Evidence-based teaching methods are now being demanded by the Central College for Medical Specialists. Methods include a modular-structured, competency-based curriculum, including regular skills, lab activities, and other training sessions, and the use of portfolios and mini clinical-evaluation exercises for formative and cumulative assessment.5,6
There are also practical problems on the working floor. In contrast to the preclinical teaching setting, which should be student-centered, the clinical environment of the hospital is primarily patient-centered. Interns and residents therefore have a double role: that of learner and care provider. These activities sometimes conflict, and the time allotted to each one is not clearly defined.
This became a greater problem after the restriction of resident working hours to 48 hours weekly in 1997. An attempt to divide these already strongly reduced hours to 36 “white-coat” hours and 12 “jacket” hours—purely dedicated to learning activities—has been abandoned.
In addition, the number of different parties on the working floor is sizable, and patients, nurses, medical staff, paramedics, and management often have different priorities, of which teaching is not always No. 1. Obviously such problems interfere with a structured, competency-based curriculum.
The Role of the Teaching Professor
In the Netherlands there is much work to do in the affiliated teaching hospitals, and a more professional approach is urgently needed. Professionalism, learning goals, curricula planning, evidence-based teaching methods, and solutions for practical problems that interfere with the proper implementation of evidence-based learning should all be addressed. The ruling committee and the professional organizations have set outlines that meet the requirements of modern times, but the elaboration and implementation have yet to be realized.
The Free University Medical Centre has taken the lead by appointing medical specialists as full professors with a specific assignment for teaching in non-university hospitals in order to develop and promote the teaching facilities in those institutions. They elected practicing non-university medical specialists with a demonstrable record in the field of education and an academic background comparable to that of university professors. Their assignment is to teach for one day a week. By doing so, they are not only putting teaching more prominently on the agenda, but also opening career perspectives that will promote a broader involvement in the development of educational programs.
The teaching professors develop and implement modern medical curricula and collaborate on research projects to evaluate the effectiveness of the new curricula in clinical teaching. Teaching professors also form a bridge between the university and the affiliated hospitals by transferring knowledge and ideas on medical education from the university to the non-university teaching hospitals—and vice versa. They also have input in the development of preclinical and clinical education programs from the point of view of the non-university hospital. For instance, they take part in the curriculum committee that advises on the bachelor’s and master’s programs, and they help create tests for the assessment of knowledge.
Summary
Non-university teaching hospitals have an essential place in the clinical phase of the medical curriculum in the Netherlands. A paradigm shift from the old master-mate relationship toward a structured, competency-based curriculum is taking place. Nomination of teaching professors in these institutions helps to create the professional structure that is mandatory for quality improvement in clinical teaching, and it also promotes the required interaction between university and non-university hospitals. TH
A.B. Bijnen works at the Foreest Institute, Medical Centre Almaar, the Netherlands; F. Scheele works at Sint Lucas Andreas Ziekenhuis, Amsterdam, the Netherlands, and the Institute for Medical Education, Free University Medical Centre, Amsterdam, the Netherlands; A.E.R. Arnold also works at the Foreest Institute, as well as the Institute for Medical Education, Free University Medical Centre; A.M.J.J. Verweij works at the Sint Lucas Andreas Ziekenhuis, as well as the Institute for Medical Education at Free University Medical Centre; and H.J.M. van Rossum and J.A.A.M. van Diemen-Steenvoorde work at the Institute for Medical Education at Free University Medical Centre.