MED-NET Conference 1997. Rotterdam, the Netherlands.
Proceedings 4.4.

Professionalisation of medical teachers: recent developments in The Netherlands

C. Fluit, J. Metz (Nijmegen, The Netherlands),
A. Scherpbier (Maastricht, The Netherlands)

Abstract

The quality of higher education is an increasingly important issue, not only in The Netherlands but also in other countries in and outside Europe. Quality improvement can be realised, among other things, by stimulating the professionalisation of medical teachers by training and education.

A feasibility study, carried out in 1993 in The Netherlands, indicated that medical teachers would really value compulsory teacher training courses. An inventory of existing courses at medical schools revealed that most of these courses appeared to focus only on didactic skills. A desire was expressed for advanced training facilities with a view to creating academic careers in medical schools.

To achieve a balanced provision of courses of high quality a national organisation called ODOS was founded in close co-operation between the deans of the eight medical schools and the Dutch Association of Medical Education and Courses, called 'Specialisation in Medical Education'. These are developed and executed by ODOS. The specialisation consists of a variety of courses including curriculum design, teaching methods, assessment of clinical competence and research in medical education. In 1995 the first two courses were conducted: an introductory course to medical education and a course on assessment of clinical competence. The first results of this joint effort are encouraging.

Introduction

During the last years the quality of medical education is an increasingly important issue in The Netherlands. One of the ways to improve this quality is to stimulate the professionalisation of medical teachers. This contains a spectrum of activities concerning at one end the individual teacher and at the other the organisation in which teachers are working.

In this article recent developments in The Netherlands in the field of professionalisation of medical teachers are described, especially the training of teachers.

The content of this article was also presented at the first MED-NET conference held in May 1997. This was a starting point for the exchange of information and the discussion about the professionalisation of medical teachers in Europe.

Professionalisation of medical teachers

Professionalisation can be described as the (further) improvement of skills, knowledge and attitudes of teachers, that are important to effectively fulfil their tasks (1). To realise this a spectrum of activities can be undertaken concerning in broad outline, the training and education of medical teachers, the development of career tracks and incentives for medical teachers and the development of a stimulating organisational environment.

This article focuses mainly on the educational training of medical doctors and the developments that took place in The Netherlands during the last years, after discussing briefly the last two aspects.

Development of career tracks and incentives
In the past, and even at this moment, excellence in teaching has been less valued and recognised as compared with other criteria for promotion e.g. research activities and publications. This lack of incentives and rewards for people who spend time and energy on educational tasks is widely perceived to be a major barrier to change in medical education and improving the quality of teaching (2).

Furthermore, it is becoming apparent that it is increasingly difficult for each individual to contribute equally to the areas of education, patient care and research. The development of well defined career tracks can facilitate the alignment of talents, training, and effort with career goals (3) .

At several universities in The Netherlands career tracks in the field of medical education have already been developed or are being developed at this moment, including the formulation of promotion criteria. This makes it possible for academic staff to be promoted on the basis of major achievements in education and that people can choose for a career within the field of medical education (4) .

Development of a stimulating organisational environment
Material rewards alone will not in themselves improve the quality of teaching. There should be a stimulating environment in which the academic staff can perform to their maximum ability. This includes a range of activities like feedback from peers and learners, informing teachers about medical education (e.g. evaluation data and reports from the own organisation, journals, books, reports), creating opportunities to participate in meetings, congresses, conferences and workshops about medical education, the training of teachers etc. All these activities can contribute to a positive organisational climate that can generate an intrinsic motivation and a belief that the organisation cares for the teacher's welfare.

Training and teachers
Teachers in medicine are specialists in their own discipline, but, in general, they have had no training in the many aspects of teaching. There is now a growing awareness that teaching is also a speciality that can and has to be learned (6-7). There are several reasons why this teacher training is necessary.

There is a growing insight in the way learning processes take place. Nowadays learning is being conceived as an active and constructive process. In traditional education the major activity of the teacher was the transfer of knowledge. The teacher decided what had to be learned, in what sequence and so on. This is called a teacher-centered approach. In the future education to a greater extent relies on the students responsibility. In this student-centered approach the teacher will have an important task in guiding the student. A lot of teachers are not familiar with this new role and therefore training is important.

Based on the new educational insights the medical curricula have been changed or will be changed in the future. More and more medical teachers will be involved in this process of innovation of medical education. This stresses also the need for teacher training.

Finally, medical teachers are more and more involved in the management and co-ordination of medical  education, but most of the doctors are not trained for these tasks.

Almost all doctors are teachers to some extent. Changes in the sort of education required by students and the educational tasks mean that a more professional attitude to teaching must be developed. We can no longer assume that because someone can do the job they can teach the skill. We must train staff to teach as effectively as possible and should encourage them to see this as an important part of their job. We must also encourage a few enthusiasts to specialise  further, taking responsibility for co-ordinating teaching tasks, on a par with other tasks (8).

Developments in The Netherlands in the field of medical teacher training

In 1991, Dutch medical schools took the initiative for a joint project aiming at a definition of the common objectives of the undergraduate medical curriculum, resulting in the 'Blueprint 1994'(9). This report has been formally accepted by all Dutch medical schools as a leading document for their curriculum development. One chapter of this 'Blueprint' is devoted to the need of educational training of medical teachers. In 1993, the Visiting Committee of the External Programme Review (which is part of the system of quality assurance of Dutch Higher Education)  published its report on Medicine and Health Sciences, and emphasised the importance of teacher training.

Separately financed by the Ministry of Education and Science a study was done within the project first mentioned, into the feasibility of postgraduate training in medical education. This study was done by an already  existing national Working Group on Professionalisation of Medical Teachers. This study included a review of   the literature on teacher training, the drawing up of an inventory of existing teacher training programmes and an invitational conference. Some 150 teachers and officials from all Dutch medical schools were invited. A questionnaire asking for opinions on teacher training was sent to 88 persons who had given a positive response to the earlier mentioned invitation, with a 67% response.

The inventory of existing teacher training courses resulted in a survey of 63 different courses. All were organised at the faculty or university level. The most important information on these courses is available in a database and in print. From the analysis of the existing courses it appeared that about 80% of the courses at the faculty level focused on practical teaching tasks, such as lecturing or tutoring small groups of students. There were virtually no courses going beyond these teaching tasks and focusing for instance on curriculum development, educational innovation, quality control or educational management. This is not surprising as it is unlikely that such courses at a single medical school should attract a sufficient number of teachers to make them viable.

However, more than 60% of the respondents in the mentioned questionnaire indicated that they needed training in education, and that attention should be paid to teaching and learning processes, educational innovation, curriculum theory and quality control. They indicated that such courses should be offered at a national level. The advantages of a national course are, besides the numerical criterion, the possibility of bringing together the existing expertise from different schools.

Specialisation in Medical Education

Based on the results of the feasibility study mentioned above the Working Group on Professionalisation proposed to develop a flexible course consisting of several modules. Teachers are not obliged to follow all these modules, but can subscribe to those modules they are interested in. Together these modules are called 'Specialisation in Medical Education' (Dutch abbreviation: SMO) to emphasise the advance of expertise in medical education. An organisation called ODOS, a Dutch abbreviation for 'Didactic and Educational Training of Medical Teachers', was established for the organisation of these modules. The board of ODOS is composed of two deans from medical schools and two members of the Board of the Dutch Association for Medical Education. The already mentioned Working Group on Professionalisation is closely involved as an executive of these modules. ODOS is financially supported by all Dutch medical schools.

SMO started as a flexible course with optional modules. In the future it is pursued to give the training a more mandatory character, including certification through medical and educational institutions, with implications for academic promotion. At the moment this is already partially realised in the way that general practitioners who participate in these courses get their credit points.

The SMO modules are focusing on subjects like Assessment of Clinical Competence, Evaluation and Quality Assessment, Curriculum Theory and Practice, Educational Methods, Practical Clinical Education and Systematic Skills Training, Clinical Reasoning, Research of Medical Education, Teaching Skills and Educational Management. Within two years 12 modules will be available.

Each module is co-ordinated by an experienced clinical teacher and an educationalist. Supported by the director of ODOS and the Working Group on Professionalisation, these co-ordinators develop course objectives, select learning materials and leading articles, choose educational methods and invite guest speakers. The co-ordinators take care that there is enough time in the programme for discussions and exchange of ideas and experiences. Although there is a detailed plan for every module, the leading teachers will endeavour to provide tailor-made learning experiences for the individual participants. The mean duration of each module is two days. Incidentally modules of three days have been organised. In order to emphasise the national character, the courses take place at a central location in the country, for instance at an easily accessible conference centre. The first modules were conducted in 1995.

The introductory module of ODOS, called "Main lines of Medical Education", has been conducted now five times. In this module, participants are introduced to the most important developments in the field of medical education. Four other modules have been offered until now: one on Assessing Clinical Competence, one on Evaluation and Quality Assessment, one on Research of Medical Education and one on Curriculum Design. Figure 1 shows an outline of the module on Assessing Clinical Competence.

The participants of the SMO modules are mostly senior teachers, enrolled from nearly all medical schools in The Netherlands and some schools in Belgium, with a reasonable spread across the disciplines.

Conclusion

It has been emphasised for several years that more attention should be paid to the quality of teaching as an important condition for improving medical education. Teachers therefore need to be trained for their educational tasks. Incentives and rewards for people should be created for those who spend time and energy  on educational activities. Several medical schools are already paying attention to the training and promotion of teachers. By the establishment of ODOS the facility is offered for national courses with the co-operation of all medical schools. The possibility of linking the SMO modules to academic career planning will be considered seriously.

For the further development of the professionalisation of medical teachers it is important to work together at a national and an international level and to exchange all kind of information about training and education of medical teachers, career tracks, incentives, qualification criteria, organisations that work on the professionalisation etc. For this purpose MED-NET offers a good opportunity to exchange information and to be a forum for discussion about this topic.

References

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Figure 1. Survey of SMO-module "Assessment of Clinical Competence"

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