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Paternotte E, Dijksterhuis M, Goverde A, Ezzat H, Scheele F. Comparison of OBGYN postgraduate curricula and assessment methods between Canada and the Netherlands: an auto-ethnographic study. Front Med (Lausanne) 2024; 11:1363222. [PMID: 38601119 PMCID: PMC11004340 DOI: 10.3389/fmed.2024.1363222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/27/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Although the Dutch and the Canadian postgraduate Obstetrics and Gynecology (OBGYN) medical education systems are similar in their foundations [programmatic assessment, competency based, involving CanMED roles and EPAs (entrustable professional activities)] and comparable in healthcare outcome, their program structures and assessment methods considerably differ. Materials and methods We compared both countries' postgraduate educational blueprints and used an auto-ethnographic method to gain insight in the effects of training program structure and assessment methods on how trainees work. The research questions for this study are as follows: what are the differences in program structure and assessment program in Obstetrics and Gynecology postgraduate medical education in the Netherlands and Canada? And how does this impact the advancement to higher competency for the postgraduate trainee? Results We found four main differences. The first two differences are the duration of training and the number of EPAs defined in the curricula. However, the most significant difference is the way EPAs are entrusted. In Canada, supervision is given regardless of EPA competence, whereas in the Netherlands, being competent means being entrusted, resulting in meaningful and practical independence in the workplace. Another difference is that Canadian OBGYN trainees have to pass a summative written and oral exit examination. This difference in the assessment program is largely explained by cultural and legal aspects of postgraduate training, leading to differences in licensing practice. Discussion Despite the fact that programmatic assessment is the foundation for assessment in medical education in both Canada and the Netherlands, the significance of entrustment differs. Trainees struggle to differentiate between formative and summative assessments. The trainees experience both formative and summative forms of assessment as a judgement of their competence and progress. Based on this auto-ethnographic study, the potential for further harmonization of the OBGYN PGME in Canada and the Netherlands remains limited.
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Affiliation(s)
- Emma Paternotte
- Department of Obstetrics and Gynaecology, Gelre Hospitals, Apeldoorn, Netherlands
| | - Marja Dijksterhuis
- Department of Obstetrics and Gynaecology, Amphia Ziekenhuis, Breda, Netherlands
| | - Angelique Goverde
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hanna Ezzat
- Division of General Gynaecology and Obstetrics, University of British Columbia, Vancouver, BC, Canada
| | - Fedde Scheele
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands
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Kors JM, Paternotte E, Martin L, Verhoeven CJ, Schoonmade L, Peerdeman SM, Kusurkar RA. Factors influencing autonomy supportive consultation: A realist review. Patient Educ Couns 2020; 103:2069-2077. [PMID: 32471798 DOI: 10.1016/j.pec.2020.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/08/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Gaining insight into contextual factors and mechanisms supporting or hindering autonomy supportive consultation and into outcomes of such consultations. METHODS We conducted a systematic review using the realist synthesis procedure according to RAMESES guideline. A search was performed in PubMed, Embase, PsycINFO and Cinahl from inception to March 2019 using the search terms: 'autonomy' AND 'support' AND 'consultation' OR 'communication' AND 'intervention'. The review process including paper selection, quality assessment, full text reading for data-extraction was conducted by two researchers independently. RESULTS Of 2792 articles, 18 met our inclusion criteria. Contextual factors influencing an autonomy supportive consultation were: work organization and the attitude of professionals. An overarching supporting mechanism for AS was relationship building. In addition, each phase of the decision-making process seems to need supporting mechanisms fulfilling patients 'specific psychological needs in that phase. The outcome of AS is higher levels of patient well-being. CONCLUSION Autonomy supportive consultation works under various contexts coupled with mechanisms that give rise to favourable-outcomes, of which relationship building, taking time and exploring patients' needs seem the most important. PRACTICE IMPLICATIONS The results of our review facilitate professionals to reflect on their autonomy supportive consultation skills, which could improve their autonomy supportive behaviour.
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Affiliation(s)
- Joyce M Kors
- Faculty of Medicine Vrije Universiteit Amsterdam, Research in Education, Amsterdam UMC, de Boelelaan1118 1081 HZ Amsterdam, the Netherlands; LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University, Van der Boechorststraat 1 1081 BT Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Van der Boechorststraat 7 1081 BT Amsterdam, the Netherlands.
| | - Emma Paternotte
- UMC Utrecht, Location Wilhelmina Kinderziekenhuis, Lundlaan 6 3584 EA Utrecht, the Nederlands.
| | - Linda Martin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Van der Boechorststraat 7 1081 BT Amsterdam, the Netherlands.
| | - Corine J Verhoeven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Van der Boechorststraat 7 1081 BT Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Maxima Medical Centre, De Run 4600 5504 DB Veldhoven, the Netherlands.
| | - Linda Schoonmade
- Vrije Universiteit Amsterdam, Medical Library, De Boelelaan 1117 1081 HV Amsterdam, the Netherlands.
| | - Sakia M Peerdeman
- Faculty of Medicine Vrije Universiteit Amsterdam, Research in Education, Amsterdam UMC, de Boelelaan1118 1081 HZ Amsterdam, the Netherlands.
| | - Rashmi A Kusurkar
- Faculty of Medicine Vrije Universiteit Amsterdam, Research in Education, Amsterdam UMC, de Boelelaan1118 1081 HZ Amsterdam, the Netherlands; LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University, Van der Boechorststraat 1 1081 BT Amsterdam, the Netherlands.
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van Rossum TR, Scheele F, Sluiter HE, Paternotte E, Heyligers IC. Effects of implementing time-variable postgraduate training programmes on the organization of teaching hospital departments. Med Teach 2018; 40:1036-1041. [PMID: 29385864 DOI: 10.1080/0142159x.2017.1418850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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.
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Affiliation(s)
- Tiuri R van Rossum
- a School of Health Professions Education (SHE) , Maastricht University , Maastricht , The Netherlands
| | - Fedde Scheele
- b Athena Institute for Transdisciplinary Research , VU University/VU Medical Centre , Amsterdam , The Netherlands
- c OLVG Teaching Hospital , Amsterdam , The Netherlands
| | - Henk E Sluiter
- d Department of Internal Medicine , Deventer Hospital , Deventer , The Netherlands
| | - Emma Paternotte
- e Department of Gynaecology and Obstetrics , Meander Medical Center , Amersfoort , The Netherlands
| | - Ide C Heyligers
- a School of Health Professions Education (SHE) , Maastricht University , Maastricht , The Netherlands
- f Zuyderland Medical Center , Heerlen , The Netherlands
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Akdemir N, Lombarts KMJMH, Paternotte E, Schreuder B, Scheele F. How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement. BMC Med Educ 2017; 17:98. [PMID: 28577536 PMCID: PMC5455208 DOI: 10.1186/s12909-017-0937-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/21/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Evaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training. Moreover, accreditors determine whether a PGME program passes the assessment, which may have major consequences, such as starting, continuing or discontinuing PGME. However, there is limited evidence for the benefits of different choices in accreditation design. Therefore, this study aims to explain how changing views on educational quality and quality management have impacted the design of the PGME accreditation system in the Netherlands. METHODS To determine the historical development of the Dutch PGME accreditation system, we conducted a document analysis of accreditation documents spanning the past 50 years and a vision document outlining the future system. A template analysis technique was used to identify the main elements of the system. RESULTS Four themes in the Dutch PGME accreditation system were identified: (1) objectives of accreditation, (2) PGME quality domains, (3) quality management approaches and (4) actors' responsibilities. Major shifts have taken place regarding decentralization, residency performance and physician practice outcomes, and quality improvement. Decentralization of the responsibilities of the accreditor was absent in 1966, but this has been slowly changing since 1999. In the future system, there will be nearly a maximum degree of decentralization. A focus on outcomes and quality improvement has been introduced in the current system. The number of formal documents striving for quality assurance has increased enormously over the past 50 years, which has led to increased bureaucracy. The future system needs to decrease the number of standards to focus on measurable outcomes and to strive for quality improvement. CONCLUSION The challenge for accreditors is to find the right balance between trusting and controlling medical professionals. Their choices will be reflected in the accreditation design. The four themes could enhance international comparisons and encourage better choices in the design of accreditation systems.
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Affiliation(s)
- Nesibe Akdemir
- Department of Medical Education, OLVG Teaching Hospital, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands
| | - Kiki M. J. M. H. Lombarts
- Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Emma Paternotte
- Department of Medical Education, OLVG Teaching Hospital, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands
| | - Bas Schreuder
- Royal Dutch Medical Association, Specialist Physicians’ Registration Committee, Utrecht, The Netherlands
| | - Fedde Scheele
- Department of Medical Education, OLVG Teaching Hospital, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands
- School of Medical Sciences, VU Medical Center, Amsterdam, The Netherlands
- Athena Institute for Transdisciplinary Research, VU, Amsterdam, The Netherlands
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Paternotte E, van Dulmen S, Bank L, Seeleman C, Scherpbier A, Scheele F. Intercultural communication through the eyes of patients: experiences and preferences. Int J Med Educ 2017; 8:170-175. [PMID: 28535143 PMCID: PMC5457791 DOI: 10.5116/ijme.591b.19f9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/16/2017] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To explore patients' preferences and experiences regarding intercultural communication which could influence the development of intercultural patient-centred communication training. METHODS This qualitative study is based on interviews with non-native patients. Thirty non-native patients were interviewed between September and December 2015 about their preferences and experiences regarding communication with a native Dutch doctor. Fourteen interviews were established with an interpreter. The semi-structured interviews took place in Amsterdam. They were focused on generic and intercultural communication skills of doctors. Relevant fragments were coded by two researchers and analysed by the research team by means of thematic network analysis. Informed consent and ethical approval was obtained beforehand. RESULTS All patients preferred a doctor with a professional patient-centred attitude regardless of the doctor's background. Patients mentioned mainly generic communication aspects, such as listening, as important skills and seemed to be aware of their own responsibility in participating in a consultation. Being treated as a unique person and not as a disease was also frequently mentioned. Unfamiliarity with the Dutch healthcare system influenced the experienced communication negatively. However, a language barrier was considered the most important problem, which would become less pressing once a doctor-patient relation was established. CONCLUSIONS Remarkably, patients in this study had no preference regarding the ethnic background of the doctor. Generic communication was experienced as important as specific intercultural communication, which underlines the marginal distinction between these two. A close link between intercultural communication and patient-centred communication was reflected in the expressed preference 'to be treated as a person'.
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Affiliation(s)
- Emma Paternotte
- Department of Healthcare Education, OLVG hospital, Amsterdam, the Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands
| | - Lindsay Bank
- Department of Healthcare Education, OLVG hospital, Amsterdam, the Netherlands
| | - Conny Seeleman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Albert Scherpbier
- Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
| | - Fedde Scheele
- Department of Healthcare Education, OLVG hospital, Amsterdam, the Netherlands
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Paternotte E, Scheele F, Seeleman CM, Bank L, Scherpbier AJJA, van Dulmen S. Intercultural doctor-patient communication in daily outpatient care: relevant communication skills. Perspect Med Educ 2016; 5:268-275. [PMID: 27638395 PMCID: PMC5035277 DOI: 10.1007/s40037-016-0288-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Intercultural communication (ICC) between doctors and patients is often associated with misunderstandings and dissatisfaction. To develop ICC-specific medical education, it is important to find out which ICC skills medical specialists currently apply in daily clinical consultations. METHODS Doctor-patient consultations of Dutch doctors with non-Dutch patients were videotaped in a multi-ethnic hospital in the Netherlands. The consultations were analyzed using the validated MAAS-Global assessment list in combination with factors influencing ICC, as described in the literature. RESULTS In total, 39 videotaped consultations were analyzed. The doctors proved to be capable of practising many communication skills, such as listening and empathic communication behaviour. Other skills were not practised, such as being culturally aware and checking the patient's language ability. CONCLUSION We showed that doctors did practice some but not all the relevant ICC skills and that the ICC style of the doctors was mainly biomedically centred. Furthermore, we discussed the possible overlap between intercultural and patient-centred communication. Implications for practice could be to implement the relevant ICC skills in the existing communication training or develop a communication training with a patient-centred approach including ICC skills.
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Affiliation(s)
- Emma Paternotte
- Department of Healthcare Education, OLVG Hospital, Amsterdam, The Netherlands.
| | - Fedde Scheele
- Department of Healthcare Education, OLVG Hospital, Amsterdam, The Netherlands
- Medical School of Sciences, Vu University Medical Centre, Amsterdam, The Netherlands
| | - Conny M Seeleman
- Department of Social Medicine, University Medical Centre, Utrecht, The Netherlands
| | - Lindsay Bank
- Department of Healthcare Education, OLVG Hospital, Amsterdam, The Netherlands
| | - Albert J J A Scherpbier
- Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for health services research), Utrecht, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Centre, NIjmegen, The Netherlands
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
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Paternotte E, Scheele F, van Rossum TR, Seeleman MC, Scherpbier AJJA, van Dulmen AM. How do medical specialists value their own intercultural communication behaviour? A reflective practice study. BMC Med Educ 2016; 16:222. [PMID: 27558271 PMCID: PMC4997670 DOI: 10.1186/s12909-016-0727-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/06/2016] [Indexed: 05/29/2023]
Abstract
BACKGROUND Intercultural communication behaviour of doctors with patients requires specific intercultural communication skills, which do not seem structurally implemented in medical education. It is unclear what motivates doctors to apply intercultural communication skills. We investigated how purposefully medical specialists think they practise intercultural communication and how they reflect on their own communication behaviour. METHODS Using reflective practice, 17 medical specialists independently watched two fragments of videotapes of their own outpatient consultations: one with a native patient and one with a non-native patient. They were asked to reflect on their own communication and on challenges they experience in intercultural communication. The interviews were open coded and analysed using thematic network analysis. RESULTS The participants experienced only little differences in their communication with native and non-native patients. They mainly mentioned generic communication skills, such as listening and checking if the patient understood. Many participants experienced their communication with non-native patients positively. The participants mentioned critical incidences of intercultural communication: language barriers, cultural differences, the presence of an interpreter, the role of the family and the atmosphere. CONCLUSION Despite extensive experience in intercultural communication, the participants of this study noticed hardly any differences between their own communication behaviour with native and non-native patients. This could mean that they are unaware that consultations with non-native patients might cause them to communicate differently than with native patients. The reason for this could be that medical specialists lack the skills to reflect on the process of the communication. The participants focused on their generic communication skills rather than on specific intercultural communication skills, which could either indicate their lack of awareness, or demonstrate that practicing generic communication is more important than applying specific intercultural communication. They mentioned well-known critical incidences of ICC: language barriers, cultural differences, the presence of an interpreter, the role of the family and the atmosphere. Nevertheless, they showed a remarkably enthusiastic attitude overall was noteworthy. A strategy to make doctors more aware of their intercultural communication behaviour could be a combination of experiential learning and ICC training, for example a module with reflective practice.
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Affiliation(s)
- E. Paternotte
- Department of Healthcare Education, OLVG Hospital, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands
| | - F. Scheele
- Department of Healthcare Education, OLVG Hospital, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands
- Medical School of Sciences, Vu University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - T. R. van Rossum
- Department of Healthcare Education, OLVG Hospital, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands
| | - M. C. Seeleman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - A. J. J. A. Scherpbier
- Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - A. M. van Dulmen
- NIVEL (Netherlands Institute for health services research), P.O. Box 1568, 3500 BN Utrecht, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Faculty of Health Sciences, University College of Southeast Norway, P.O. Box 235, 3603 Kongsberg, Drammen, Norway
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Stammen LA, Stalmeijer RE, Paternotte E, Oudkerk Pool A, Driessen EW, Scheele F, Stassen LPS. Training Physicians to Provide High-Value, Cost-Conscious Care: A Systematic Review. JAMA 2015; 314:2384-400. [PMID: 26647260 DOI: 10.1001/jama.2015.16353] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Increasing health care expenditures are taxing the sustainability of the health care system. Physicians should be prepared to deliver high-value, cost-conscious care. OBJECTIVE To understand the circumstances in which the delivery of high-value, cost-conscious care is learned, with a goal of informing development of effective educational interventions. DATA SOURCES PubMed, EMBASE, ERIC, and Cochrane databases were searched from inception until September 5, 2015, to identify learners and cost-related topics. STUDY SELECTION Studies were included on the basis of topic relevance, implementation of intervention, evaluation of intervention, educational components in intervention, and appropriate target group. There was no restriction on study design. DATA EXTRACTION AND SYNTHESIS Data extraction was guided by a merged and modified version of a Best Evidence in Medical Education abstraction form and a Cochrane data coding sheet. Articles were analyzed using the realist review method, a narrative review technique that focuses on understanding the underlying mechanisms in interventions. Recurrent patterns were identified in the data through thematic analyses. Resulting themes were discussed within the research team until consensus was reached. MAIN OUTCOMES AND MEASURES Main outcomes were factors that promote education in delivering high-value, cost-conscious care. FINDINGS The initial search identified 2650 articles; 79 met the inclusion criteria, of which 14 were randomized clinical trials. The majority of the studies were conducted in North America (78.5%) using a pre-post interventional design (58.2%; at least 1619 participants); they focused on practicing physicians (36.7%; at least 3448 participants), resident physicians (6.3%; n = 516), and medical students (15.2%; n = 275). Among the 14 randomized clinical trials, 12 addressed knowledge transmission, 7 reflective practice, and 1 supportive environment; 10 (71%) concluded that the intervention was effective. The data analysis suggested that 3 factors aid successful learning: (1) effective transmission of knowledge, related, for example, to general health economics and prices of health services, to scientific evidence regarding guidelines and the benefits and harms of health care, and to patient preferences and personal values (67 articles); (2) facilitation of reflective practice, such as providing feedback or asking reflective questions regarding decisions related to laboratory ordering or prescribing to give trainees insight into their past and current behavior (56 articles); and (3) creation of a supportive environment in which the organization of the health care system, the presence of role models of delivering high-value, cost-conscious care, and a culture of high-value, cost-conscious care reinforce the desired training goals (27 articles). CONCLUSIONS AND RELEVANCE Research on educating physicians to deliver high-value, cost-conscious care suggests that learning by practicing physicians, resident physicians, and medical students is promoted by combining specific knowledge transmission, reflective practice, and a supportive environment. These factors should be considered when educational interventions are being developed.
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Affiliation(s)
- Lorette A Stammen
- Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Renée E Stalmeijer
- Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Emma Paternotte
- Department of Medical Education, OLVG Hospital, Amsterdam, the Netherlands
| | - Andrea Oudkerk Pool
- Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Erik W Driessen
- Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Fedde Scheele
- Department of Medical Education, OLVG Hospital, Amsterdam, the Netherlands3Department of Medical Education, VU University Medical Centre, Amsterdam, the Netherlands4Athena Institute for Trans-Disciplinary Research, VU University, Amsterdam, the Netherland
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
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Paternotte E, van Dulmen S, van der Lee N, Scherpbier AJJA, Scheele F. Factors influencing intercultural doctor-patient communication: a realist review. Patient Educ Couns 2015; 98:420-45. [PMID: 25535014 DOI: 10.1016/j.pec.2014.11.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/23/2014] [Accepted: 11/17/2014] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Due to migration, doctors see patients from different ethnic backgrounds. This causes challenges for the communication. To develop training programs for doctors in intercultural communication (ICC), it is important to know which barriers and facilitators determine the quality of ICC. This study aimed to provide an overview of the literature and to explore how ICC works. METHODS A systematic search was performed to find literature published before October 2012. The search terms used were cultural, communication, healthcare worker. A realist synthesis allowed us to use an explanatory focus to understand the interplay of communication. RESULTS In total, 145 articles met the inclusion criteria. We found ICC challenges due to language, cultural and social differences, and doctors' assumptions. The mechanisms were described as factors influencing the process of ICC and divided into objectives, core skills and specific skills. The results were synthesized in a framework for the development of training. CONCLUSION The quality of ICC is influenced by the context and by the mechanisms. These mechanisms translate into practical points for training, which seem to have similarities with patient-centered communication. PRACTICE IMPLICATIONS Training for improving ICC can be developed as an extension of the existing training for patient-centered communication.
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Affiliation(s)
- Emma Paternotte
- Department of Healthcare Education, Sint Lucas Andreas hospital, Amsterdam, The Netherlands.
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands; Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway.
| | - Nadine van der Lee
- Department of Healthcare Education, Sint Lucas Andreas hospital, Amsterdam, The Netherlands.
| | - Albert J J A Scherpbier
- Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Fedde Scheele
- Medical School of Sciences, Vu University Medical Center, Amsterdam, The Netherlands.
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Hooker AB, Muller LT, Paternotte E, Thurkow AL. Immediate and long-term complications of delayed surgical management in the postpartum period: a retrospective analysis. J Matern Fetal Neonatal Med 2014; 28:1884-9. [DOI: 10.3109/14767058.2014.972356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Paternotte E, Fokkema JPI, van Loon KA, van Dulmen S, Scheele F. Cultural diversity: blind spot in medical curriculum documents, a document analysis. BMC Med Educ 2014; 14:176. [PMID: 25150546 PMCID: PMC4236597 DOI: 10.1186/1472-6920-14-176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 08/18/2014] [Indexed: 05/10/2023]
Abstract
BACKGROUND Cultural diversity among patients presents specific challenges to physicians. Therefore, cultural diversity training is needed in medical education. In cases where strategic curriculum documents form the basis of medical training it is expected that the topic of cultural diversity is included in these documents, especially if these have been recently updated. The aim of this study was to assess the current formal status of cultural diversity training in the Netherlands, which is a multi-ethnic country with recently updated medical curriculum documents. METHODS In February and March 2013, a document analysis was performed of strategic curriculum documents for undergraduate and postgraduate medical education in the Netherlands. All text phrases that referred to cultural diversity were extracted from these documents. Subsequently, these phrases were sorted into objectives, training methods or evaluation tools to assess how they contributed to adequate curriculum design. RESULTS Of a total of 52 documents, 33 documents contained phrases with information about cultural diversity training. Cultural diversity aspects were more prominently described in the curriculum documents for undergraduate education than in those for postgraduate education. The most specific information about cultural diversity was found in the blueprint for undergraduate medical education. In the postgraduate curriculum documents, attention to cultural diversity differed among specialties and was mainly superficial. CONCLUSIONS Cultural diversity is an underrepresented topic in the Dutch documents that form the basis for actual medical training, although the documents have been updated recently. Attention to the topic is thus unwarranted. This situation does not fit the demand of a multi-ethnic society for doctors with cultural diversity competences. Multi-ethnic countries should be critical on the content of the bases for their medical educational curricula.
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MESH Headings
- Community Medicine/education
- Cultural Diversity
- Curriculum/statistics & numerical data
- Documentation/statistics & numerical data
- Education, Medical/methods
- Education, Medical/statistics & numerical data
- Education, Medical, Graduate/methods
- Education, Medical, Graduate/statistics & numerical data
- Education, Medical, Undergraduate/methods
- Education, Medical, Undergraduate/statistics & numerical data
- Humans
- Internship and Residency/statistics & numerical data
- Netherlands
- Occupational Medicine/education
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Affiliation(s)
- Emma Paternotte
- Department of Medical Education, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, P.O. Box 9243, 1061 AE Amsterdam, The Netherlands
| | - Joanne PI Fokkema
- Department of Medical Education, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, P.O. Box 9243, 1061 AE Amsterdam, The Netherlands
| | - Karsten A van Loon
- Department of Medical Education, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, P.O. Box 9243, 1061 AE Amsterdam, The Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- NIVEL (Netherlands Institute for health services research), Utrecht, The Netherlands
- Department of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| | - Fedde Scheele
- Department of Medical Education, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, P.O. Box 9243, 1061 AE Amsterdam, The Netherlands
- Department of Medical Education, VU University Medical Centre, Amsterdam, The Netherlands
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12
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Beroud J, Vincent B, Paternotte E, Nguyen VS, Kerdjoudj H, Velot E, Rouxel D, Menu P. Brillouin spectroscopy: a new tool to decipher viscoelastic properties of biological scaffold functionalized with nanoscale films. Biomed Mater Eng 2013; 23:251-61. [PMID: 23798646 DOI: 10.3233/bme-130749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In tissue engineering, the endothelialization of vascular scaffold can be a crucial step to improve graft patency. A functional cellularization requires coating surfaces. Since 2003, our group used polyelectrolyte multilayer films (PEMFs) made of poly(allylamine hydrochloride) and polystyren sulfonate to coat luminal surface of blood vessel. Previous results showed that PEMFs have remarkable effect on cellular behavior: adhesion, proliferation, differentiation. However, no method seems adapted for in vitro measurement of the viscoelastic shift after PEMFs buildup. OBJECTIVE In this present work, we proposed to use a new analytical method based on Brillouin spectroscopy (BS) to investigate the influence PEMFs coating on vessel intrinsic viscoelasticy. METHODS On human umbilical arteries and rabbit vessels, PEMFs were buildup and the luminal surfaces viscoelasticy were measuring by BS. RESULTS It seems that these films do not alter dynamic functionality and BS could be an interesting method for understanding the role of the tissue architecture, the interrelation between the different structures constituting the wall and the influence of this architecture on the tissue behavior, especially with the characterized components of the different vascular wall. CONCLUSION The ability of BS to characterize biological samples opens potential applications in tissue engineering field, especially as a tool for a better understanding of vascular diseases.
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Affiliation(s)
- J Beroud
- UMR 7365 CNRS-Université de Lorraine, IMoPA, Biopôle de l'Université de Lorraine, Vandoeuvre-lès-Nancy, France
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13
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Salmon N, Paternotte E, Decot V, Stoltz JF, Menu P, Labrude P. Polyelectrolyte multilayer films promote human cord blood stem cells differentiation into mature endothelial cells exhibiting a stable phenotype. Biomed Mater Eng 2010; 19:349-54. [PMID: 20042801 DOI: 10.3233/bme-2009-0599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND recent studies in bio-engineering have showed the influence of Polyelectrolyte Multilayer (PEM) films on endothelial cells (ECs), especially poly(sodium-4-styrene-sulfonate) (PSS) and poly(allylamine hydrochloride) (PAH). They were tested either with human mature ECs or rabbit immature endothelial progenitor cells (EPCs), but never on human EPCs. In view to obtain an EC covered surface, human cord blood (HCB) EPCs were cultivated on PSS/PAH films. MATERIAL AND METHODS PEMs were obtained by 7 alternate depositions of cationic PAH and anionic PSS layers. HCB mononuclear cells were isolated by centrifugation through density gradient. 7 days after seeding on PEM, unattached cells were removed and adherent EPCs were cultivated in endothelial specific medium until P6. Appearance of CD31 and vWF was evaluated by confocal microscopy. RESULTS EPCs not only successfully adhered on PEM, but also spread and proliferated. Moreover, cells differentiated into a typical endothelial cobblestone monolayer within 2 weeks. Immunostaining of CD31 and vWF confirmed the formation of an EC-like confluent monolayer. Furthermore, these cells showed after 6 passages a good phenotypic stability while reseeded on the PEM film. CONCLUSION these results show an easy way to obtain mature ECs from human stem cells, which may open new applications for a scaffold cellularization in tissue bio-engineering.
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Affiliation(s)
- N Salmon
- CNRS - UMR 7561 Groupe Ingénierie Cellulaire et Tissulaire et FR 32.09, Faculté de Médecine, Nancy-Université, Vandoeuvre-lès-Nancy, France
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Kerdjoudj H, Berthelemy N, Paternotte E, Stoltz JF, Voegel JC, Menu P. N006 Nouvelle génération de substituts vasculaires naturels. Arch Cardiovasc Dis 2009. [DOI: 10.1016/s1875-2136(09)72435-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Paternotte E, Gaucher C, Labrude P, Stoltz JF, Menu P. Review: behaviour of endothelial cells faced with hypoxia. Biomed Mater Eng 2008; 18:295-299. [PMID: 19065037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hypoxia is a diminution of oxygen quantity delivered to tissue for cellular need to product energy. Hypoxia derives from two major conditions in health diseases: anemia and ischemia. Anemic hypoxia comes from damage to O(2) transport like red blood cells diminution or disease. Ischemic hypoxia is a diminution of blood flow following a diminution of blood volume after a hemorrhagic shock. After hypoxia, vessels dilate to increase blood flow allowing a better oxygenation of peripheral tissues. This vasodilation appears immediately after the beginning of hypoxia and can be maintained during several hours. Today, the molecular mechanisms of this vasodilation stay unclear. But it seems that potassic channels, ATP concentration and medium acidification in addition to vasodilator/vasoconstrictor balance play a great role to facilitate the oxygenation of the ischemic areas.As endothelial cells (EC) are lining the vasculature, they are always in contact with blood, which carries, amongst other compounds, oxygen. In this way, they are the first target for an oxygen partial pressure (PO(2)) diminution. EC, through different mechanosensors, can sense a variation in PO(2) and adapt their metabolism to maintain ATP production. Under hypoxia, EC switch into hypoxic metabolism, leading to the production of reactive oxygen species (ROS). Indeed, when PO(2) is low, the respiratory chain in the mitochondria runs slower. Furthermore, cytochrome C capacity to trap O(2) is reduced; this phenomenon alters the cellular redox potential and leads to the accumulation of electrons that induce the formation of ROS.This review presents an overview of the behaviour of endothelial cells face to hypoxia. We propose to focus on nitric oxide, hypoxia inducible factor (HIF), lactate and ROS productions. Then we present the different mode of culture of EC under hypoxia. Finally, we conclude on the difficulty to study hypoxia because of the various types of system developed to reproduce this phenomenon and the different signalling ways that can be activated.
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Affiliation(s)
- E Paternotte
- Ingénierie Cellulaire et Tissulaire, LEMTA-UMR 7563, IFR 111, Faculté de Médecine, Nancy-Université, Vandoeuvre-lès-Nancy, France.
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Affiliation(s)
- E. Paternotte
- Ingénierie Cellulaire et Tissulaire, LEMTA-UMR 7563, IFR 111, Faculté de Médecine, Nancy-Université, Vandoeuvre-lès-Nancy, France
| | - C. Gaucher
- Ingénierie Cellulaire et Tissulaire, LEMTA-UMR 7563, IFR 111, Faculté de Médecine, Nancy-Université, Vandoeuvre-lès-Nancy, France
| | - P. Labrude
- Physiologie, Faculté de Pharmacie, Nancy-Université, Nancy, France
| | - J.-F. Stoltz
- Ingénierie Cellulaire et Tissulaire, LEMTA-UMR 7563, IFR 111, Faculté de Médecine, Nancy-Université, Vandoeuvre-lès-Nancy, France
| | - P. Menu
- Ingénierie Cellulaire et Tissulaire, LEMTA-UMR 7563, IFR 111, Faculté de Médecine, Nancy-Université, Vandoeuvre-lès-Nancy, France
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