Teaching Practice Organization in the vocational training of GPs in the Netherlands
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Teaching Practice Organizationin the vocational training of GPs in the Netherlands
April 2014
Fred Dijkers, MD, PhD
general practitioner
Afdeling Public health en Eerstelijnsgeneeskunde
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Leiden University Medical Center
LUMC Afdeling Public health en Eerstelijnsgeneeskunde
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Place of the Dutch GP in the healthcare system
Dutch GPs are gatekeepers in the Dutch healthcare
system. Every Dutchman is inscribed with his or her GP.
A fullltime GP has about 2200 patients inscribed.
Dutch GPs mostly work together in a practice. Some are
also owner of the practice, others work as employee (of
an organization or of another GP).
Dutch GPs offer a 24/7 service for their patients (during
out-of-office hours concentrated in special centres). Afdeling Public health en Eerstelijnsgeneeskunde
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The healthcare system is not a stable system these days.
Care given by the general practice is cheaper than care
given in the hospitals. If the quality of the care is equal,
then there will be a shift form hospital-care to GP-care.
There are more fields in the health care system where
comparible shifts can be made. Think of the domains
public health, mental health and work-related healthcare.
Often this means in GP-practice more (and a new type of)
personnel and a greater building. Choices must be made.Afdeling Public health en Eerstelijnsgeneeskunde
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Practice organization is essential for GPs
Known elements of practice organization are:
• Practice building
• Registration system
• Diagnostic equipment
• Equipment for treatment
• Personnel / staff
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Practice organization is essential for GPs
But practice organization is more, e.g.
• Cooperation with other care professionals
• Patient information
• Programs for patient safety
• Infection prevention
• Quality management
• Change management , time management
• Negotiations
• Finances
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Practice organization has two levels?
Thinking of the different aspect of practice organization
the field seems to have two levels:
• 1. Aspects, relevant for all GPs
• 2. Aspects, relevant for practice owners
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Vocational training of GPs
In the Netherlands the vocational training of GPs takes
about three years. The trainees have some special stages
(emergency care, work in a nursing home), but work most
of the time in two different GP practices under supervision
of an experienced GP.
During their training they come to one of the eight
university institutes one day a week for education.
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Vocational training of GPs
On that day the trainees get education and they have
discussions in groups of 12 together with two group
companions, a GP (mostly not a practice owner) and a
psychologist.
Practice organization is a part of the education, but the
knowledge is not given separately. That would have
resulted in an overflow of the teaching program. So
practice organization is mostly given, embedded in other
subjects.
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Is this way of teaching succesfull?
•No !!
During the process:
• The group companions hardly explain aspects of
practice organzation in the programms.
• They have no experience in this field and it is not their
core business.
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Is this way of teaching succesfull?
•No !!
During the process:
• The trainees learn theoretically relevant (new) aspects of
practice organization, but they often do not recognize
them in the training practice. So these aspects are
forgotten easily.
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Is this way of teaching succesfull?
•No !!
After the process:
• New trained GPs say they haven´t had enough practice
organization in their vocational training.
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Is this way of teaching succesfull?
•No !!
After the process:
• New trained GPs say they haven´t had enough practice
organization in their vocational training.
• We do not know whether this is a true or a false
statement: most new GPs function good. But obviously
they are uncertain about this subject.
Afdeling Public health en Eerstelijnsgeneeskunde
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•Change !
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Considerations (1)
• The GP, working as group companion, is mostly not a
practice owner, so he or she misses experience in some
fields of practice organization.
• Some investigations have been done to measure the
interest of trainees in practice organization. This interest
is concentrated in the last 6 monthes of their vocational
training (and in the two years after settlement).
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Considerations (2)
• The students that want to become a medical doctor are
mainly interested in curing patients. If their interest would
have been ´management´ then they probably had
chosen another study.
• Learning of management is easier from projects than just
from theory.
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Considerations (3)
• The university institutes are not very interested in
practice organization. They love publications.
• In the Netherlands a lot of work is done to make general
practice an evidence based profession with a lot of
international publications. Practice organization is often
experience based and strongly related to the healthcare
system in a country. That makes it less suitable for
international publications.
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A new start
• For the teaching of practice organization in the
vocational training of GPs we choose four spearheads:
• 1. All trainees do a project in the training practice
• 2. Extra attentention to those trainees who are interested
• 3. Help training practices optimizing their organization
• 4. Teach the group companions in the institute
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1. A project in the training practice
• All trainees start a project about infection prevention in
their first training practice. In the second one they do a
small project around quality improvement.
• These projects are not easy and they are often not
finished in time. But they give insight in this kind of work.
The accompaniment in the institute is not optimal yet.
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2. Extra attentention for interested trainees
• Interested trainees can make a differentiation in their
vocational training. They can choose for extra lessons in
practice organization during 6 days in the last year of
their training. This is organized in Leiden also for three
other university institutes.
• This differentiation is very popular under trainees. It is a
great succes.
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3. Improvement of the organization in training practices
• The teaching of practice organzation is focussed on the
settled GP in the training practice. The training practice
is the shop floor for the new GPs. She or he works most
of the time in that practice. We offer the settled GP in the
training practice a problem-oriented way of learning. In
this way the trainee can perceive the new developments
in practice organization and can become familiair with
them.
• This programm was also a great succes.But it is not
obligatory for all training practices yet.
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4. Teaching and instruction in the institute
• The teaching of practice organization is not only
focussed on trainees and on training practices, but also
on the group companions in the institute.
• This is the most difficult job. Because we have to
convince the group companions that this knowledge is
usefull and necessary. It takes a lot of energy.
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Instruments
• To reach our goals two instruments has been made
beside the known teaching programms:
• 1. A book
• 2. A course to get new teachers
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Text-book
The knowledge of practice organzation, relevant for GPs is
written down in an book, written by >40 authors. It contains the
most relevant elements of practice organization for GPs and is
made in cooperation with the NHG (the scientific organisation of
Dutch GPs). The text-book is available in printed form and as e-
book.
The e-book has deeplinks in the text to internet sites.
It also offers several multiple choice questions per chapter and
the correct answers (as a test for the right understanding).
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Text-book
practice organization in general practice
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Teachers
• In order to get enough teachers for all the education
programms a new course has been started some years
ago in Leiden. It is a postacademic course in Practice
Organization for settled GPs. This course takes about
one day a week during two years. Today we have some
45 graduates.
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Conclusion
• If you want to teach practice organization in the
vocational training of GPs then you can not just give
theory (lessons and workshops). Probably this
combination is a good idea:
• Give all trainees projects in this field and offer extra
education to the trainees who are interested.
• Offer problem-oriented education to settled GPs.
• Offer education about practice organization to the group
companions in the institute.
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Does it work?
We will see.
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The end
?•Do you have questions?
•Thanks for your attention.
Afdeling Public health en Eerstelijnsgeneeskunde