[Younger medical specialists and longer waiting time: cohort study of the duration of medical training]. / Jongere specialisten en langere wachttijd.

OBJECTIVE: To describe trends and developments in the total duration of training medical specialists in the Netherlands, including their ages upon completion of the components of medical education: undergraduate medical program, waiting time and further post-graduate specialist training. DESIGN: Population cohort study. METHOD: From the combined data from Statistics Netherlands and the Registration Committee for Medical Specialists for the period 1986 to 2018 relevant populations were selected and training trajectories were mapped. The population size was 40,604 individuals for undergraduate medical programs, 41,885 for the duration of post-graduate specialist training, 31,915 for the waiting periods and 21666 for the total duration of the trajectory from the start of medical school until registration as a specialist. RESULTS: The median duration of undergraduate medical programs was 7.1 years, which is longer than the nominal duration and this remained unchanged over the observation period. The average waiting time between graduating medical school and postgraduate specialist training has increased from 2010 onwards to 3.7 years in 2018. The average duration of postgraduate specialist training is increasing. The average age at graduation of medical school fell by 1.7 years to 26.1. The average age at the start of post-graduate specialist training decreased, as did the average age at registration as a specialist. CONCLUSION: The total duration of training of medical specialists is stable. Changes such as "dedicated transition year" and flexible arrangements for postgraduate training have had no discernible influence on the total duration of medical training. Because the average age at start of postgraduate specialist training has decreased, medical specialists are on average younger upon registration.

[Dutch medical disciplinary law cases concerning psychiatry, 2015-2019]. / Uitspraken van regionale tuchtcolleges in zaken betreffende de psychiatrie, 2015-2019.

BACKGROUND: The aim of medical disciplinary law (as part of the Dutch law 'Wet BIG') is to safeguard the quality of professional practice in the health services. Quantitative data about Dutch medical disciplinary law is sparse: little is known about the nature, quantity and the verdicts of disciplinary law complaints against psychiatrists and residents. AIM: Gaining insight in Dutch medical disciplinary law, in particular with regard to number and nature of disciplinary law complaints against psychiatrists(-psychotherapist) and psychiatry residents. METHOD: Descriptive retrospective study. We examined all medical disciplinary law cases against psychiatrists(-psychotherapist) and psychiatry residents in the period 2015-2019. RESULTS: In the study period the regional medical disciplinary courts handled 353 cases against psychiatrists(-psychotherapist) and residents psychiatry, on average 70.6 per year. 321 of these cases were against psychiatrists and 32 against residents. Complaint density was 1.74 for psychiatrists and 0.37 for residents. Subject of most cases was 'wrong diagnosis', followed by 'wrong therapeutic plan' and 'incorrect communication'. The number of cases resulting in a disciplinary measure was on average 31%: warning (49%), reprimand (30%), (conditional) suspension (15%). In 17 cases the professional was (partially) denied to practice. CONCLUSIONS Within Dutch psychiatry little attention is paid to disciplinary law, despite the fact that psychiatrists are relatively often confronted with disciplinary law complaints. The current explorative analysis underlines the need for further research, especially on the difference between male/female psychiatrists and an international comparison with respect to complaints about (sexual) misconduct.

[A different look at the quality of psychiatry education: trainee perspective]. / Kwaliteit van de opleiding tot psychiater anders bezien ­ de blik van de aios.

BACKGROUND: The (medical) educational literature does not contain an unequivocal answer to the question 'what is a good quality post-graduate education in psychiatry?'.
AIM: To describe the meaning of 'quality' and the role of psychiatrists in training (residents or trainees) in achieving and monitoring high-quality post-graduate psychiatry education in the Netherlands.
METHOD: Critical consideration of the current system of post-graduate education in psychiatry.
RESULTS: A qualitatively good post-graduate training system offers residents an optimal learning climate in which the individual development plan is central and there is opportunity to acquire a good basis for all competency domains. Possibilities for improvement concern the quality of supervisors, flexibility in internships and curricular education, and extra attention for management and policy skills.
CONCLUSION: Suggestions are made for further development of post-graduate psychiatry training in the Netherlands.

[Trends and developments in medical education research]. / Trends en ontwikkelingen in het medisch-onderwijskundig onderzoek.

BACKGROUND: In medical educational research specific approaches and research methods are used, the risk being that the field becomes less accessible to clinicians and teachers.
AIM: To highlight the relevance of educational research for clinical practice.
METHOD: A description of the development of medical educational research as a field and of the different types of research questions and the role of theories from related social sciences such as psychology, pedagogy and sociology.
RESULTS: First, there are the descriptive studies, based on the question 'what has been done'. Second, there are justification studies that compare educational innovations with existing practice to provide insight into 'did the intervention work better?'. A third group of studies focuses on clarification of underlying learning processes, with the question 'why or how did it work?' Theory helps with the design of studies and interpretation of research results, thereby increasing the quality and relevance of medical educational research.
CONCLUSION: Medical educational research has developed rapidly, and the involvement of teachers and clinicians (such as psychiatrists) is necessary to ensure that it remains closely connected to practice.

Teacher perceptions of desired qualities, competencies and strategies for clinical skills teachers.

INTRODUCTION: Clinical skills centres (or Skillslabs) prepare students for patient-encounters. Evidence on teaching skills in these centres is lacking. What teaching skills do teachers view as effective in supporting the acquisition of physical examination skills in undergraduate medical training? METHOD: Structured interviews of 10 teachers (1/3 of staff of Maastricht University, Skillslab) were conducted. Selection was based on even representation of age, years teaching experience, gender and previous experience at Maastricht University. A topic grid was used to ensure comparability. Interviews (average 70 min, range 33-95 min) were recorded and transcripts were analyzed independently by two researchers. RESULTS: Teaching skills identified include the ability to adapt content of the training, level of depth and teaching method according to the needs of any particular group. Thorough comprehension of students' context (level of knowledge,prior experience and insight in the curriculum) is considered helpful. Explicitly inviting students to ask questions and providing relevant literature is seen to stimulate learning. Providing constructive feedback is essential, as is linking physical examination skills training to clinical situations. The ideal attitude includes appropriate dress and behaviour, as well as the use of humour. Affinity for teaching is regarded as the most important reason to work as a teacher. CONCLUSION: Desired characteristics for undergraduate skills teachers resemble findings in other teaching roles. Affinity for teaching and flexibility in teaching methods are novel findings.