Variations in assessment and certification in postgraduate anaesthesia training: a European survey.

BACKGROUND: Postgraduate specialty training has traditionally been based on a time- and rotation-based model, but competency-based models are emerging. Because anaesthesia training evolves differently across Europe, variations in assessment and certification processes are expected, but the extent of similarities and differences is unknown. The aim of this study was to compare anaesthesia training programmes in Europe, focusing on assessment and certification processes. METHODS: We performed an online survey among national representatives of the Union of European Medical Specialists/European Board of Anaesthesiology. RESULTS: All 36 countries participated. Duration of training had a median of 5 yr (range 2.75-7). Mean number of different assessment tools was 7.45 (range 4-13), with more tools being used in competency-based programmes [mean 9.1 (sd 2.97) vs 7.0 (sd 1.97); P=0.03]. Most countries had a nationally uniform certification process. Based on a qualitative analysis of the survey findings, a categorization of countries emerged, reflecting the approach to assessment and certification. We observed two main streams of countries with an underlying knowledge or procedural focus within a time- and rotation-based apprenticeship model. These main streams are evolving, to different extents, towards a third orientation, competency-based training. CONCLUSIONS: Assessment and certification processes in European anaesthesia training are diverse. In many countries, a time-based apprenticeship model is evolving towards a competency-based certification process. This diversity precludes comparison of competence of graduating anaesthetists across Europe.

Motivation as an independent and a dependent variable in medical education: a review of the literature.

BACKGROUND: Motivation in learning behaviour and education is well-researched in general education, but less in medical education. AIM: To answer two research questions, 'How has the literature studied motivation as either an independent or dependent variable? How is motivation useful in predicting and understanding processes and outcomes in medical education?' in the light of the Self-determination Theory (SDT) of motivation. METHODS: A literature search performed using the PubMed, PsycINFO and ERIC databases resulted in 460 articles. The inclusion criteria were empirical research, specific measurement of motivation and qualitative research studies which had well-designed methodology. Only studies related to medical students/school were included. RESULTS: Findings of 56 articles were included in the review. Motivation as an independent variable appears to affect learning and study behaviour, academic performance, choice of medicine and specialty within medicine and intention to continue medical study. Motivation as a dependent variable appears to be affected by age, gender, ethnicity, socioeconomic status, personality, year of medical curriculum and teacher and peer support, all of which cannot be manipulated by medical educators. Motivation is also affected by factors that can be influenced, among which are, autonomy, competence and relatedness, which have been described as the basic psychological needs important for intrinsic motivation according to SDT. CONCLUSION: Motivation is an independent variable in medical education influencing important outcomes and is also a dependent variable influenced by autonomy, competence and relatedness. This review finds some evidence in support of the validity of SDT in medical education.

Twelve tips to stimulate intrinsic motivation in students through autonomy-supportive classroom teaching derived from self-determination theory.

BACKGROUND: Self-determination theory (SDT) of motivations distinguishes between intrinsic and extrinsic motivations. Intrinsic motivation is observed when one engages in an activity out of genuine interest and is truly self-determined. Intrinsic motivation is the desired type of motivation for study as it is associated with deep learning, better performance and positive well-being in comparison to extrinsic motivation. It is dependent on the fulfilment of three basic psychological needs described by SDT. These are the needs for autonomy, competence and relatedness. According to SDT, autonomy-supportive teaching is important, because it makes students feel autonomous and competent in their learning and also supported (relatedness) by their teachers. AIM: The concept of autonomy-supportive teaching is relevant to medical education, but less known. Through this article, we aim to make this concept understood and practically used by medical teachers. METHODS: We used SDT literature as a basis to formulate these 12 tips. RESULTS: We present 12 practical tips derived from SDT, for teachers in health professions, on how to engage in autonomy-supportive teaching behaviours in order to stimulate intrinsic motivation in their students. CONCLUSION: These tips demonstrate that it is not difficult to engage in autonomy-supportive teaching behaviour. It can be learned through practice and self-reflection on teaching practices.

[Career goals and choice of profession among recently graduated physicians]. / Carrièrewensen en beroepskeuze van recent afgestudeerde artsen.

OBJECTIVE: To obtain insight into the career choice of recently graduated physicians and the factors that influence this choice. DESIGN: Descriptive. METHOD: Questionnaires were sent to 1091 physicians who graduated from the VU University in Amsterdam or the University Utrecht between 1 July 1999 and 30 June 2002. Graduates were asked to provide the following information: current occupation, number of days that they have worked in current occupation, 5-year career goals, prerequisites for obtaining a residency, time spent on patient care and research, and the extent to which certain factors have influenced their career choice. Respondents were subdivided into three groups: clinical specialists, general practitioners, and public or occupational health professionals. RESULTS: The response was 70%, and approximately half of the respondents were engaged in additional resident training: 68% in a clinical specialty, 23% in general practice, 9% in public or occupational health, and 2% in another occupation. Most of the respondents worked full-time but would prefer to work less in the future. Full-time availability was the most important prerequisite for a clinical residency. Work experience after graduation was also considered important to obtain a residency in general practice or public or occupational health. Among clinical and general practitioner residents, the most important factor influencing career choice was interest in the specific field. For public and occupational health residents, the most important factor was working within office hours, particularly for female respondents. CONCLUSION: Various factors influence career choice in recently graduated physicians, and these factors are specialty-dependent. Graduates are interested in the possibility of working part-time in their present occupation and in the near future.