Perception of social media behaviour among medical students, residents and medical specialists.

INTRODUCTION: Behaviour is visible in real-life events, but also on social media. While some national medical organizations have published social media guidelines, the number of studies on professional social media use in medical education is limited. This study aims to explore social media use among medical students, residents and medical specialists. METHODS: An anonymous, online survey was sent to 3844 medical students at two Dutch medical schools, 828 residents and 426 medical specialists. Quantitative, descriptive data analysis regarding demographic data, yes/no questions and Likert scale questions were performed using SPSS. Qualitative data analysis was performed iteratively, independently by two researchers applying the principles of constant comparison, open and axial coding until consensus was reached. RESULTS: Overall response rate was 24.8%. Facebook was most popular among medical students and residents; LinkedIn was most popular among medical specialists. Personal pictures and/or information about themselves on social media that were perceived as unprofessional were reported by 31.3% of students, 19.7% of residents and 4.1% of medical specialists. Information and pictures related to alcohol abuse, partying, clinical work or of a sexually suggestive character were considered inappropriate. Addressing colleagues about their unprofessional posts was perceived to be mainly dependent on the nature and hierarchy of the interprofessional relation. DISCUSSION: There is a widespread perception that the presence of unprofessional information on social media among the participants and their colleagues is a common occurrence. Medical educators should create awareness of the risks of unprofessional (online) behaviour among healthcare professionals, as well as the necessity and ways of addressing colleagues in case of such lapses.

Specialty Training's Organizational Readiness for curriculum Change (STORC): validation of a questionnaire.

BACKGROUND: The field of postgraduate medical education (PGME) is continuously evolving as a result of social demands and advancing educational insights. Change experts contend that organizational readiness for change (ORC) is a critical precursor for successful implementation of change initiatives. However, in PGME, assessing change readiness is rarely considered while it could be of great value for managing educational change such as curriculum change. Therefore, in a previous Delphi study the authors developed an instrument for assessing ORC in PGME: Specialty Training's Organizational Readiness for curriculum Change (STORC). In this study, the psychometric properties of this questionnaire were further explored. METHODS: In 2015, STORC was distributed among clinical teaching teams in the Netherlands. The authors conducted a confirmatory factor analysis on the internal factor structure of STORC. The reliability of the measurements was estimated by calculating Cronbach's alpha for all sub-scales. Additionally, a behavioral support-for-change measure was distributed as well to assess correlations with change-related behavior. RESULTS: In total, the STORC questionnaire was completed by 856 clinical teaching team members from 39 specialties. Factor analysis led to the removal of 1 item but supported the expected factor structure with very good fit for the other 43 items. Supportive behavior was positively correlated to a higher level of ORC. DISCUSSION: In this study, additional steps to collect validity evidence for the STORC questionnaire were taken successfully. The final subscales of STORC represent the core components of ORC in the literature. By breaking down this concept into multiple measurable aspects, STORC could help to enable educational leaders to diagnose possible hurdles in implementation processes and to perform specifically targeted interventions when needed.

Are they ready? Organizational readiness for change among clinical teaching teams.

INTRODUCTION: Curriculum change and innovation are inevitable parts of progress in postgraduate medical education (PGME). Although implementing change is known to be challenging, change management principles are rarely looked at for support. Change experts contend that organizational readiness for change (ORC) is a critical precursor for the successful implementation of change initiatives. Therefore, this study explores whether assessing ORC in clinical teaching teams could help to understand how curriculum change takes place in PGME. METHODS: Clinical teaching teams in hospitals in the Netherlands were requested to complete the Specialty Training's Organizational Readiness for curriculum Change, a questionnaire to measure ORC in clinical teaching teams. In addition, change-related behavior was measured by using the "behavioral support-for-change" measure. A two-way analysis of variance was performed for all response variables of interest. RESULTS: In total, 836 clinical teaching team members were included in this study: 288 (34.4%) trainees, 307 (36.7%) clinical staff members, and 241 (28.8%) program directors. Overall, items regarding whether the program director has the authority to lead scored higher compared with the other items. At the other end, the subscales "management support and leadership," "project resources," and "implementation plan" had the lowest scores in all groups. DISCUSSION: The study brought to light that program directors are clearly in the lead when it comes to the implementation of educational innovation. Clinical teaching teams tend to work together as a team, sharing responsibilities in the implementation process. However, the results also reinforce the need for change management support in change processes in PGME.

Teachers' conceptions of learning and teaching in student-centred medical curricula: the impact of context and personal characteristics.

BACKGROUND: Gibbs and Coffey (2004) have reported that teaching practices are influenced by teachers' conceptions of learning and teaching. In our previous research we found significant differences between teachers' conceptions in two medical schools with student-centred education. Medical school was the most important predictor, next to discipline, gender and teaching experience. Our research questions for the current study are (1) which specific elements of medical school explain the effect of medical school on teachers' conceptions of learning and teaching? How? and (2) which contextual and personal characteristics are related to conceptions of learning and teaching? How? METHODS: Individual interviews were conducted with 13 teachers of the undergraduate curricula in two medical schools. Previously their conceptions of learning and teaching were assessed with the COLT questionnaire. We investigated the meanings they attached to context and personal characteristics, in relation to their conceptions of learning and teaching. We used a template analysis. RESULTS: Large individual differences existed between teachers. Characteristics mentioned at the medical school and curriculum level were 'curriculum tradition', 'support by educational department' and 'management and finances'. Other contextual characteristics were 'leadership style' at all levels but especially of department chairs, 'affordances and support', 'support and relatedness', and 'students' characteristics'. Personal characteristics were 'agency', 'experience with PBL (as a student or a teacher)','personal development', 'motivation and work engagement'and 'high content expertise'. CONCLUSION: Several context and personal characteristics associated with teachers' conceptions were identified, enabling a broader view on faculty development with attention for these characteristics, next to teaching skills.

High acceptability of a newly developed urological practical skills training program.

BACKGROUND: Benefits of simulation training are widely recognized, but its structural implementation into urological curricula remains challenging. This study aims to gain insight into current and ideal urological practical skills training and presents the outline of a newly developed skills training program, including an assessment of the design characteristics that may increase its acceptability. METHODS: A questionnaire was sent to the urology residents (n = 87) and program directors (n = 45) of all Dutch teaching hospitals. Open- and close-ended questions were used to determine the views on current and ideal skills training and the newly developed skills training program. Eight semi-structured interviews were conducted with 39 residents and 15 program directors. All interviews were audiotaped, fully transcribed, and thereafter analyzed. RESULTS: Response was 87.4% for residents and 86.7% for program directors. Residents appeared to be still predominantly trained 'by doing'. Structured practical skills training in local hospitals takes place according to 12% of the residents versus 44% of the program directors (p < 0.001). Ideally, residents prefer to practice certain procedures on simulation models first, especially in endourology. The majority of residents (92%) and program directors (87%) approved of implementing the newly developed skills training program (p = 0.51). 'Structured scheduling', 'use of peer teaching' and 'high fidelity models' were indicated as design characteristics that increase its acceptability. CONCLUSIONS: Current urological residency training consists of patient-related 'learning by doing', although more practice on simulation models is desired. The acceptability of implementing the presented skills-training program is high. Design characteristics that increase its acceptability are structured scheduling, the use of peer teaching and high fidelity models.

Effect of comprehensive oncogenetics training interventions for general practitioners, evaluated at multiple performance levels.

General practitioners (GPs) are increasingly called upon to identify patients at risk for hereditary cancers, and their genetic competencies need to be enhanced. This article gives an overview of a research project on how to build effective educational modules on genetics, assessed by randomized controlled trials (RCTs), reflecting the prioritized educational needs of primary care physicians. It also reports on an ongoing study to investigate long-term increase in genetic consultation skills (1-year follow-up) and interest in and satisfaction with a supportive website on genetics among GPs. Three oncogenetics modules were developed: an online Continuing Professional Development (G-eCPD) module, a live genetic CPD module, and a "GP and genetics" website (huisartsengenetica.nl) providing further genetics information applicable in daily practice. Three assessments to evaluate the effectiveness (1-year follow-up) of the oncogenetic modules were designed: 1.An online questionnaire on self-reported genetic competencies and changes in referral behaviour, 2.Referral rates from GPs to clinical genetics centres and 3.Satisfaction questionnaire and visitor count analytics of supportive genetics website. The setting was Primary care in the Netherlands and three groups of study participants were included in the reported studies:. Assessment 1. 168 GPs responded to an email invitation and were randomly assigned to an intervention or control group, evaluating the G-eCPD module (n = 80) or the live module (n = 88). Assessment 2. Referral rates by GPs were requested from the clinical genetics centres, in the northern and southern parts of the Netherlands (Amsterdam and Maastricht), for the two years before (2010 [n = 2510] and 2011 [n = 2940]) and the year after (2012 [n = 2875]) launch of the oncogenetics CPD modules and the website. Assessment 3. Participants of the website evaluation were all recruited online. When they visited the website during the month of February 2013, a pop-up invitation came up. Of the 1350 unique visitors that month, only 38 completed the online questionnaire. Main outcomes measure showed long-term (self-reported) genetic consultation skills (i.e. increased genetics awareness and referrals to clinical genetics centres) among GPs who participated in the oncogenetic training course, and interest in and satisfaction with the supportive website. 42 GPs (52%) who previously participated in the G-eCPD evaluation study and 50 GPs (57%) who participated in the live training programme responded to the online questionnaire on long-term effects of educational outcome. Previous RCTs showed that the genetics CPD modules achieved sustained improvement of oncogenetic knowledge and consultation skills (3-months follow-up). Participants of these RCTs reported being more aware of genetic problems long term; this was reported by 29 GPs (69%) and 46 GPs (92%) participating in the G-eCPD and live module evaluation studies, respectively (Chisquare test, p<0.005). One year later, 68% of the respondents attending the live training reported that they more frequently referred patients to the clinical genetics centres, compared to 29% of those who attended the online oncogenetics training (Chisquare test, p<0.0005). However, the clinical genetics centres reported no significant change in referral numbers one year after the training. Website visitor numbers increased, as did satisfaction, reflected in a 7.7 and 8.1 (out of 10) global rating of the website (by G-eCPD and live module participants, respectively). The page most often consulted was "family tree drawing". Self-perceived genetic consultation skills increased long-term and GPs were interested in and satisfied with the supportive website. Further studies are necessary to see whether the oncogenetics CPD modules result in more efficient referral. The results presented suggest we have provided a flexible and effective framework to meet the need for effective educational programmes for non-geneticist healthcare providers, enabling improvement of genetic medical care.

Impact of institute and person variables on teachers' conceptions of learning and teaching.

BACKGROUND: Teachers' conceptions of learning and teaching are important for faculty development to result in enduring changes in teaching practices. Until now, studies on these conceptions have mostly focused on traditional, lecture-based curricula rather than on small-group student-centred educational formats, which are gaining ground worldwide. AIM: To explore which factors predict teachers' conceptions in student-centred curricula. METHODS: In two Dutch medical schools with 10 and 40 years of student-centred education, teachers were asked to fill out the Conceptions of Learning and Teaching (COLT) Questionnaire to assess their 'teacher-centredness', 'appreciation of active learning' and 'orientation to professional practice'. Next, we quantitatively assessed the relations of teachers' conceptions with their personal and occupational characteristics and institute. RESULTS: Overall response was 49.4% (N = 319/646). Institute was the main predictor for variance in all three scales, and discipline, gender and teaching experience significantly explained variance in two of the scales. More than 80% of the variance was not explained by these factors. CONCLUSION: Longer exposure to a student-centred curriculum was associated with fewer teacher-centred conceptions, greater 'appreciation of active learning' and stronger 'orientation towards professional practice'. In line with studies on lecture-based curricula, discipline, gender and teaching experience also appeared important for teachers' conceptions in student-centred curricula. More research is necessary to better understand the influence of institute on the three teachers' conceptions scales.

The threat of the dyscompetent resident: A plea to make the implicit more explicit!

Although several examples of frameworks dealing with students' unprofessional behaviour are available, guidance on how to deal locally or regionally with dysfunctional residents is limited (Hickson et al. in Acad Med 82(11):1040-1048, 2007b; Leape and Fromson in Ann Intern Med 144(2):107-115, 2006). Any 'rules' are mostly unwritten, and often emerge by trial and error within the specialty training programme (Stern and Papadakis in N Engl J Med 355(17):1794-1799, 2006). It is nevertheless of utmost importance that objectives, rules and guidelines comparable to those existing in undergraduate training (Project Team Consilium Abeundi van Luijk in Professional behaviour: teaching, assessing and coaching students. Final report and appendices. Mosae Libris, 2005; van Mook et al. in Neth J Crit Care 16(4):162-173, 2010a) are developed for postgraduate training. And that implicit rules are made explicit. This article outlines a framework based on the lessons learned from contemporary postgraduate medical training programmes.

Five teacher profiles in student-centred curricula based on their conceptions of learning and teaching.

BACKGROUND: Teachers' conceptions of learning and teaching are partly unconscious. However, they are critical for the delivery of education and affect students' learning outcomes. Lasting changes in teaching behaviour can only be realized if conceptions of teachers have been changed accordingly. Previously we constructed a questionnaire named COLT to measure conceptions. In the present study, we investigated if different teacher profiles could be assessed which are based on the teachers' conceptions. These teacher profiles might have implications for individual teachers, for faculty development activities and for institutes. Our research questions were: (1) Can we identify teacher profiles based on the COLT? (2) If so, how are these teacher profiles associated with other teacher characteristics? METHODS: The COLT questionnaire was sent electronically to all teachers in the first three years of the undergraduate curriculum of Medicine in two medical schools in the Netherlands with student-centred education. The COLT (18 items, 5 point Likert scales) comprises three scales: 'teacher centredness', 'appreciation of active learning' and 'orientation to professional practice'. We also collected personal information about the participants and their occupational characteristics. Teacher profiles were studied using a K-means cluster analysis and calculating Chi squares. RESULTS: The response rate was 49.4% (N = 319/646). A five-cluster solution fitted the data best, resulting in five teacher profiles based on their conceptions as measured by the COLT. We named the teacher profiles: Transmitters (most traditional), Organizers, Intermediates, Facilitators and Conceptual Change Agents (most modern). The teacher profiles differed from each other in personal and occupational characteristics. CONCLUSIONS: Based on teachers' conceptions of learning and teaching, five teacher profiles were found in student-centred education. We offered suggestions how insight into these teacher profiles might be useful for individual teachers, for faculty development activities and for institutes and departments, especially if involved in a curriculum reform towards student-centred education.

Effectiveness of oncogenetics training on general practitioners' consultation skills: a randomized controlled trial.

PURPOSE: General practitioners are increasingly called upon to deliver genetic services and could play a key role in translating potentially life-saving advancements in oncogenetic technologies to patient care. If general practitioners are to make an effective contribution in this area, their genetics competencies need to be upgraded. The aim of this study was to investigate whether oncogenetics training for general practitioners improves their genetic consultation skills. METHODS: In this pragmatic, blinded, randomized controlled trial, the intervention consisted of a 4-h training (December 2011 and April 2012), covering oncogenetic consultation skills (family history, familial risk assessment, and efficient referral), attitude (medical ethical issues), and clinical knowledge required in primary-care consultations. Outcomes were measured using observation checklists by unannounced standardized patients and self-reported questionnaires. RESULTS: Of 88 randomized general practitioners who initially agreed to participate, 56 completed all measurements. Key consultation skills significantly and substantially improved; regression coefficients after intervention were equivalent to 0.34 and 0.28 at 3-month follow-up, indicating a moderate effect size. Satisfaction and perceived applicability of newly learned skills were highly scored. CONCLUSION: The general practitioner-specific training proved to be a feasible, satisfactory, and clinically applicable method to improve oncogenetics consultation skills and could be used as an educational framework to inform future training activities with the ultimate aim of improving medical care.

Sustained effects of online genetics education: a randomized controlled trial on oncogenetics.

Medical professionals are increasingly expected to deliver genetic services in daily patient care. However, genetics education is considered to be suboptimal and in urgent need of revision and innovation. We designed a Genetics e-learning Continuing Professional Development (CPD) module aimed at improving general practitioners' (GPs') knowledge about oncogenetics, and we conducted a randomized controlled trial to evaluate the outcomes at the first two levels of the Kirkpatrick framework (satisfaction, learning and behavior). Between September 2011 and March 2012, a parallel-group, pre- and post-retention (6-month follow-up) controlled group intervention trial was conducted, with repeated measurements using validated questionnaires. Eighty Dutch GP volunteers were randomly assigned to the intervention or the control group. Satisfaction with the module was high, with the three item's scores in the range 4.1-4.3 (5-point scale) and a global score of 7.9 (10-point scale). Knowledge gains post test and at retention test were 0.055 (P<0.05) and 0.079 (P<0.01), respectively, with moderate effect sizes (0.27 and 0.31, respectively). The participants appreciated applicability in daily practice of knowledge aspects (item scores 3.3-3.8, five-point scale), but scores on self-reported identification of disease, referral to a specialist and knowledge about the possibilities/limitations of genetic testing were near neutral (2.7-2.8, five-point scale). The Genetics e-learning CPD module proved to be a feasible, satisfactory and clinically applicable method to improve oncogenetics knowledge. The educational effects can inform further development of online genetics modules aimed at improving physicians' genetics knowledge and could potentially be relevant internationally and across a wider range of potential audiences.

Development of an instrument (the COLT) to measure conceptions on learning and teaching of teachers, in student-centred medical education.

BACKGROUND: Conceptions of medical teachers regarding learning and teaching affect their teaching practice. Therefore conceptions should be addressed in faculty development. AIM: To facilitate this, we constructed the Conceptions Of Learning and Teaching (COLT) instrument. METHOD: The COLT was adapted based on experts' comments during a meeting and interviews, followed by a Delphi procedure (Part I). It was administered to teachers from two Dutch medical schools with different traditions in student-centred education (Part II; N=646). The data were analyzed using confirmatory factor analysis and reliability analysis. RESULTS: 324 Teachers (50.2%) completed the questionnaire. Confirmatory factor analysis did not confirm the underlying theoretical model, but an alternative model demonstrated a good fit. This led to an instrument with eighteen items reflecting three underlying factors: 'teacher centredness', 'appreciation of active learning', and 'orientation to professional practice'. We found significant differences in COLT scores between the faculty of the two medical schools. CONCLUSIONS: The COLT appears to be a construct valid tool resulting in reliable scores of teachers' conceptions of learning and teaching, in student-centred medical education. Two of the three factors are new and may be specific for student-centred medical education. The COLT may be a promising tool to improve faculty development.

Prioritization of future genetics education for general practitioners: a Delphi study.

PURPOSE: General practitioners (GPs) are increasingly expected to deliver genetics services in daily patient care. Education in primary care genetics is considered suboptimal and in urgent need of revision and innovation. The aim of this study was to prioritize topics for genetics education for general practice. METHODS: A Delphi consensus procedure consisting of three rounds was conducted. A purposively selected heterogeneous panel (n = 18) of experts, comprising six practicing GPs who were also engaged in research, five GP trainers, four clinical genetics professionals, and three representatives of patient organizations, participated. Educational needs regarding genetics in general practice in terms of knowledge, skills, and attitudes were rated and ranked in a top-10 list. RESULTS: The entire panel completed all three rounds. Kendall's coefficient of concordance indicated significant agreement regarding the top 10 genetic education needs (P < 0.001). "Recognizing signals that are potentially indicative of a hereditary component of a disease" was rated highest, followed by "Evaluating indications for referral to a clinical genetics centre" and "Knowledge of the possibilities and limitations of genetic tests." CONCLUSIONS: The priorities resulting from this study can inform the development of educational modules, including input for case-based education, to improve GP performance in genetic patient care.

Possible solutions for barriers in incident reporting by residents.

RATIONALE, AIMS AND OBJECTIVES: Incident reporting can contribute to safer health care. Since the rate of reporting by residents is low, it is useful to investigate which barriers exist and how these can be solved. METHODS: Data were collected in a large teaching hospital in the Netherlands. The hospital uses a confidential, voluntary and web-based incident reporting system. Residents working in the hospital participated in focus group discussions to explore barriers and possible solutions. A grounded theory approach was used to analyse the transcribed discussions. RESULTS: In each focus group six to eight residents participated, resulting in a total number of 22 participants. After three focus group discussions, information saturation had been reached. Residents do not report all incidents because of a negative attitude towards incident reporting, because they experience a non-stimulating culture and because of a lack of perceived ability to report. Residents suggest several solutions to solve the barriers: providing the possibility to report anonymously, providing feedback, creating an incident reporting culture, simplifying the procedure, clarifying what and how to report, and exciting residents to report. CONCLUSIONS: Residents have useful suggestions to resolve the barriers that prevent them from reporting incidents. They include solutions that influence attitude, culture and perceived ability. These suggestions should be considered when making an effort to improve incident reporting by residents.

Genetic educational needs and the role of genetics in primary care: a focus group study with multiple perspectives.

BACKGROUND: Available evidence suggests that improvements in genetics education are needed to prepare primary care providers for the impact of ongoing rapid advances in genomics. Postgraduate (physician training) and master (midwifery training) programmes in primary care and public health are failing to meet these perceived educational needs. The aim of this study was to explore the role of genetics in primary care (i.e. family medicine and midwifery care) and the need for education in this area as perceived by primary care providers, patient advocacy groups and clinical genetics professionals. METHODS: Forty-four participants took part in three types of focus groups: mono-disciplinary groups of general practitioners and midwives, respectively and multidisciplinary groups composed of a diverse set of experts. The focus group sessions were audio-taped, transcribed verbatim and analysed using content analysis. Recurrent themes were identified. RESULTS: Four themes emerged regarding the educational needs and the role of genetics in primary care: (1) genetics knowledge, (2) family history, (3) ethical dilemmas and psychosocial effects in relation to genetics and (4) insight into the organisation and role of clinical genetics services. These themes reflect a shift in the role of genetics in primary care with implications for education. Although all focus group participants acknowledged the importance of genetics education, general practitioners felt this need more urgently than midwives and more strongly emphasized their perceived knowledge deficiencies. CONCLUSION: The responsibilities of primary care providers with regard to genetics require further study. The results of this study will help to develop effective genetics education strategies to improve primary care providers' competencies in this area. More research into the educational priorities in genetics is needed to design courses that are suitable for postgraduate and master programmes for general practitioners and midwives.

Bad apples spoil the barrel: Addressing unprofessional behaviour.

Given the changes in society we are experiencing, the increasing focus on patient-centred care and acknowledgement that medical education including professionalism issues needs to continue not only in the residency programmes but also throughout the doctors career, is not surprising. Although most of the literature on professionalism pertains to learning and teaching professionalism issues, addressing unprofessional behaviour and related patient safety issues forms an alternative or perhaps complementary approach. This article describes the possibility of selecting applicants for a medical school based on personality characteristics, the attention to professional lapses in contemporary undergraduate training, as well as the magnitude, aetiology, surveillance and methods of dealing with reports of unprofessional behaviour in postgraduate education and CME.

Combined formative and summative professional behaviour assessment approach in the bachelor phase of medical school: a Dutch perspective.

BACKGROUND: Teaching and assessment of professional behaviour (PB) has been receiving increasing attention in the educational literature and educational practice. Although the focus tends to be summative aspects, it seems perfectly feasible to combine formative and summative approaches in one procedural approach. AIMS AND METHOD: Although, many examples of frameworks of professionalism and PB can be found in the literature, most originate from North America, and only few are designed in other continents. This article presents the framework for PB that is used at Maastricht medical school, the Netherlands. RESULTS: The approach to PB used in the Dutch medical schools is described with special attention to 4 years (2005-2009) of experience with PB education in the first 3 years of the 6-year undergraduate curriculum of Maastricht medical school. Future challenges are identified. CONCLUSIONS: The adages 'Assessment drives learning' and 'They do not respect what you do not inspect' [Cohen JJ. 2006. Professionalism in medical education, an American perspective: From evidence to accountability. Med Educ 40, 607-617] suggest that formative and summative aspects of PB assessment can be combined within an assessment framework. Formative and summative assessments do not represent contrasting but rather complementary approaches. The Maastricht medical school framework combines the two approaches, as two sides of the same coin.

Promoting professional behaviour in undergraduate medical, dental and veterinary curricula in the Netherlands: evaluation of a joint effort.

BACKGROUND: From 2002 onwards, a nationwide working group of representatives from all medical (8), dental (3) and veterinary medicine (1) schools collaborated in order to develop and implement recommendations for teaching and assessing professional behaviour. AIM: The aim of this article is to describe the outcomes of this process, including hurdles encountered and challenges to be met. METHOD: By a qualitative survey, information was requested on teaching professional behaviour, assessment, instruments used, consequences of unprofessional behaviour and faculty training. RESULTS: All schools have adopted at least parts of the 2002 recommendations. Differences exist mainly in the organisational structure of teaching and assessment as well as in the assessment instruments used. In all schools a longitudinal assessment of professional behaviour was accomplished. CONCLUSION: All schools involved have made progress since 2002 with regard to teaching and assessment of professional behaviour, resulting in a shift from an instrumental to a cultural change for some schools. A stimulating factor was society's call to focus on patient safety and therefore on assessment of unprofessional behaviour. Hurdles yet to be taken are the involvement of students in the assessment process, teacher confidence in personal assessment capacities, remediation programmes and logistic and administrative support.

Professionalism beyond medical school: an educational continuum?

Given the changes in society we are experiencing, the increasing focus on patient centred care and acknowledgment that medical education needs to continue not only in the residency programmes but throughout the doctors career, is not surprising. This article describes the attention currently paid to professionalism in the residency programmes, differences in perception of professionalism between patients, faculty, students and residents, differences in professionalism issues in the different educational phases, as well as their consequences for training and assessment regarding professionalism. Continuous medical education in professionalism is thereafter briefly discussed.

[Professional behaviour during medical training]. / Professioneel gedrag in de opleiding geneeskunde.

Assessment of professional behaviour (PB) is increasingly receiving attention in undergraduate and postgraduate medical training. Its aim is to prevent later inappropriate behaviour and to strengthen appropriate behaviour by self-reflection and feedback. Assessment should start early in the curriculum and be repeated frequently, preferably by different assessors in differing educational situations, and with longitudinal follow-up. The consequences of the assessment as well as any agreements reached, must be clearly documented. If remediation of inappropriate behaviour is unsuccessful, a consilium abeundi, i.e. a recommendation to leave the programme, should be discussed with the student. The Dutch Higher Education and Scientific Research Act (WHW) does not provide for denying students access to educational activities and exams after completing the first year. However, the new Higher Education and Research Act (WHOO), which has yet not been implemented, will provide for obligatory cessation of studies.