Effects of implementing time-variable postgraduate training programmes on the organization of teaching hospital departments

Abstract

Introduction: As competency-based education has gained currency in postgraduate medical education, it is acknowledged that trainees, having individual learning curves, acquire the desired competencies at different paces. To accommodate their different learning needs, time-variable curricula have been introduced making training no longer time-bound. This paradigm has many consequences and will, predictably, impact the organization of teaching hospitals. The purpose of this study was to determine the effects of time-variable postgraduate education on the organization of teaching hospital departments.

Methods: We undertook exploratory case studies into the effects of time-variable training on teaching departments’ organization. We held semi-structured interviews with clinical teachers and managers from various hospital departments.

Results: The analysis yielded six effects: (1) time-variable training requires flexible and individual planning, (2) learners must be active and engaged, (3) accelerated learning sometimes comes at the expense of clinical expertise, (4) fast-track training for gifted learners jeopardizes the continuity of care, (5) time-variable training demands more of supervisors, and hence, they need protected time for supervision, and (6) hospital boards should support time-variable training.

Conclusions: Implementing time-variable education affects various levels within healthcare organizations, including stakeholders not directly involved in medical education. These effects must be considered when implementing time-variable curricula.

Ethical approval

This study was approved by the ethical review board of the Netherlands Association for Medical Education (NVMO-ERB; file number 549). The work was carried out in accordance with the Declaration of Helsinki.

Acknowledgements

The authors wish to thank Angelique van den Heuvel and Lisette van Hulst for their writing assistance.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Notes on contributors

Tiuri R. van Rossum, MSc, is a researcher and lecturer at the School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.

Fedde Scheele, MD, PhD, is a Professor at the Athena institute, VU University and School of Medical Sciences of the VU University medical centre, Amsterdam, the Netherlands, and practices gynecology at the OLVG Teaching Hospital, Amsterdam, The Netherlands.

Henk E. Sluiter, MD, PhD, is a manager of postgraduate medical education, Deventer Hospital, Deventer, The Netherlands, and practices internal medicine in the department of internal medicine and nephrology, Deventer hospital, Deventer, The Netherlands.

Emma Paternotte, MD, PhD, practices gynaecology at Meander Medical Center, Amersfoort, The Netherlands.

Ide C. Heyligers, MD, PhD, is a Professor at the School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands, and Orthopaedic surgeon and manager of postgraduate medical education at Zuyderland medical centre, Heerlen, The Netherlands.

Additional information

Funding

This work was supported by the Dutch Ministry of Health, Welfare and Sports ?Project: RIO, The Dutch Association of Medical Specialists. The funding body had no influence on the design of the study and collection, analysis, and interpretation of data and writing of the manuscript.