regimens with a regimen consisting of nelfinavir, didanosine, and stavudine in antiretroviral therapy-naïve adults: 48-week results from the Antiretroviral Regimen Evaluation Study (ARES).

BACKGROUND: To improve the dosing frequency and pill burden of antiretroviral therapy, we compared two once-daily dosed regimens to a twice-daily dosed regimen. METHOD: HIV-1-infected, antiretroviral drug-naïve adults were randomized to either twice-daily nelfinavir and stavudine and once-daily didanosine (regimen A) or simplified once-daily dosed antiretroviral regimens consisting of nevirapine, didanosine, and lamivudine (regimen B) or saquinavir, ritonavir, didanosine, and lamivudine (regimen C). RESULTS: At 48 weeks of therapy, the proportion of patients with a blood plasma HIV-1 RNA concentration (pVL) <50 copies/mL by intention-to treat analysis was 42.3%, 50.0%, and 56.5% for regimens A (n = 26), B (n = 22), and C (n = 23), respectively. The time to a pVL <50 copies/mL for the first time was significantly shorter in regimen C, and there was significantly more progression to CDC events in regimen B. These differences are possibly due to differences in baseline characteristics. Adverse events were lowest for regimen C; more signs associated with mitochondrial toxicity occurred in regimen A. Increase in CD4 count was comparable between arms. CONCLUSION: No statistically significant difference in efficacy was found between the two investigated once-daily dosed treatment regimens (B and C) and the reference (A). Regimen C possibly had a better virological response and less toxicity than regimens A and B.

Competency-based training for internal medicine.

The Central College of Medical Specialities has presented guidelines for modernisation of all postgraduate speciality training programmes. These guidelines include the definition of seven general competency fields, each of them described in more detail with four key competencies. By 2006, all postgraduate speciality training programmes will be based on these competency fields. Furthermore, by then assessment of residents will be focused on the achievement of competence, rather than only on fulfilment of length of specified rotations, numbers of clinical experiences and numbers of performed skills. The application of this competency model emphasises the fact that the education of medical doctors entails more than providing them with the required theoretical and clinical knowledge and skills.