Development of TOEKAN, a 360° evaluation tool for the clinical learning environment in General Practice postgraduate training

Abstract

Background

The General Practice (GP) postgraduate program exists for 80% out of workplace learning. The quality of the clinical learning environment (CLE) has a direct effect on the quality of training and the professional development of GP trainees.

Methodology

Participatory research was used to involve all stakeholders in the development process of a 360° evaluation tool that should improve the average quality of GP training practices, guide GP trainees towards the best training practices and detect and remediate GP trainers of lower quality.

Results

TOEKAN (Tool for Communication and Evaluation of Quality Standards) was developed, which consists of a 72-item questionnaire for GP trainees and GP trainers and an 18-item questionnaire for those who coach and remediate GP trainers. The outcomes of the TOEKAN questionnaires are visualized in an online dashboard.

Discussion

TOEKAN is the first 360° evaluation tool for CLE in GP education. All stakeholders will complete the survey on a regular basis and have access to the results. By creating intrinsic and extrinsic motivation as well as mediation measures, the quality of CLE will improve. Continuous monitoring of the use and outcomes of TOEKAN will allow to critically review and improve this new evaluation tool as well as support the broader implementation.

Keywords:

• Workplace learning
• clinical learning environment
• evaluation tool

Acknowledgements

We wish to express our gratitude to all participants of this study and to Adriaan De Jonge for the translation of the questionnaires.

Disclosure statement

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

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Lotta Coenen

Dr. Lotta Coenen, MD, is a young practicing general practitioner (GP) in a multidisciplinary group practice in Sint-Pieters-Leeuw, Flanders. Furthermore, she is member of the academic staff at the department of family medicine at the Vrije Universiteit Brussel as well as member of the medical ethical committee of the UZ Brussels. In 2021–2022 she was the president of ‘t HOP, the organization that represents GP trainees in Flanders. As such, she was involved in all aspects of the organisation of GP education and participated at the education committee of ICHO. She co-created the interuniversity policy tackling sexually transgressive behaviour. Moreover, she has been involved in research concerning the impact of COVID-19 on GP training.

Laura Daman

Dr. Laura Daman, MD, is a General Practitioner trainee in Antwerp. She graduated in Medicine at the University of Antwerp in 2016 and started a training as an anaesthesiology resident at Antwerp University Hospital. In 2020 she switched to the general practitioner training and she is currently in the third and last year of the postgraduate GP training. She was involved in the TOEKAN project through her engagement in ‘t HOP, the organization that represents GP trainees in Flanders.

Guy Gielis

Guy Gielis, PsyM, is general manager of the Interuniversitarian Center for the vocational trainig of General Practitioners in Flanders (ICHOvzw). This center organizes the master-after-master in Family Medicine for the Catholic University Louvain (KUL), the University of Ghent (UG), the University of Antwerp (UA) and the Free University of Brussels (VUB). He’s also member of the board of SUivzw, the official employer for the thousand candidates general practitioners in Flanders. He published about the educational program, the working conditions, behavioral medicine, mental health. He’s a master in clinical psychology and a master in management sciences.

An Stockmans

An Stockmans, MScC, is operational manager of the Interuniversity Centre for general practioner training in Flanders (ICHOvzw). This centre organizes the master-after-master in Family Medicine commissioned by the Catholic University of Louvain (KU Leuven), the University of Ghent (UG), the University of Antwerp (UA) and the Free University of Brussels (VUB). She is also a board member of SUivzw, the official employer for the candidate general practitioners in Flanders. She has graduated as a master in communication sciences at KU Leuven.

Arne Van Renterghem

Dr. Arne Van Renterghem, MD, is GP trainer in a group practice in Merelbeke Flanders. He is the regional deputy at the Orde der Artsen, the Belgian association for doctors. Moreover, he is president of OVERSTAG, an organization that represents Flemish GP trainers. As such, he is member of the Education Committee of ICHO and board member of Sui vzw.

Eline Maes

Eline Maes, MScC, started her career at WES Research & Strategy after graduating as a master in applied economics in 2005, where she was in charge of quantitative research projects. In 2007 she started to work at the market research agency Synovate (part of Ipsos as of 2011) where she deeply explored the domain of customer experience and service optimisation. She worked closely with internal departments to coordinate research projects in various sectors and, later on, she was also responsible for managing a research team. Eline joined the consulting company Möbius Business Redesign in 2015. Within the Möbius Healthcare team, she is responsible for the health policy segment and works as a project manager. She has many years of experience in guiding large participatory stakeholder processes and combines knowledge of toolboxes such as Holacracy and Sociocracy 3.0 and strong skills in facilitating interviews, focus groups, workshops, world cafes … with strong analytical skills.

Marc Van Nuland

Marc Van Nuland, MD, PhD, is a practicing general practitioner (GP) and visiting professor at the Academic Center for General practice—KU Leuven (Belgium). He has been doing research in the field of medical education especially regarding teaching and assessing communication skills and regarding curriculum reform. Other research was related to mental health care provided by GPs with a special interest on deprescribing and registry-based studies. He is an active member in EACH (International Association for communication in Healthcare) where he is leading the assessment group within tEACH (https://each.international/teaching/). His teaching is in undergraduate and postgraduate education and addressing mental health care issues, patient diversity and communication skills.

Nele R. Michels

Nele Michels, MD, PhD, is general practitioner (GP) and associate professor at the Faculty of Medicine and Health Sciences, University of Antwerp. She is president of EURACT, the European Academy for Teachers in GP. For both the GP postgraduate training at the University of Antwerp and the Flemish Interuniversity Centre for the Education of GPs (ICHO), she is the educational coordinator. She is chair of the Steering Group Workplace Learning (ICHO) and board Member of the Educational Council at the University of Antwerp. Focus of research is GP training, medical education, workplace learning, competence-based education, burnout and resilience, and capacity building in GP. She has both national and international publications and is promotor and co-promotor of national and international research PhD projects. She coordinates an Erasmus Mobility project with the Tbilisi Medical Academy, Georgia.