Care Management in Postgraduate Medical Education in the Netherlands: Assessing needs, developing strategies, evaluating outcomes.

Background:

Postgraduate medical training programs are expected to prepare trainee physicians to practice adequately in the current health care environment. This mandate is reflected in the seven CANMEDs competencies namely: medical expert, collaborator, communicator, scholar, professional, manager and health advocate. Unfortunately, the background of these competency descriptions is based on the premise that health care is provided within a managed (or controlled) care environment. Recently, it has become evident that the part of the reason why the implementation of the reformed Dutch postgraduate medical curricula of pediatrics and obstetrics and gynecology experienced some hindrance is related to (the complexity of) several unpredictable factors within the clinical learning environment. The hospital setting where clinical learning takes place is systematically subjected to continual change and situations that are difficult to predict and/or control.
Besides the basic clinical knowledge and (problem-solving) skills that residents have to acquire during their training, the reformed postgraduate curricula for medical specialists spans other areas of medicine that are considered to be essential for their professional development. Some of these areas include health care systems, organization, population health, patient-physician communication, ethics, quality assurance and improvement and practice management. In a recent synthesis by Halpern et al., 10 medical domains regarded as important for the practice of medicine were identified, and were classified under the term “care management”. This concept of care management provides an operational description of how physicians’ managerial skills are translated into clinical responsibilities and at the same time, how they relate to the six other professional responsibilities. Hence, care management as described here imbibes the elements of the CANMEDS competency “manager” as represented in the curriculum of the Dutch postgraduate medical training. In the current postgraduate medical training, the implementation and further development of the competency as manager has not received a lot of attention as compared to the attention devoted to the competencies “medical expert” and “professional”. This is remarkable bearing in mind that good managerial skills are equally important as are the other competencies for good clinical practice.

PHASE 1:

1. Identify the extent to which care management (as a competency) is implemented in the curriculum of postgraduate medical education in the Netherlands;

2. Evaluate stakeholders’ perceptions of the concept of care management (in medical education);

3. Identify the perceived needs in developing and or improving care management as a competency.

PHASE 2:

1. Based on the findings in phase 1 study, develop an educational intervention to promote and improve the implementation of care management in the curriculum of postgraduate medical education;

2. Evaluate the impact of the designed intervention through:

A. Trainees’ perceived satisfaction of the intervention;

B. Observable changes in trainees behaviors and attitudes.

1. End of Phase 1 study: 28-05-2010;

2. Start Phase 2: 2010.

Phase 1:

1. Literature review;

2. Questionnaire survey;

3. Interviews.



Phase 2:

1. Workshop on care management;

2. Self evaluation;

3. Evaluation attitude or behaviour change.