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Between Trust and Accountability: Different Perspectives on the Modernization of Postgraduate Medical Training in the Netherlands

Wallenburg, Iris MSc; van Exel, Job MSc; Stolk, Elly PhD; Scheele, Fedde MD, PhD; de Bont, Antoinette PhD; Meurs, Pauline PhD

Academic Medicine:
doi: 10.1097/ACM.0b013e3181dc1f0f
Academic Medicine in the Netherlands
Abstract

Purpose: Postgraduate medical training was reformed to be more responsive to changing societal needs. In the Netherlands, as in various other Western countries, a competency-based curriculum was introduced reflecting the clinical and nonclinical roles a modern doctor should fulfill. It is still unclear, however, what this modernization process exactly comprises and what its consequences might be for clinical practice and medical work.

Method: The authors conducted a Q methodological study to investigate which different perspectives exist on the modernization of postgraduate medical training among actors involved.

Results: The authors found four distinct perspectives, reflecting the different features of medical training. The accountability perspective stresses the importance of formal regulations within medical training and the monitoring of results in order to be more transparent and accountable to society. According to the educational perspective, medical training should be more formalized and directed at the educational process. The work–life balance perspective stresses the balance between a working life and a private life, as well as the changing professional relationship between staff members and residents. The trust-based perspective reflects the classic view of medical training in which role modeling and trust are considered most important.

Conclusions: The four perspectives on the modernization of postgraduate medical training show that various aspects of the modernization process are valued differently by stakeholders, highlighting important sources of agreement and disagreement between them. An important source of disagreement is diverging expectations of the role of physicians in modern medical practice.

Author Information

Ms. Wallenburg is researcher, Institute of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands.

Dr. Van Exel is assistant professor, Institute of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands.

Mr. Stolk is assistant professor, Institute of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands.

Dr. Scheele is full professor, Institute for Medical Education and Training, VU University, Amsterdam, the Netherlands.

Dr. de Bont is associate professor, Institute of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands.

Dr. Meurs is full professor, Institute for Health Policy and Management, Erasmus University, Rotterdam, the Netherlands.

Correspondence should be addressed to Dr. de Bont, Institute of Health Policy and Management, Erasmus University, Post Box 1738, 3000 DR Rotterdam, the Netherlands; telephone: +0031104088548; e-mail: debont@bmg.eur.nl.

Editor's Note: A commentary on this article appears on pages 932–934.

© 2010 Association of American Medical Colleges