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The Dutch Case Developments in Medical Education in the Netherlands prof dr Herman JM van Rossum Free University of Amsterdam Porto February 24 th 2007.

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Presentation on theme: "The Dutch Case Developments in Medical Education in the Netherlands prof dr Herman JM van Rossum Free University of Amsterdam Porto February 24 th 2007."— Presentation transcript:

1 The Dutch Case Developments in Medical Education in the Netherlands prof dr Herman JM van Rossum Free University of Amsterdam Porto February 24 th 2007

2 Groningen Nijmegen Maastricht Rotterdam UtrechtLeyden Amsterdam AMC Amsterdam VU

3 Developments in Medical Education in the Netherlands Medical education in the Netherlands: a continuum, many stakeholders Undergraduate medical education Postgraduate education Conclusions contentBlueprint (8/8), competency based (5/8) process the Bologna process: restructuring the program (5/8) structureIntegration of medical faculties and hospitals (8/8) contentRevising all programs; competencies, Teach the Teachers processshorter programs? new professions? pilot study structure other umbrella: together with all health professions

4 Independent Learning Selection Competencies Medical education: a continuum PrimarySecundaryGP Pub Specialist Undergrad Bologna Competencies Accountability Efficiency Quality Assurance Medical Practice

5 Independent Learning Selection Competencies Medical education: a continuum PrimarySecundaryGP Pub Specialist Undergrad Bologna Competencies Accountability Efficiency Quality Assurance Medical Practice

6 Medical education and Health Care PrimarySecundaryGP Pub Specialist Undergrad Medical Practice EducationHealth Care 1.Two Ministries are financing: Education and Health Care. 2.Health Care: from individual doctor-patient health relation to Care market Providers Hospitals, homes, clinics Brokers Insurance companies EmployeesDoctors and other personnel Market

7 Developments in Medical Education in the Netherlands Medical education in the Netherlands: a continuum, many stakeholders Undergraduate medical education Postgraduate education Conclusions contentBlueprint (8/8), competency based (5/8) process the Bologna process: restructuring the program (5/8) structureIntegration of medical faculties and hospitals (8/8) contentRevising all programs; competencies, Teach the Teachers processshorter programs? new professions? pilot study structure other umbrella: together with all health professions

8 Blueprint: Final Learning Outcomes Basic curriculum Blueprint LAW Formats content

9 VUmc Compass CURRICULUM Blueprint clinical conditions competencies VUmc 8 roles 31 competencies Consult Give information Literature search Team work … 20 clusters 188 conditions Sore throat Shock Proteinuria Dying Misabuse Preconception care Early detection of … 17 domains > 150 concepts ApoptosisBio-psychosocial model DNA-repairStress HomeostasisEthics AdaptationAutonomy FeedforwardLaws … concepts CanMEDS Calgary Translation Blueprint into program

10 Tasks in practice Curriculum Professional field Exercise tasksStudy tasks Scientific field Clinical conditions Competencies Concepts content behaviour Concept of the translation

11 Rotterdam Leyden Amsterdam AMC Groningen Nijmegen Maastricht Utrecht Amsterdam VU Content of Dutch Curricula Common learning outcomes Eight different curricula More electives (about 20%) More research training (about 10%)

12 medical expert professional scholar collaboratorcommunicator health advocate manager self reflector VUmc-Compass VU doctor: Competent with passion.

13 MD bachelor Structure and characteristics new curriculum 1. grown-ups: similarities and differences 2. development of humans: man and wife 3. mechanisms of deseases 4. basic doctors skills 5. health care settings as working environment 6. choices in health care and in research sem 1: 20 wsem 2: 20 w

14 MD bachelor Health care settings in new curriculum

15 MD bachelor Science in new curriculum

16 MD bachelor Assessment in new curriculum

17 MD bachelor Characteristics new VUmc-curriculum sem 1: 20 wsem 2: 20 w medical expert professional scholar collaboratorcommunicator health advocate manager reflector Didactic learning environment Scientific setting Health care setting Formal assessment Portfolio assessment

18 Developments in Medical Education in the Netherlands Medical education in the Netherlands: a continuum, many stakeholders Undergraduate medical education Postgraduate education Conclusions contentBlueprint (8/8), competency based (5/8) process the Bologna process: restructuring the program (5/8) structureIntegration of medical faculties and hospitals (8/8) contentRevising all programs; competencies, Teach the Teachers processshorter programs? new professions? pilot study structure other umbrella: together with all health professions

19 Undergraduate Medical Education: process The Bologna declaration process - is a declaration, not a law, nor a treaty - countries are free to participate and to what degree - countries can make their own laws and regulations - the reasons for participation are varied, mainly political Eastern-Europe:want to join the European club Denmark/Belgium:quick followers UK:medicine does not want to follow France:what is Bologna? Netherlands:split response by deans, not a political item yet

20 History of the Bologna process Year Place Topic # countries 1998 Sorbonne Harmonising of higher education in Europe Bologna One European Higher Education Area by Prague Quality Assurance framework Berlin Peer review for Quality assurance Bergen Adoption of standards and guidelines ENQA London ??

21 Ten action lines of Bologna now 1.System of comparable degrees 2.2 cycles: - Bachelor: 3 jaar with possibility of outflow - Master 3.Creditsystem: ECTS 4.Mobility of students and teachers 5.Quality assurance: visitations and accreditation 6.European dimension in the programmes 7.Third Cycle: the doctorate with PhD 8.Acknowledgement of grades and study periods /supplements of certificates 9.Learning Outcomes, final goals? competencies? 10.Longlive learning: national qualification structures, European qualification framework

22 The Bologna process The main question about the 2-cycle item is whether medical bachelors have relevant options to choose from other than the medical master program? If not, why should medical schools put so much effort in establishing two programs with the entire bureaucratic burden going along with it? Here is the answer of the deans... But is this the most relevant item? What about quality assurance and learning outcomes?

23 Rotterdam Leyden Amsterdam AMC Groningen Nijmegen Maastricht Utrecht Amsterdam VU Bologna in the Netherlands All Universities comply... but... the 2-cycle! Medical deans are split: 5-3 Unclear what will happen in 2010

24 Developments in Medical Education in the Netherlands Medical education in the Netherlands: a continuum, many stakeholders Undergraduate medical education Postgraduate education Conclusions contentBlueprint (8/8), competency based (5/8) process the Bologna process: restructuring the program (5/8) structureIntegration of medical faculties and hospitals (8/8) contentRevising all programs; competencies, Teach the Teachers processshorter programs? new professions? pilot study structure other umbrella: together with all health professions

25 Undergraduate Medical Education: structure DEVELOPMENT in the LAST TWO DECADES Merge of Medical Faculties and University Hospitals: all eight medical faculties now have been fused into University Medical Centers

26 The 8 Faculties of Medicine... - all have new students a year - are identically financed by the Ministry of Education - all comply with the national Blueprint work together: quality assessments of education and research - each have their own type of program from complete problem-based to all kind of mixed curricula; all have early patient contacts. - all have one principal bed University Hospital.

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29 Funding of the Medical Faculty Ministry of Education University Faculty Departments number of Students number of Diplomas number of PhDs and strategic research compartment Model 28 M Euro/Year (40% Education - 60% Research)

30 Funding of the University Hospital Ministry of Health Routine Care Budget Academic Care Budget Budget for the academic workplace function: Clinical Education, Training, Clinical Research Care sources University Hospital ~ 260 M Euro~ 50 M Euro

31 Integral budget VUmc (2004) Ministry of Education28 Ministry of Health50 Care sources 260 Contract research25 Various 8 _______ 370 M Euro

32 ADVANTAGES One board of directors One employer One management for the three main tasks: education, research and care Multidisciplinary research (preclinical combined with clinical) The use of common lab. facilities and specialised personnel More flexibility because of larger budget Merging: to do or not to do?

33 FEARS and possible DISADVANTAGES Culture differences (democratic versus hierarchical) David vs Goliath sentiments (Care will eat us all) Drifting away from the rest of the University The loss of Academic character and status

34 A battle?... or...

35 ... a (happy) marriage?

36 The development of UMCs The main question was whether the academic processes of research and education would survive, perish or flourish when they had to compete with the demands of health care. Would it be Academia or Health Care, David or Goliath? Here is the answer of the deans...

37 Conclusions of the deans In the Netherlands the UMC is a success formula! - well organised education of high standard - productive research helped by the flexibility of bigger budgets - basic research not sacrificed at the altar of care - new forms of integrated management developed Prerequisites and conditions -Most Deans have changed into professional executives! -Charter with a well defined relation of University and UMC -Clear and accepted role of the Dean in the Board of Directors of the UMC i.e. responsible for Education and Research as well as for the selection of new academic staff -Separate Budgets for Education and Research

38 Deans are happy about the marriage so far, but... what about the children? the student and the patient? What should the dean take care of?

39 region dean secundary school IN OUT learn teach steer patient student Steering Execution organize teacher leaders ! UMC +50% ? Staff / boards Vocational programs

40 Now the dean has his basic structure. What about the primary educational process? What should the dean take care of? money alone... or time of the doctors and their teaching qualities?

41 Health care system inout patient doctor patient History taking Physical examination First consultation operation Patient care

42 Health care system inout patient History taking Physical examination First consultation operation Patient care TOO SIMPLE ! management of care doctor patient

43 integrated management Education and vocational training In the health care system in doctor / teacher assistant clerk Vocational training education out patient History taking Physical examination First consultation operation Patient care steering support

44 Now the dean has his basic structure and the time for teaching and the organization? What about the learning needs of the students and assistants?

45 STUDENT TEACHER TASK Prepares himself LISTENS reflects Gives JUDGMENT DOES LOOKS Gives FEEDBACK The heart of clinical teaching IN practice Task description Organization of setting Teacher-training

46 Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7. Knows Shows how Knows how Does Professional authenticity Cognition Behaviour facts and conceptsproblem solvingskills labspractice Training of competencies: Miller

47 Knows Shows how Knows how Does ? ?? 2007 Training of doctors should be on the top

48 Can deans use allies? Yes, they need help of their colleagues. How to mobilize the enthusiasm of the doctors, the professionals?

49 Developments in Medical Education in the Netherlands Medical education in the Netherlands: a continuum, many stakeholders Undergraduate medical education Postgraduate education Conclusions contentBlueprint (8/8), competency based (5/8) process the Bologna process: restructuring the program (5/8) structureIntegration of medical faculties and hospitals (8/8) contentRevising all programs; competencies, Teach the Teachers processshorter programs? new professions? pilot study structure other umbrella: together with all health professions

50 Royal Dutch Society for Medicine took the decision... to innovate all 33 programs according to modern educational principles: observation, feedback on behavior, varied assessment procedures... 1.Competency based (CAN-meds) 2.Portfolio mandatory 3.Regular assessment sessions 4.KPBs (mini-CEX): 10 a year 5.360° Judgment on performance 6.Knowledge tests 7.Teach the Teachers programs Postgraduate Medical Education: content

51 A nation-wide pilot-study has started this year by two disciplines (Pediatrics and Obstetrics / Gynecology) financed by Ministry of Health OBJECTIVES - to develop prototypes for educational formats - to improve educational expertise of program directors - to increase support / analyze resistance - to develop a model for quality assurance Postgraduate Medical Education: process

52 Postgraduate Medical Education: structure UMCs and the Professional societies are creating regional expertise centers for medical education - linked to the eight University Medical Centers - serving all Health Professions - together serving all regions in the Netherlands

53 Rotterdam Leyden Amsterdam AMC Groningen Nijmegen Maastricht Utrecht Amsterdam VU The dream for the next decade 8 regions linked to the UMCs covering all HC-professions

54 Conclusions 1.University Medical Centers are powerful structures in which care, research and education can be managed successfully. But what about the primary educational process in the clinics? 2. The Medical professional organizations are creating a spirit of renewal and enthusiasm about education and training. 3. Regional centers for health care education should create the structure for clinical education of students and assistants AND to enable doctors to become competent clinical teachers.

55 Ο βίος βραχύς, ή δε τέχνη μακρή, We have to work together in educating the new generation of doctors Ars longa, vita brevis Hippocrates

56 Thanks for your attention! Let us work together in educating the new generation of doctors Hippocrates

57 Conclusions 1.More tuning between undergraduate and postgraduate education - for educational methods: new spirits in postgraduate programs - improving educational skills of clinical teachers - quality assurance methodology 2. Tuning between education of doctors and other HC personnel - educational methods - organization and governance 3. Tuning between policy of department of Education and department of Health Care at the operational level - merging medical faculties and University Hospitals - plans for eight regional medical education centers for all health care personnel, each linked to one of the eight Universities

58 Questions for the future? 1.Bologna process and medicine: when will the politics decide? 2.Will the marriage between University and Health Care last? 3.What will be the role of the doctor and the patient in the Health Care market ? Will the patient profit from all these development?

59 New programs, cooperations GP Pub Specialist Undergrad Medical Practice University Prof. Schools P. Assist Nurse P

60 Ministry of Health is stimulating... shorter postgraduate medical training programs (eg hospital doctors) more physician assistant programs more nurse practitioner programs in order to.... make Health Care more efficient and cheaper. Postgraduate Medical Education: process


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