A preliminary study on the quality of the intensive care medicine training programmes in the Netherlands

Background: Setting up a quality assurance system for postgraduate medical training includes monitoring the training environment and the functioning of the clinical supervisors. This study assesses the quality of the postgraduate training programmes in intensive care medicine in Dutch teaching hospitals. Methods: Two validated questionnaires, the Dutch Residents' Educational Climate Test (D-RECT) and Maastricht Clinical Teaching Questionnaire (MCTQ+) were used, which assess the training environment and the quality of the clinical supervisors, respectively. All 82 intensivists-in-training were asked to complete the questionnaires. Results: The response rate was 45% for the D-RECT and 38% for the MCTQ+. The average scores over all the items in both the D-RECT and the MCTQ+ questionnaires were in the range of 4 (on a fivepoint scale) for almost all centres. The grade (on a ten-point scale) for the functioning of the clinical supervisors in the MCTQ+ was above a 71⁄2. A significant correlation between the average scores on both instruments was found. Respondents mentioned many strengths of the training programmes in the D-RECT and MCTQ+. Suggestions for improvement were also provided and focused on seven and three aspects of the training programme, respectively. Conclusions: The postgraduate intensive care medicine training programmes in the Netherlands are of good quality, with a limited number of specific points of attention per centre. A number of suggestions for further improvement of the training programme in general were provided, most of which suggest a leading role for each local training centre. Introduction Competency-based training necessitates a training framework which includes a detailed description of tasks, learning objectives and responsibilities for both trainees and clinical educators. [1] In the Netherlands, the competency domains, initially identified by the European Society of Intensive Care Medicine, have been applied to the Dutch intensive care training programme in the document ‘The Intensive Care Medicine training programme’. [2] Internal and external quality assurance practices are crucial in maintaining high-quality training programmes, such as the Dutch Intensive Care training programme. [3,4] Good quality assurance is characterised by structural and systematic data collection on all relevant aspects of the educational programme at timely intervals, followed by enough time to implement improvements suggested by the quality assurance data. The evaluation activities should be integrated within the daily practices of an educational programme involving all stakeholders. [5] Recently, these systematic, structural and integrated aspects of quality assurance were translated to the postgraduate training programmes in the Netherlands, for which a working group (Scherpbier 2.0 report) described quality assurance practices and strategies. [6] Such a quality assurance system, in which the external quality assurance measures are supportive of the internal quality assurance frameworks, will soon become mandatory for all postgraduate training programmes. The Scherpbier 2.0 report, finalised in December 2015, indicated that quality assurance frameworks should focus on the areas Organisation and Development; Learning, Teaching and Working Climate; Faculty Development and Competency Development, as derived from the current literature. One of the quality indicators is the teaching and learning climate,[6] which can be defined as the atmosphere, tone Netherlands Journal of Critical Care NETH J CRIT CARE VOLUME 24 NO 7 NOVEMBER 2016 11 A preliminary study on the quality of the intensive care medicine training programmes in the Netherlands and culture or personality of an institution or department. [7] The teaching and learning, or educational climate is a major determinant of the effectiveness of a training programme regarding development of the required competencies. [8] The Dutch General Medical Council (‘College voor Geneeskundige Specialismen’, GCS) refers to a favourable educational climate when ‘the prerequisites are met for creating and maintaining an educational training programme with an optimal yield for the individual physician trainee’. [9] Interaction with staff members contributes to the educational climate. The staff members formally responsible for the programme play a pivotal role herein, and their personal contact with the trainees is especially valued. Apart from this personal interaction, the role of formal supervisors has gained interest over the last decades. [10] Likewise, evaluation of the supervisors is increasingly emphasised. [11] Even more recent, enhanced clinical supervision of trainees has been associated with improved patientand education-related outcomes. [12,13] However, measuring the quality of the educational climate on one hand, and the role of the supervisors on the other hand, was not common practice in all Dutch Intensive Care Medicine training programmes at the time of this study.