Introducing competency-based postgraduate medical education in the Netherlands

Abstract

Medical boards around the world face the challenge of creating competency-based postgraduate training programs. Recent legislation requires that all postgraduate medical training programmes in The Netherlands be reformed. In this article the Dutch Advisory Board for Postgraduate Curriculum Development shares some of their experiences with guiding the design of specialist training programs, based on the Canadian Medical Educational Directives for Specialists (CanMEDS). All twenty-seven Dutch Medical Specialty Societies take three steps in designing a curriculum. First they divide the entire content of a specialty into logical units, so-called 'themes'. The second step is discussing, for each theme, for which tasks trainees have to be instructed, guided, and assessed. Finally, for each task an assessment method is chosen to focus on a limited number of CanMEDS roles. This leads to a three step training cycle: (i) based on their in-training assessment and practices, trainees will gather evidence on their development in a portfolio; (ii) this evidence stimulates the trainee and the supervisor to regularly reflect on a trainee's global development regarding the CanMEDS roles as well as on the performance in specific tasks; (iii) a personal development plan structures future learning goals and strategies. The experiences in the Netherlands are in line with international developments in postgraduate medical education and with the literature on workplace-based teaching and learning.

Cognitive and Psychomotor Entrustable Professional Activities: Can Simulators Help Assess Competency in Trainees?

“…Creating entrustable professional activities allows faculty to identify and select the most important, representative, and critical tasks that should be mastered [30]. Scheele et al [34] recommended focusing on those tasks critically important in daily practice or that address highrisk or error-prone activities; certainly the list of competencies listed by the Accreditation Council for Graduate Medical Education include care of patients with ankle fractures, knee osteoarthritis, and hip fractures [1]. In such settings, entrustable professional activities may then be used to define five levels of responsibility: observe the activity, act under direct supervision, act under indirect supervision (available within minutes) on call, act unsupervised, and ability to supervise others [36][37][38].…”

Transforming Primary Care Training—Patient-Centered Medical Home Entrustable Professional Activities for Internal Medicine Residents

“…Our EPAs can frame curriculum reform for teaching practices in varying stages of PCMH redesign. 36,37,41 We suggest Scheele's criteria for prioritizing EPA implementation. 41 In this schema, highpriority EPAs for implementation include those which 1) are critically important in daily practice, 2) address high-risk or error-prone activities, and 3) integrate multiple competencies.…”

“…36,37,41 We suggest Scheele's criteria for prioritizing EPA implementation. 41 In this schema, highpriority EPAs for implementation include those which 1) are critically important in daily practice, 2) address high-risk or error-prone activities, and 3) integrate multiple competencies. Once high-priority EPAs are selected, programs can address feasibility for implementation in the existing training environment, and fashion continuity clinics to maximize opportunities for residents to perform EPAs with supervision, feedback, and repetition.…”

Conditions d’implantation du portfolio électronique « Aristote » dans un programme de formation en spécialité : une étude pilote en radio-oncologie

“…Lors de sa rencontre avec son superviseur de stage, le résident pourrait exposer des preuves de sa progression à partir des expériences et des réflexions contenues dans son portfolio. Une telle modalité d'utilisation formative a été rapportée par Scheele et al [22] en Hollande.…”