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Jorissen A, van de Kant K, Ikiz H, van den Eertwegh V, van Mook W, de Rijk A. The importance of creating the right conditions for group intervision sessions among medical residents- a qualitative study. BMC Med Educ 2024; 24:375. [PMID: 38580954 PMCID: PMC10996180 DOI: 10.1186/s12909-024-05342-0] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND The burnout rates among residents urge for adequate interventions to improve resilience and prevent burnout. Peer reflection, also called group intervision sessions, is a potentially successful intervention to increase the resilience of young doctors. We aimed to gain insight into the perceived added value of intervision sessions and the prerequisite conditions to achieve this, according to residents and intervisors. Our insights might be of help to those who think of implementing intervision sessions in their institution. METHODS An explorative, qualitative study was performed using focus groups and semi-structured interviews with both residents (n = 8) and intervisors (n = 6) who participated in intervision sessions in a university medical center in the Netherlands. The topic list included the perceived added value of intervision sessions and factors contributing to that. The interviews were transcribed verbatim and coded using NVivo. Thematic analysis was subsequently performed. RESULTS According to residents and intervisors, intervision sessions contributed to personal and professional identity development; improving collegiality; and preventing burn-out. Whether these added values were experienced, depended on: (1) choices made during preparation (intervisor choice, organizational prerequisites, group composition, workload); (2) conditions of the intervision sessions (safety, depth, role of intervisor, group dynamics, pre-existent development); and (3) the hospital climate. CONCLUSIONS Intervision sessions are perceived to be of added value to the identity development of medical residents and to prevent becoming burned out. This article gives insight in conditions necessary to reach the added value of intervision sessions. Optimizing preparation, meeting prerequisite conditions, and establishing a stimulating hospital climate are regarded as key to achieve this.
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Affiliation(s)
- Anouk Jorissen
- Department of Social Medicine, Care and Public Health, Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Kim van de Kant
- Academy for Postgraduate Medical Training, Maastricht University Medical Center, PO Box 5800, Maastricht, 6202 AZ, the Netherlands.
- Department of Family Medicine, Care and Public Health, Research Institute (CAPHRI), Maastricht University, PO Box 5800, Maastricht, 6202 AZ, the Netherlands.
| | - Habibe Ikiz
- Department of Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Valerie van den Eertwegh
- Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Walther van Mook
- Academy for Postgraduate Medical Training, Maastricht University Medical Center, PO Box 5800, Maastricht, 6202 AZ, the Netherlands
- Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands
| | - Angelique de Rijk
- Department of Social Medicine, Care and Public Health, Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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van Dijk N, de Jongh W, Stärcke P, Shaw D, Bollen J, van Mook W. Case report: Organ donation after euthanasia for psychiatric suffering: some of the practical and ethical lessons Martijn taught us. Front Psychiatry 2024; 15:1234741. [PMID: 38505793 PMCID: PMC10948434 DOI: 10.3389/fpsyt.2024.1234741] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/02/2024] [Indexed: 03/21/2024] Open
Abstract
Euthanasia in psychiatric patients presents unique challenges, especially when combined with organ donation. In this article, the hurdles psychiatric patients might encounter after expressing their wish for organ donation after euthanasia, are discussed and illustrated by the case of Martijn, a 45-year-old psychiatric patient who altruistically donated his organs after euthanasia. Hospital and physician-related factors, including caution in determination of mental capacity, consideration of conflicting interests, and healthcare staff stress are discussed as impediments to organ donation after euthanasia (ODE) in psychiatric patients. The primary objective of this article is to raise awareness among psychiatrists regarding the fact that although the combination of euthanasia and organ donation is an uncommonly performed procedure, it is frequently requested by psychiatric patients. In conclusion, the article advocates for a nuanced approach, respecting patients' altruistic wishes while at the same time addressing challenges associated with ODE in psychiatric suffering. Where possible, and within the current medical, ethical and legal boundaries, the importance of facilitating organ donation without unnecessarily prolonging the suffering of competent psychiatric patients seeking euthanasia is emphasized. The topic calls, for example, for further qualitative research to understand the stakeholders' perspectives to determine the perceived possibilities on the one hand and boundaries on the other.
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Affiliation(s)
- Nathalie van Dijk
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Wim de Jongh
- Department of Organ Donation Coordination, Maastricht University Medical Center+, Maastricht, Netherlands
| | | | - David Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
- Academy for Postgraduate Training, Maastricht University Medical Center+, Maastricht, Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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3
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Godschalx-Dekker J, van Mook W. Dutch dismissal practices: characteristics, consequences, and contrasts in residents' case law in community-based practice versus hospital-based specialties. BMC Med Educ 2024; 24:160. [PMID: 38374054 PMCID: PMC10877891 DOI: 10.1186/s12909-024-05106-w] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 01/28/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND In the Netherlands, 2 to 10% of the residents terminate training prematurely. Infrequently, termination of training is by dismissal. Incidentally, residents may disagree, dispute and challenge these decisions from the programme directors. Resident dismissal is always a difficult decision, most commonly made after, repeated assessments, and triangulation of the resulting assessment data and one or more remediation attempts. Nevertheless, the underlying reasons for dismissal and the policies for remediation and dismissal may differ between training programmes. Such differences may however impact the chance of remediation success, the chance of dismissal and subsequent residents' appeals. METHOD We included a total of 70 residents from two groups (community-based and hospital-based specialties) during 10 years of appeals. Subsequently, we compared these groups on factors potentially associated with the outcome of the conciliation board decision regarding the residents' dismissal. We focused herein on remediation strategies applied, and reasons reported to dismiss residents. RESULTS In both groups, the most alleged reason to dismiss residents was lack of trainability, > 97%. This was related to deficiencies in professionalism in community-based practice and medical expertise in hospital-based specialties respectively. A reason less frequently mentioned was endangerment of patient care, < 26%. However, none of these residents accused of endangerment, actually jeopardized the patients' health, probably due to the vigilance of their supervisors. Remediation strategies varied between the two groups, whereas hospital-based specialties preferred formal remediation plans in contrast to community-based practice. A multitude of remediation strategies per competency (medical expertise, professionalism, communication, management) were applied and described in these law cases. DISCUSSION Residents' appeals in community-based practice were significantly less likely to succeed compared to hospital-based specialties. Hypothesised explanatory factors underlying these differences include community-based practices' more prominent attention to the longitudinal assessment of professionalism, the presence of regular quarterly progress meetings, precise documentation of deficiencies, and discretion over the timing of dismissal in contrast to dismissal in the hospital-based specialties which is only formally possible during scheduled formal summative assessment meetings.
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Affiliation(s)
- Judith Godschalx-Dekker
- Department of Psychiatry and Medical Psychology, GGZ Central, Flevoziekenhuis, Almere, The Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Academy for Postgraduate Training, Maastricht UMC+, and School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
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Al-Sabiry M, Barnhoorn P, Slootweg I, van Mook W, Numans M. Which 'end' do you have in mind? Clinical supervisors' perceptions of professional Identity Formation outcomes in GP residency. Med Teach 2024:1-7. [PMID: 38295758 DOI: 10.1080/0142159x.2024.2308070] [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] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Professional Identity Formation (PIF) is crucial for high-quality patient care and physician well-being. Few empirical studies examined PIF in residency from the perspective of supervisors. In GP residency, residents are supervised with an 'end in mind' that remains unexplored. To encourage supervisors to reflect on their teaching behaviours, this study investigated GP clinical supervisors' perceptions of PIF outcomes in GP residency. METHODS Applying qualitative description, focus group interviews were conducted between spring and autumn 2019. Using a semi-structured interview guide, supervisors' perceptions of PIF outcomes were explored. In an iterative coding process applying constant comparison, a thematic analysis was performed of focus group transcripts. RESULTS We conducted eight focus groups with 55 supervisors at four training institutes across the Netherlands. Half of the supervisors were female. GP supervisors tend to address the 'poor GP' when prompted to address the 'good GP'. PIF outcomes in GP residency should revolve around taking ownership in patient care, self-care and the persistence of GP as a profession. CONCLUSION PIF can be challenged by a lack of positive language. Supervisors' strong beliefs regarding ideals of the profession potentially compromise PIF when they do not resonate with residents' beliefs, resulting in poor educational alliance.
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Affiliation(s)
- Miami Al-Sabiry
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
| | - Pieter Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
| | - Irene Slootweg
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Centre, the Netherlands
- School of Health Professions Education, Maastricht University, the Netherlands
| | - Mattijs Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands
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Charnetski MD, Asoodar M, Yu H, van Mook W. Cultural Considerations in the Formal Process of Simulation Curriculum Adaptation: A Scoping Review. Simul Healthc 2023:01266021-990000000-00082. [PMID: 37655814 DOI: 10.1097/sih.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
SUMMARY STATEMENT Transborder curriculum partnerships in health professions education have been increasing in numbers in recent years. These partnerships present unique challenges when transferring curricula from one context to another. It has been noted that cultural differences between institutions, faculty, staff, and learners can have profound effects on collaboration. Given the significant need for context and fidelity (especially relative to cultural considerations) in healthcare simulation education, there are gaps that need to be addressed in the transfer of these curricula. A scoping literature review was conducted examining recently published articles with relevance to simulation curriculum design or adaptation in transborder contexts to determine to what extent cultural elements are considered in the design and adaptation of simulation-based education in transborder curriculum partnerships. This review resulted in 19 studies requiring full-text review. Studies represented every region of the world with both near and distant proximity of partnering parties. From the reviewed studies, 8 categories related to curriculum adaptation were identified. These categories, when compared with the themes present in Campinha-Bacote's model of cultural competency, showed complete overlap with the 5 themes of the model plus an additional theme complementary to the model. This scoping review demonstrates that cultural considerations clearly play a role in the adaptation of simulation curricula in transborder healthcare curricular partnerships, but further research is needed to further define the exact nature of that relationship.
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Affiliation(s)
- Matthew D Charnetski
- From the Maastricht University, Maastricht Netherlands Dartmouth Health, Lebanon, NH (M.D.C.); and Maastricht University, Maastricht Netherlands (M.A., H.Y., W.V.M.)
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Godschalx J, van Mook W. Dismissed Psychiatry Residents Who Appeal: Exploring Unprofessional Behavior. Acad Psychiatry 2023; 47:344-351. [PMID: 36853268 PMCID: PMC10447273 DOI: 10.1007/s40596-023-01746-0] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Dutch psychiatry residents who are dismissed from their training program have the opportunity to appeal the decision. Those appeals are publicly available. This report explores the appeals of residents dismissed for unprofessional behavior. METHODS The authors analyzed caselaw of dismissed psychiatry residents brought before the conciliation board of The Royal Dutch Medical Association and compared them to a control group of caselaw of dismissed family medicine residents. RESULTS From 2011 to 2020, 19 psychiatry residents were dismissed for failing to meet the competencies of the CanMEDS professional domain and matched with 19 family medicine residents. Most psychiatry residents deficient in professionalism were considered deficient in their attitude, in reliability of keeping agreements, or in their ability to profit from supervisors' feedback. Insufficient professional behavior overlapped with insufficient communication, collaboration, and management. Half of the psychiatry residents with deficits in professionalism went on sick leave at some time. Between residents in psychiatry and family medicine, or between psychiatry residents with and without a favorable conciliation board decision, no statistical differences were found regarding gender, year of residency, and number of insufficient competencies. CONCLUSIONS The deficiencies in the professionalism of residents who challenged their program director's decision to be dismissed mostly consisted of inadequate attitude or the inability to profit from feedback, suggesting that these residents lack empathy, introspection, or both.
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Affiliation(s)
- Judith Godschalx
- Flevoziekenhuis Almere GGZ Centraal Flevoland, Almere, The Netherlands
| | - Walther van Mook
- Maastricht University Medical Centre+, Maastricht, The Netherlands
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van Dijk N, Shaw D, Shemie S, Wiebe K, van Mook W, Bollen J. Directed Organ Donation After Euthanasia. Transpl Int 2023; 36:11259. [PMID: 37324219 PMCID: PMC10262997 DOI: 10.3389/ti.2023.11259] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023]
Abstract
Organ donation after euthanasia is performed in Belgium, the Netherlands, Canada and Spain. Directed deceased organ donation is currently possible under strict conditions in a limited number of countries, while it is currently not possible to opt for directed donation following euthanasia. While organ donation after euthanasia is a deceased donation procedure, directed organ donation after euthanasia could be seen as a deceased donation procedure with a living donation consent process. Therefore, directed organ donation after euthanasia is feasible on medical and ethical grounds. Strict safeguards should be in place, including the requirement of a pre-existing familial or personal relationship with the proposed recipient, without any evidence of coercion or financial gain.
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Affiliation(s)
- Nathalie van Dijk
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - David Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Sam Shemie
- Division of Critical Care, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
- Canadian Blood Services, Ottawa, ON, Canada
| | - Kim Wiebe
- Medical Assistance in Dying, Shared Health Services, Winnipeg, MB, Canada
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
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8
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Tajaâte N, van Dijk N, Pragt E, Shaw D, Kempener-Deguelle A, Jongh WD, Bollen J, van Mook W. Reply to reaction on 'Organ donation after euthanasia starting at home in a patient with multiple system atrophy - case report'. BMC Med Ethics 2023; 24:33. [PMID: 37248488 DOI: 10.1186/s12910-023-00914-z] [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: 01/12/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
We would like to respond to the comment we received from our colleagues on our case report about organ donation after euthanasia starting at home. We reply to their statements on medical and legal aspects, and provide more information on our view of informed consent.
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Affiliation(s)
- Najat Tajaâte
- Department of Anesthesiology, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - Nathalie van Dijk
- Department of Anesthesiology, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - Elien Pragt
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - David Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
| | - A Kempener-Deguelle
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wim de Jongh
- Department of Organ Donation Coordination, Department of Organ Donation Coordination, Maastricht, The Netherlands
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Walther van Mook
- Department of Anesthesiology, Zuyderland Medisch Centrum, Heerlen, The Netherlands
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van Dijk N, Stärcke P, de Jongh W, Jansen N, Shaw D, Bollen J, van Mook W. Organ Donation After Euthanasia in Patients Suffering From Psychiatric Disorders: 10-Years of Preliminary Experiences in the Netherlands. Transpl Int 2023; 36:10934. [PMID: 36846601 PMCID: PMC9948004 DOI: 10.3389/ti.2023.10934] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
Euthanasia based on psychiatric suffering, followed by subsequent organ donation, is considered medically and legally permissible in the Netherlands. Although organ donation after euthanasia (ODE) in patients suffering from unbearable psychiatric illness is performed, it is not specifically addressed in the Dutch guideline on organ donation after euthanasia, and national data on ODE in psychiatric patients have not yet been published. In this article, the preliminary results of the 10-year Dutch case series of psychiatric patients who choose ODE are presented and potential factors influencing opportunities for donation in this population are discussed. We conclude that further future in-depth qualitative exploration of ODE in patients suffering from psychiatric illness and its associated ethical and practical dilemmas, including the consequences for the patient and their family and healthcare professionals, will be important to help make sense of potential barriers to donation for people undergoing euthanasia as a result of psychiatric suffering.
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Affiliation(s)
- Nathalie van Dijk
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | | | - Wim de Jongh
- Department of Surgery, Transplantation Coordination Services, Maastricht University Medical Center+, Maastricht, Netherlands
| | | | - David Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
- Academy for Postgraduate Training, Maastricht University Medical Center+, Maastricht, Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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Bollen J, Vissers K, van Mook W. Organ Donation after Euthanasia for Patients Suffering from Huntington's Disease. J Palliat Med 2022; 25:527-528. [PMID: 35363063 DOI: 10.1089/jpm.2021.0647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jan Bollen
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Bollen J, Vissers K, van Mook W. Dividing line between organ donation and euthanasia in a combined procedure. J Med Ethics 2022; 48:196-197. [PMID: 33632728 DOI: 10.1136/medethics-2021-107230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/10/2021] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
In this article, we want to reply to the recent article by Buturovic, to be able to correct some statements and allegations about this combined procedure. Organ donation after euthanasia is an extremely difficult procedure from an ethical point of view. On the one hand, we see a suffering patient who wants to die but who also wants to make an altruistic effort to donate his organs. On the other hand, we visualise a patient in need of an organ but who is wary of the fact that someone else needs to die in order to potentially receive a transplant organ. Healthcare professionals seem to walk a tightrope when balancing between the interests of the patients at these two extremes: while facilitating the dying patient's last wish on the one hand and abiding by all regulations regarding donation and transplantation on the other. Yet, these physicians, nurses and transplant coordinators do their utmost best to keep a strict line between euthanasia and organ donation, to avoid any external pressure on the patient, and to respect his autonomy. They really make an utmost attempt to make the process bearable for the donating patient. However, undeniably the patient who is about to undergo organ donation after euthanasia is nevertheless confronted with dozens of feelings and thoughts. However, this does not imply that procedural safeguards are failing to disentangle organ donation from euthanasia.
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Affiliation(s)
- Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc Medical Center Nijmegen, Nijmegen, Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc Medical Center Nijmegen, Nijmegen, Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, Netherlands
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12
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Khan N, van Mook W, Dave S, Ha S, Sagisi J, Davi N, Aftab C, Tiwari S, Hickman M, Gilliar W. Learner perspectives of professionalism: a mixed method systematic review protocol (Preprint). JMIR Res Protoc 2022; 11:e37473. [PMID: 36006688 PMCID: PMC9459844 DOI: 10.2196/37473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/04/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Professionalism has come to be associated with competence in medical education, with the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served. Recent studies indicate students should have the opportunity to observe the application of knowledge and skills by their mentors to improve patient health and safety. A noticeable detail that needs implementation into the curriculum is the inclusion of student perspectives. This review will explore students’ understanding and experience of professionalism in undergraduate medical education (UME). Objective This paper presents the protocol for a review that aims to develop an integrated synthesis of qualitative and quantitative studies resulting in recommendations for medical school curricula to incorporate the learners’ perspectives in teaching professionalism in UME. Methods We will take an integrated approach to synthesis. Data will be extracted from the included studies, and quantitative data will be “qualitized.” PubMed (Medline), Embase, PsycInfo, and ERIC (Education Resources Information Center) will be searched for studies published in English from 2010 to 2021. Studies will be screened and critically appraised for methodological quality using the Mixed Methods Appraisal Tool by 2 researchers, with disagreements resolved by a third researcher. Qualitative, quantitative, and mixed methods studies will be considered. Our population of interest is undergraduate medical students; hence, studies on medical residents and graduate medical students will be excluded. We will consider studies that explore how concepts of professionalism are understood, experienced, and taught in undergraduate medicine and on how medical students understand and develop the identified constructs of professionalism. Results This study is in the screening phase; therefore, no results are available at this time. However, we had initiated the searches, screening, and are currently in the critical appraisal stage. We will commence preparation to clean and convert the data for coding in July 2022, and analysis will be ongoing from the end of July 2022 until submission for publication in November 2022. Conclusions This research will contribute to the student perspectives on professionalism in medical education literature. The findings will aid in the creation of a checklist to guide the development of a curriculum on professionalism in UME. International Registered Report Identifier (IRRID) PRR1-10.2196/37473
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Affiliation(s)
- Nagina Khan
- Department of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
- Association of University Teachers of Psychiatry, London, United Kingdom
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- School of Health Professions Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
- Maastricht UMC+ Academy, Maastricht, Netherlands
| | - Subodh Dave
- Department of Osteopathic Medicine, Derbyshire Healthcare NHS Foundation Trust, Derbyshire, United Kingdom
- Department of Osteopathic Medicine, University of Bolton, Bolton, United Kingdom
- Royal College of Psychiatrists, London, United Kingdom
| | - Sohyun Ha
- Department of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
| | - Joshua Sagisi
- Department of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
| | - Nicole Davi
- Department of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
| | - Chantel Aftab
- Department of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
| | - Sucheta Tiwari
- East London NHS Foundation Trust, London, United Kingdom
| | - Marie Hickman
- Department of Osteopathic Medicine, Derbyshire Healthcare NHS Foundation Trust, Derbyshire, United Kingdom
| | - Wolfgang Gilliar
- Department of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
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Affiliation(s)
- Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Walther van Mook
- Department of Intensive Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, the Netherlands
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14
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Pacifico JL, van Mook W, Donkers J, Jacobs JCG, van der Vleuten C, Heeneman S. Extending the use of the conceptions of learning and teaching (COLT) instrument to the postgraduate setting. BMC Med Educ 2021; 21:32. [PMID: 33413352 PMCID: PMC7792289 DOI: 10.1186/s12909-020-02461-2] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Several studies have shown that conceptions of teachers on teaching and learning can influence the teaching practices and behavior in higher education. This association is also found in undergraduate medical education but not yet established in postgraduate medical setting. An instrument, Conceptions of Learning and Teaching (COLT) was developed to measure conception of teachers in undergraduate medical education. COLT is a 3-factor 18-item questionnaire. The objective of this study is to evaluate if COLT is valid for postgraduate medical education. METHODS We invited postgraduate clinical faculty from 3 hospitals in the Netherlands to fill out the COLT. Confirmatory and exploratory factor analysis were performed to evaluate the fit of the postgraduate clinical faculty data to the COLT. Analysis of variance was done to evaluate if there was difference among the 3 hospitals in terms of the response by the clinical faculty. RESULTS Confirmatory factor analysis showed that the postgraduate faculty data had a 2 factor structure after removal of five items. These factors were Teacher Centeredness (TC) and combined Appreciation of Active Learning and Orientation to Professional Practice (A-P) and were considered as comparable to the factors in the original COLT, expressing the post-graduate learning and teaching setting. As several items were removed, the fit was suboptimal, yet did suggest validity for use of the COLT for postgraduate medical education. CONCLUSION The modified COLT can be used to measure conceptions of teaching and learning in postgraduate medical education. We recommend further study to improve the factor structure of the modified COLT.
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Affiliation(s)
- Jaime L. Pacifico
- De La Salle University College of Medicine, De La Salle Medical Health Sciences Institute, Dasmarinas, Cavite, Philippines
| | | | - Jeroen Donkers
- Maastricht University Medical Centre, Maastricht, Netherlands
| | | | | | - Sylvia Heeneman
- Maastricht University Medical Centre, Maastricht, Netherlands
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Aries M, Segers R, van Bussel B, van Mook W. Transiently relieving visual impairment due to subcutaneous emphysema: a simple, bedside intervention. BMJ Case Rep 2020; 13:13/9/e232499. [PMID: 32878849 DOI: 10.1136/bcr-2019-232499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Marcel Aries
- Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ruud Segers
- Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bas van Bussel
- Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Walther van Mook
- Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
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Noben CYG, Stammen LA, Vaassen S, Haeren R, Stassen L, Mook WV, Essers B. Discrete choice experiment on educating value-based healthcare. Postgrad Med J 2020; 97:515-520. [PMID: 32796111 DOI: 10.1136/postgradmedj-2019-137190] [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: 09/30/2019] [Revised: 03/19/2020] [Accepted: 06/20/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Identifying costs and values in healthcare interventions as well as the ability to measure and consider costs relative to value for patients are pivotal in clinical decision-making and medical education. This study explores residents' preferences in educating value-based healthcare (VBHC) during postgraduate medical education. Exploring residents' preferences in VBHC education, in order to understand what shapes their choices, might contribute to improved medical residency education and healthcare as a whole. METHODS A discrete choice experiment (DCE) examined which conditions for educating VBHC are preferred by residents. DCE gives more insight into the trade-off's residents make when choosing alternatives, and which conditions for educating VBHC have the most influence on residents' preference. RESULTS This DCE shows that residents prefer knowledge on both medical practice as well as the process of care-to be educated by an expert on VBHC together with a clinician. They prefer limited protected time to conduct VBHC initiatives (thus while at work) and desire the inclusion of VBHC in formal educational plans. CONCLUSION When optimising graduate and postgraduate medical education curricula, these preferences should be considered to create necessary conditions for the facilitation and participation of residents in VBHC education and the set-up of VBHC initiatives.
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Affiliation(s)
- Cindy Y G Noben
- Academy of Postgraduate Medical Education, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Lorette A Stammen
- Department of Educational Development and Research, Maastricht University - Location Randwyck, Maastricht, Netherlands
| | - Sanne Vaassen
- Pediatrics, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Roel Haeren
- Neurosurgery, Maastricht University Medical Centre+, Maastricht, Netherlands.,Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Laurents Stassen
- Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands.,Department of Educational Development and Research, Maastricht University, Maastricht, Netherlands
| | - Brigitte Essers
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, Netherlands
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Mak-van der Vossen M, Teherani A, van Mook W, Croiset G, Kusurkar RA. How to identify, address and report students' unprofessional behaviour in medical school. Med Teach 2020; 42:372-379. [PMID: 31880194 DOI: 10.1080/0142159x.2019.1692130] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This AMEE guide provides a research overview of the identification of, and responding to unprofessional behaviour in medical students. It is directed towards medical educators in preclinical and clinical undergraduate medical education. It aims to describe, clarify and categorize different types of unprofessional behaviours, highlighting students' unprofessional behaviour profiles and what they mean for further guidance. This facilitates identification, addressing, reporting and remediation of different types of unprofessional behaviour in different types of students in undergraduate medical education. Professionalism, professional behaviour and professional identity formation are three different viewpoints in medical education and research. Teaching and assessing professionalism, promoting professional identity formation, is the positive approach. An inevitable consequence is that teachers sometimes are confronted with unprofessional behaviour. When this happens, a complementary approach is needed. How to effectively respond to unprofessional behaviour deserves our attention, owing to the amount of time, effort and resources spent by teachers in managing unprofessional behaviour of medical students. Clinical and medical educators find it hard to address unprofessional behaviour and turn toward refraining from handling it, thus leading to the 'failure to fail' phenomenon. Finding the ways to describe and categorize observed unprofessional behaviour of students encourages teachers to take the appropriate actions.
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Affiliation(s)
- Marianne Mak-van der Vossen
- Department of Research in Education, Faculty of Medicine VU University Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arianne Teherani
- Department of Medicine and Center for Faculty Educators, University of California, School of Medicine, San Francisco, CA, USA
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Gerda Croiset
- Department of Research in Education, Faculty of Medicine VU University Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- Department of Research in Education, Faculty of Medicine VU University Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Amalba A, Abantanga F, Scherpbier A, van Mook W. Recruitment and retention of healthcare professionals in rural areas is a major, worldwide concern. Medical education has integrated community-oriented medical education strategies to help address these challenges. This study explored medical trainees' preferences regarding place of work and choice of specialty after completing training using either the traditional or mixed Problem-Based Learning/Community-Based Education and Service curriculum in Ghanaian medical schools. Rural Remote Health 2019; 19:5087. [DOI: 10.22605/rrh5087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Mak-van der Vossen M, van Mook W, van der Burgt S, Kors J, Ket JC, Croiset G, Kusurkar R. Descriptors for unprofessional behaviours of medical students: a systematic review and categorisation. BMC Med Educ 2017; 17:164. [PMID: 28915870 PMCID: PMC5603020 DOI: 10.1186/s12909-017-0997-x] [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: 03/15/2017] [Accepted: 09/04/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND Developing professionalism is a core task in medical education. Unfortunately, it has remained difficult for educators to identify medical students' unprofessionalism, because, among other reasons, there are no commonly adopted descriptors that can be used to document students' unprofessional behaviour. This study aimed to generate an overview of descriptors for unprofessional behaviour based on research evidence of real-life unprofessional behaviours of medical students. METHODS A systematic review was conducted searching PubMed, Ebsco/ERIC, Ebsco/PsycINFO and Embase.com from inception to 2016. Articles were reviewed for admitted or witnessed unprofessional behaviours of undergraduate medical students. RESULTS The search yielded 11,963 different studies, 46 met all inclusion criteria. We found 205 different descriptions of unprofessional behaviours, which were coded into 30 different descriptors, and subsequently classified in four behavioural themes: failure to engage, dishonest behaviour, disrespectful behaviour, and poor self-awareness. CONCLUSIONS This overview provides a common language to describe medical students' unprofessional behaviour. The framework of descriptors is proposed as a tool for educators to denominate students' unprofessional behaviours. The found behaviours can have various causes, which should be explored in a discussion with the student about personal, interpersonal and/or institutional circumstances in which the behaviour occurred. Explicitly denominating unprofessional behaviour serves two goals: [i] creating a culture in which unprofessional behaviour is acknowledged, [ii] targeting students who need extra guidance. Both are important to avoid unprofessional behaviour among future doctors.
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Affiliation(s)
- Marianne Mak-van der Vossen
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
- Department for General Practice and Elderly Care Management, VU Medical Center, Amsterdam, the Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Medical Education Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Stéphanie van der Burgt
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
| | - Joyce Kors
- AVAG Midwifery Academy Amsterdam Groningen, Amsterdam, the Netherlands
| | - Johannes C.F. Ket
- Medical Library, University Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - Gerda Croiset
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
| | - Rashmi Kusurkar
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
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Bollen J, van Heurn E, van Mook W. Organ Donation After Euthanasia-Reply. JAMA 2017; 318:576-577. [PMID: 28787503 DOI: 10.1001/jama.2017.8617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jan Bollen
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ernst van Heurn
- Pediatric Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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Affiliation(s)
- Jan Bollen
- Department of Intensive Care Medicine, Maastricht University Medical Center, the Netherlands
| | - Tim van Smaalen
- Surgery, Maastricht University Medical Center, the Netherlands
| | | | - Ernst van Heurn
- Pediatric Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Dirk Ysebaert
- Transplant Surgery, University Hospital Antwerp, Antwerp, Belgium
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, the Netherlands
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Mak-van der Vossen M, van Mook W, Croiset G, Kusurkar R. In Reply to Bynum. Acad Med 2017; 92:424-425. [PMID: 28350589 DOI: 10.1097/acm.0000000000001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Marianne Mak-van der Vossen
- Medical educator and PhD candidate in medical education, VUmc School of Medical Sciences, Amsterdam, the Netherlands; . Associate professor, internist/intensivist, and dean for postgraduate medical training, Maastricht University Medical Center, Maastricht, the Netherlands. Professor in medical education and director, VUmc School of Medical Sciences, Amsterdam, the Netherlands. Associate professor and head, Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
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Bollen J, Ten Hoopen R, Ysebaert D, van Mook W, van Heurn E. Legal and ethical aspects of organ donation after euthanasia in Belgium and the Netherlands. J Med Ethics 2016; 42:486-489. [PMID: 27012736 DOI: 10.1136/medethics-2015-102898] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 05/13/2015] [Accepted: 03/03/2016] [Indexed: 06/05/2023]
Abstract
Organ donation after euthanasia has been performed more than 40 times in Belgium and the Netherlands together. Preliminary results of procedures that have been performed until now demonstrate that this leads to good medical results in the recipient of the organs. Several legal aspects could be changed to further facilitate the combination of organ donation and euthanasia. On the ethical side, several controversies remain, giving rise to an ongoing, but necessary and useful debate. Further experiences will clarify whether both procedures should be strictly separated and whether the dead donor rule should be strictly applied. Opinions still differ on whether the patient's physician should address the possibility of organ donation after euthanasia, which laws should be adapted and which preparatory acts should be performed. These and other procedural issues potentially conflict with the patient's request for organ donation or the circumstances in which euthanasia (without subsequent organ donation) traditionally occurs.
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Affiliation(s)
- Jan Bollen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rankie Ten Hoopen
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - Dirk Ysebaert
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
| | - Walther van Mook
- Department of Intensive Care, Coordinating Intensivist for Donation Affairs, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ernst van Heurn
- Department of Pediatric Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Mak-van der Vossen M, Peerdeman S, van Mook W, Croiset G, Kusurkar R. Assessing professional behaviour: Overcoming teachers' reluctance to fail students. BMC Res Notes 2014; 7:368. [PMID: 24938392 PMCID: PMC4080734 DOI: 10.1186/1756-0500-7-368] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 06/13/2014] [Indexed: 11/25/2022] Open
Abstract
Background Developing professional behaviour is an important goal of medical education in which teachers play a significant part. Many teachers can be reluctant to fail students demonstrating unprofessional behaviour. We hypothesize that supporting teachers in teaching and assessing professional behaviour and involving them in remediation will reduce this reluctance. Findings In 2010, VUmc School of Medical Sciences Amsterdam introduced an educational theme on professional behaviour for the bachelor's and master's programmes in medicine with a special emphasis on supporting teachers in teaching and assessing professional behaviour and involving them in the remediation process. Information was extracted from the student database on the number of unprofessional behaviour judgments awarded over 2008-2010 (before the intervention), and 2010-2013 (after introducing the intervention), which was compared. To find out if teachers' reluctance to fail had decreased, qualitative feedback from the teachers was gathered and analysed. Since the implementation of the educational theme, the number of unprofessional behaviour judgments has risen. The teachers are positive about the implemented system of teaching and assessing professional behaviour, and feel less reluctant to award an unsatisfactory professional behaviour judgment. Conclusions Supporting teachers in teaching and assessing professional behaviour and involving them in students' remediation appears to reduce their reluctance to fail students demonstrating unprofessional behaviour.
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Abstract
Professional values and behaviours are intrinsic to all medical practice, yet remain one of the most difficult subjects to integrate explicitly into a curriculum. Professionalism for the twenty-first century raises challenges not only to adapting the course to changing societal values but also for instilling skills of ongoing self-directed continuous development in trainees for future revalidation. This Guide is based on the contemporary available literature and focuses on instilling Professionalism positively into both undergraduate and postgraduate training deliberately avoiding the more negative aspects of Fitness to Practise. The literature on Professionalism is extensive. An evidence-based approach has been taken throughout. We have selected only some of the available publications to offer practical advice. Comprehensive reviews are available elsewhere (van Mook et al. 2009a-g). This Guide takes a structured stepwise approach and sequentially addresses: (i) agreeing an institutional definition, (ii) structuring the curriculum to integrate learning across all years, (iii) suggesting learning models, (iv) harnessing the impact of the formal, informal and hidden curricula and (v) assessing the learning. Finally, a few well-evaluated case studies for both teaching and assessment have been selected to illustrate our recommendations.
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Affiliation(s)
- Helen O'Sullivan
- Institute of Learning and Teaching, Faculty of Health and Life Sciences, The University of Liverpool, UK.
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Abstract
Professional values and behaviours are intrinsic to all medical practice yet remain one of the most difficult subjects to integrate explicitly into a curriculum. Professionalism in the twenty-first century raises challenges not only for the adaptation of the medical training programme to changing societal values but also for ensuring that trainees gain the skills for self-directed continuous development and future revalidation. This article is an introduction to the AMEE Guide in Medical Education No 61: Integrating Professionalism into the Curriculum ( www.amee.org ), which is based on the extensive contemporary available literature. An evidence-based approach has been taken throughout the Guide as it focuses on instilling professionalism positively into both undergraduate and postgraduate training. It takes a structured, stepwise approach and sequentially addresses: (i) agreeing an institutional definition, (ii) structuring the curriculum to integrate learning across all years, (iii) suggesting learning models, (iv) harnessing the impact of the formal, informal and hidden curricula and (v) assessing the learning of the trainee. A few well-evaluated case studies for both teaching and assessment have been selected to illustrate the recommendations.
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Affiliation(s)
- Helen O'Sullivan
- Institute of Learning and Teaching, Faculty of Health and Life Sciences, The University of Liverpool, UK.
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Abstract
OBJECTIVE To evaluate the prevalence of reactive type II pneumocytes (RPII) in bronchoalveolar lavage (BAL) fluid samples obtained from patients with various pulmonary disorders. STUDY DESIGN Consecutive BAL fluid samples were screened for the presence of RPII on May-Grünwald-Giemsa-stained cytocentrifuge preparations. BAL fluid samples with and without RPII were compared with regard to prevalence, associated clinical diagnoses and cytologic findings. RESULTS RPII were generally large cells with a high nuclear:cytoplasmic ratio and deeply blue-stained, vacuolated cytoplasm. Most RPII occurred in cohesive cell groups, and the vacuoles tended to be confluent. Cytologic findings associated with RPII were foamy alveolar macrophages, activated lymphocytes and plasma cells. RPII were present in 94 (21.7%) of 433 included BAL fluid samples. The highest prevalences were noted in patients with systemic inflammatory response syndrome and alveolar hemorrhage. In addition, RPII tended to occur more frequently in ventilator-associated pneumonia, Pneumocystis carinii pneumonia, extrinsic allergic alveolitis and drug-induced pulmonary disorders. In contrast, RPII were not observed in BAL fluid samples obtained from patients with sarcoidosis. CONCLUSION RPII were prevalent in about 20% of BAL fluid specimens. They were associated mainly with conditions of acute lung injury and not observed in sarcoidosis.
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Affiliation(s)
- Kitty C F M Linssen
- Department of Medical Microbiology, University Hospital Maastricht, Maastricht, The Netherlands
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