BackgroundRecent studies suggest that ethnic minority students underperform in standardised asses... more BackgroundRecent studies suggest that ethnic minority students underperform in standardised assessments commonly used to evaluate their progress. This disparity seems to also hold for postgraduate medical students and GP trainees, and may affect the quality of primary health care, which requires an optimally diverse workforce.AimsTo address the following: 1) to determine to what extent ethnic minority GP trainees are more at risk of being assessed as underperforming than their majority peers; 2) to investigate whether established underperformance appears in specific competence areas; and 3) to explore first- and second-generation ethnic minority trainees’ deviations.Design & settingQuantitative retrospective cohort design in Dutch GP specialty training (start years: 2015–2017).MethodIn 2020–2021, the authors evaluated files on assessed underperformance of 1700 GP trainees at seven Dutch GP specialty training institutes after excluding five opt-outs and 165 incomplete datasets (17.4%...
1.BackgroundSome postgraduate medical trainees in the General Practice (GP) and Elderly Care Medi... more 1.BackgroundSome postgraduate medical trainees in the General Practice (GP) and Elderly Care Medicine (ECM) training program, are considered being talented trainees (TTs) by their peers, teachers (at the institute), trainers (in clinical practice), and/or patients. We are currently unaware if these TTs are trained to meet their maximal potential or whether they are not fully stimulated during their learning process in the postgraduate training program. It is important to acknowledge them, because if we fail to acknowledge and suitably challenge TTs, it may lower their work ethos and satisfaction or cause loss of our TTs. As a first step, we will explore the way TTs make use of the learning possibilities provided during the postgraduate training program and what stimulates and hinders their learning in the clinical workplace.Knowledge on this subject is important for two reasons. First, knowing how TTs learn, can provide insights for improving learning in the workplace for all traine...
ObjectivesIn order to recognise and facilitate the development of excellent medical doctors (phys... more ObjectivesIn order to recognise and facilitate the development of excellent medical doctors (physicians and residents), it is important to first identify the characteristics of excellence. Failure to recognising excellence causes loss of talent, loss of role models and it lowers work ethos. This causes less than excellent patient care and lack of commitment to improve the healthcare system.DesignSystematic review performed according to the Association for Medical Education in Europe guideline.Information sourcesWe searched Medline, Embase, Psycinfo, ERIC and CINAHL until 14 March 2022.Eligibility criteriaWe included original studies describing characteristics of excellent medical doctors, using a broad approach as to what is considered excellence. Assuming that excellence will be viewed differently depending on the interplay, and that different perspectives (peers, supervisors and patients) will add to a complete picture of the excellent medical doctor, we did not limit this review ...
IntroductionThere is a broad call for change in existing quality systems within health care. One ... more IntroductionThere is a broad call for change in existing quality systems within health care. One of the anticipated reforms, is transferring ownership back to care deliverers. A promising way to establish this in general practice care, is to combine audit and feedback with peer group discussion. However, it is unknown what different stakeholder groups think of giving prominence to this type of quality improvement. In this study we explore ideas and opinions of different stakeholder groups in general practice on the opportunities and risks that could arise.MethodsWe conducted an exploratory qualitative study, combining interviews with focus discussion groups. Included stakeholder groups were general practitioners, patients, professional organizations and insurance companies. Within a constructivist paradigm, two researchers coded the data in three rounds, using thematic analysis. After continuously comparing and discussing codes with a third researcher, a final code tree emerged, pre...
Semi-gestructureerde vragenlijst beoordeling MITS: This is the Dutch questionnaire that the asses... more Semi-gestructureerde vragenlijst beoordeling MITS: This is the Dutch questionnaire that the assessors filled out when assessing the consultations. (DOCX 16Â kb)
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 16, 2015
The thentest design aims to detect and control for recalibration response shift. This design assu... more The thentest design aims to detect and control for recalibration response shift. This design assumes (1) more consistency in the content of the cognitive processes underlying patients' quality of life (QoL) between posttest and thentest assessments than between posttest and pretest assessments; and (2) consistency in the time frame and description of functioning referenced at pretest and thentest. Our objective is to utilize cognitive interviewing to qualitatively examine both assumptions. We conducted think-aloud interviews with 24 patients with cancer prior to and after radiotherapy to elicit cognitive processes underlying their assessment of seven EORTC QLQ-C30 items at pretest, posttest and thentest. We used an analytic scheme based on the cognitive process models of Tourangeau et al. and Rapkin and Schwartz that yielded five cognitive processes. We subsequently used this input for quantitative analysis of count data. Contrary to expectation, the number of dissimilar cogniti...
The aim of this research was to investigate teachers' perception of the concept of impulsivit... more The aim of this research was to investigate teachers' perception of the concept of impulsivity and its relation to the concept of reflectivity. Teacher rating scales for both concepts were constructed by means of the prototype method (Study 1). It appeared that impulsivity refers to social behaviour, whereas reflectivity is more cognitive in character. A Principal Components Analysis (Study 2) showed that the item pools for impulsive and reflective behaviour account for separate components. It is concluded that impulsivity and reflectivity as perceived by teachers are not two extremes of one dimension, but refer to different behavioural domains: social and cognitive.
CMAJ - Canadian Medical Association Journal, Feb 4, 2003
Stress and stress-related illnesses are increasing among medical specialists. This threatens the ... more Stress and stress-related illnesses are increasing among medical specialists. This threatens the quality of patient care. In this study we investigated (a) levels of job stress and job satisfaction among medical specialists, (b) factors contributing to stress and satisfaction and (c) the effect of stress and satisfaction on burnout. A questionnaire was mailed to a random sample of 2400 Dutch medical specialists. Measures included job stress, job satisfaction, burnout, personal characteristics, job characteristics and perceived working conditions. The final response rate was 63%. Of the respondents, 55% acknowledged high levels of stress, and 81% reported high job satisfaction. Personal and job characteristics explained 2%-6% of the variance in job stress and satisfaction. Perceived working conditions were more important, explaining 24% of the variance in job stress and 34% of the variance in job satisfaction. Among perceived working conditions, the interference of work on home life ...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2003
BACKGROUND Stress and stress-related illnesses are increasing among medical specialists. This thr... more BACKGROUND Stress and stress-related illnesses are increasing among medical specialists. This threatens the quality of patient care. In this study we investigated (a) levels of job stress and job satisfaction among medical specialists, (b) factors contributing to stress and satisfaction and (c) the effect of stress and satisfaction on burnout. METHODS A questionnaire was mailed to a random sample of 2400 Dutch medical specialists. Measures included job stress, job satisfaction, burnout, personal characteristics, job characteristics and perceived working conditions. RESULTS The final response rate was 63%. Of the respondents, 55% acknowledged high levels of stress, and 81% reported high job satisfaction. Personal and job characteristics explained 2%-6% of the variance in job stress and satisfaction. Perceived working conditions were more important, explaining 24% of the variance in job stress and 34% of the variance in job satisfaction. Among perceived working conditions, the interfe...
This study tests the hypothesis that a discrepancy between resources and demands explains most of... more This study tests the hypothesis that a discrepancy between resources and demands explains most of the variance in fatigue in cancer patients undergoing radiotherapy. Patients (n=250) were interviewed at pretreatment, posttreatment, and at 9-month follow-up. Resources involved physical condition, neuroticism, optimism, social support, gender, age, and level of education. Demands entailed prognosis, radiotherapy dose, the effort associated with actual activity, and the patient's perception of overall burden. Regression analyses were performed, using interaction terms to operationalize the discrepancy between resources and demands. The hypothesis was not supported. At pretreatment, physical condition explained most of the fatigue, whereas, at posttreatment, both the patients' physical condition and perception of burden contributed to fatigue. At follow-up, demands did not add to the variance already explained by resources, and vice versa. Factors that contribute to the patient's physical condition before starting radiotherapy and to his/her perception of burden need to be addressed to further our understanding of their fatigue.
ObjectivesAdopting an attributional perspective, the current article investigates how audit and f... more ObjectivesAdopting an attributional perspective, the current article investigates how audit and feedback group sessions contribute to general practitioners’ (GPs) motivation to change their practice behaviour to improve care. We focus on the contributions of the audit and feedback itself (content) and the group discussion (process).MethodsFour focus groups, comprising a total of 39 participating Dutch GPs, discussed and compared audit and feedback of their practices. The focus groups were analysed thematically.ResultsAudit and feedback contributed to GPs’ motivation to change in two ways: by raising awareness about aspects of their current care practice and by providing indications of the possible impact of change. For these contributions to play out, the audit and feedback should be reliable and valid, specific, recent and recurrent and concern GPs’ own practices or practices within their own influence sphere. Care behaviour attributed to external, uncontrollable or unstable causes...
ObjectivesTrust plays an important role in workplace-based postgraduate medical education program... more ObjectivesTrust plays an important role in workplace-based postgraduate medical education programmes. Trainers must trust their trainees for granting them greater independence. Trainees must trust their trainer for a safe learning environment. As trainers’ and trainees’ trust in each other plays an important role in trainee learning and development, the authors aimed to explore the development of the mutual trust relationship between trainers and trainees.SettingThis study was performed in a general practice training department in the Netherlands.ParticipantsAll trainers and trainees of the general practice training department were invited to participate. Fifteen trainers and 34 trainees, voluntarily participated in focus group discussions.Outcome measuresThe authors aimed to gain insight in the factors involved in the development of the mutual trust relationship between trainers and trainees, in order to be able to create a model for the development of a mutual trust relationship b...
BackgroundRecent studies suggest that ethnic minority students underperform in standardised asses... more BackgroundRecent studies suggest that ethnic minority students underperform in standardised assessments commonly used to evaluate their progress. This disparity seems to also hold for postgraduate medical students and GP trainees, and may affect the quality of primary health care, which requires an optimally diverse workforce.AimsTo address the following: 1) to determine to what extent ethnic minority GP trainees are more at risk of being assessed as underperforming than their majority peers; 2) to investigate whether established underperformance appears in specific competence areas; and 3) to explore first- and second-generation ethnic minority trainees’ deviations.Design & settingQuantitative retrospective cohort design in Dutch GP specialty training (start years: 2015–2017).MethodIn 2020–2021, the authors evaluated files on assessed underperformance of 1700 GP trainees at seven Dutch GP specialty training institutes after excluding five opt-outs and 165 incomplete datasets (17.4%...
1.BackgroundSome postgraduate medical trainees in the General Practice (GP) and Elderly Care Medi... more 1.BackgroundSome postgraduate medical trainees in the General Practice (GP) and Elderly Care Medicine (ECM) training program, are considered being talented trainees (TTs) by their peers, teachers (at the institute), trainers (in clinical practice), and/or patients. We are currently unaware if these TTs are trained to meet their maximal potential or whether they are not fully stimulated during their learning process in the postgraduate training program. It is important to acknowledge them, because if we fail to acknowledge and suitably challenge TTs, it may lower their work ethos and satisfaction or cause loss of our TTs. As a first step, we will explore the way TTs make use of the learning possibilities provided during the postgraduate training program and what stimulates and hinders their learning in the clinical workplace.Knowledge on this subject is important for two reasons. First, knowing how TTs learn, can provide insights for improving learning in the workplace for all traine...
ObjectivesIn order to recognise and facilitate the development of excellent medical doctors (phys... more ObjectivesIn order to recognise and facilitate the development of excellent medical doctors (physicians and residents), it is important to first identify the characteristics of excellence. Failure to recognising excellence causes loss of talent, loss of role models and it lowers work ethos. This causes less than excellent patient care and lack of commitment to improve the healthcare system.DesignSystematic review performed according to the Association for Medical Education in Europe guideline.Information sourcesWe searched Medline, Embase, Psycinfo, ERIC and CINAHL until 14 March 2022.Eligibility criteriaWe included original studies describing characteristics of excellent medical doctors, using a broad approach as to what is considered excellence. Assuming that excellence will be viewed differently depending on the interplay, and that different perspectives (peers, supervisors and patients) will add to a complete picture of the excellent medical doctor, we did not limit this review ...
IntroductionThere is a broad call for change in existing quality systems within health care. One ... more IntroductionThere is a broad call for change in existing quality systems within health care. One of the anticipated reforms, is transferring ownership back to care deliverers. A promising way to establish this in general practice care, is to combine audit and feedback with peer group discussion. However, it is unknown what different stakeholder groups think of giving prominence to this type of quality improvement. In this study we explore ideas and opinions of different stakeholder groups in general practice on the opportunities and risks that could arise.MethodsWe conducted an exploratory qualitative study, combining interviews with focus discussion groups. Included stakeholder groups were general practitioners, patients, professional organizations and insurance companies. Within a constructivist paradigm, two researchers coded the data in three rounds, using thematic analysis. After continuously comparing and discussing codes with a third researcher, a final code tree emerged, pre...
Semi-gestructureerde vragenlijst beoordeling MITS: This is the Dutch questionnaire that the asses... more Semi-gestructureerde vragenlijst beoordeling MITS: This is the Dutch questionnaire that the assessors filled out when assessing the consultations. (DOCX 16Â kb)
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 16, 2015
The thentest design aims to detect and control for recalibration response shift. This design assu... more The thentest design aims to detect and control for recalibration response shift. This design assumes (1) more consistency in the content of the cognitive processes underlying patients' quality of life (QoL) between posttest and thentest assessments than between posttest and pretest assessments; and (2) consistency in the time frame and description of functioning referenced at pretest and thentest. Our objective is to utilize cognitive interviewing to qualitatively examine both assumptions. We conducted think-aloud interviews with 24 patients with cancer prior to and after radiotherapy to elicit cognitive processes underlying their assessment of seven EORTC QLQ-C30 items at pretest, posttest and thentest. We used an analytic scheme based on the cognitive process models of Tourangeau et al. and Rapkin and Schwartz that yielded five cognitive processes. We subsequently used this input for quantitative analysis of count data. Contrary to expectation, the number of dissimilar cogniti...
The aim of this research was to investigate teachers' perception of the concept of impulsivit... more The aim of this research was to investigate teachers' perception of the concept of impulsivity and its relation to the concept of reflectivity. Teacher rating scales for both concepts were constructed by means of the prototype method (Study 1). It appeared that impulsivity refers to social behaviour, whereas reflectivity is more cognitive in character. A Principal Components Analysis (Study 2) showed that the item pools for impulsive and reflective behaviour account for separate components. It is concluded that impulsivity and reflectivity as perceived by teachers are not two extremes of one dimension, but refer to different behavioural domains: social and cognitive.
CMAJ - Canadian Medical Association Journal, Feb 4, 2003
Stress and stress-related illnesses are increasing among medical specialists. This threatens the ... more Stress and stress-related illnesses are increasing among medical specialists. This threatens the quality of patient care. In this study we investigated (a) levels of job stress and job satisfaction among medical specialists, (b) factors contributing to stress and satisfaction and (c) the effect of stress and satisfaction on burnout. A questionnaire was mailed to a random sample of 2400 Dutch medical specialists. Measures included job stress, job satisfaction, burnout, personal characteristics, job characteristics and perceived working conditions. The final response rate was 63%. Of the respondents, 55% acknowledged high levels of stress, and 81% reported high job satisfaction. Personal and job characteristics explained 2%-6% of the variance in job stress and satisfaction. Perceived working conditions were more important, explaining 24% of the variance in job stress and 34% of the variance in job satisfaction. Among perceived working conditions, the interference of work on home life ...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2003
BACKGROUND Stress and stress-related illnesses are increasing among medical specialists. This thr... more BACKGROUND Stress and stress-related illnesses are increasing among medical specialists. This threatens the quality of patient care. In this study we investigated (a) levels of job stress and job satisfaction among medical specialists, (b) factors contributing to stress and satisfaction and (c) the effect of stress and satisfaction on burnout. METHODS A questionnaire was mailed to a random sample of 2400 Dutch medical specialists. Measures included job stress, job satisfaction, burnout, personal characteristics, job characteristics and perceived working conditions. RESULTS The final response rate was 63%. Of the respondents, 55% acknowledged high levels of stress, and 81% reported high job satisfaction. Personal and job characteristics explained 2%-6% of the variance in job stress and satisfaction. Perceived working conditions were more important, explaining 24% of the variance in job stress and 34% of the variance in job satisfaction. Among perceived working conditions, the interfe...
This study tests the hypothesis that a discrepancy between resources and demands explains most of... more This study tests the hypothesis that a discrepancy between resources and demands explains most of the variance in fatigue in cancer patients undergoing radiotherapy. Patients (n=250) were interviewed at pretreatment, posttreatment, and at 9-month follow-up. Resources involved physical condition, neuroticism, optimism, social support, gender, age, and level of education. Demands entailed prognosis, radiotherapy dose, the effort associated with actual activity, and the patient's perception of overall burden. Regression analyses were performed, using interaction terms to operationalize the discrepancy between resources and demands. The hypothesis was not supported. At pretreatment, physical condition explained most of the fatigue, whereas, at posttreatment, both the patients' physical condition and perception of burden contributed to fatigue. At follow-up, demands did not add to the variance already explained by resources, and vice versa. Factors that contribute to the patient's physical condition before starting radiotherapy and to his/her perception of burden need to be addressed to further our understanding of their fatigue.
ObjectivesAdopting an attributional perspective, the current article investigates how audit and f... more ObjectivesAdopting an attributional perspective, the current article investigates how audit and feedback group sessions contribute to general practitioners’ (GPs) motivation to change their practice behaviour to improve care. We focus on the contributions of the audit and feedback itself (content) and the group discussion (process).MethodsFour focus groups, comprising a total of 39 participating Dutch GPs, discussed and compared audit and feedback of their practices. The focus groups were analysed thematically.ResultsAudit and feedback contributed to GPs’ motivation to change in two ways: by raising awareness about aspects of their current care practice and by providing indications of the possible impact of change. For these contributions to play out, the audit and feedback should be reliable and valid, specific, recent and recurrent and concern GPs’ own practices or practices within their own influence sphere. Care behaviour attributed to external, uncontrollable or unstable causes...
ObjectivesTrust plays an important role in workplace-based postgraduate medical education program... more ObjectivesTrust plays an important role in workplace-based postgraduate medical education programmes. Trainers must trust their trainees for granting them greater independence. Trainees must trust their trainer for a safe learning environment. As trainers’ and trainees’ trust in each other plays an important role in trainee learning and development, the authors aimed to explore the development of the mutual trust relationship between trainers and trainees.SettingThis study was performed in a general practice training department in the Netherlands.ParticipantsAll trainers and trainees of the general practice training department were invited to participate. Fifteen trainers and 34 trainees, voluntarily participated in focus group discussions.Outcome measuresThe authors aimed to gain insight in the factors involved in the development of the mutual trust relationship between trainers and trainees, in order to be able to create a model for the development of a mutual trust relationship b...
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