Phenomenon: Rising healthcare expenditures threaten the accessibility and affordability of healthcare systems. Research has demonstrated that teaching (junior) physicians to deliver high-value,... Show morePhenomenon: Rising healthcare expenditures threaten the accessibility and affordability of healthcare systems. Research has demonstrated that teaching (junior) physicians to deliver high-value, cost-conscious care can be effective when learning is situated in a supportive environment. This study aims to offer insight into how residents learn to provide high-value, cost-conscious care in the workplace and how the postgraduate training environment influences this learning. Approach: Six homogeneous focus groups were held between August 2015 and July 2016 with 36 residents from six residency programs (dermatology, n=5; elderly care, n=8; family medicine, n=5; internal medicine, n=6; orthopedic surgery, n=6; surgery, n=6). An iterative grounded theory approach was used to analyze the qualitative data. Findings: Influential factors in learning of high-value, cost-conscious care delivery operated on three levels: individual resident, training program, and the workplace. On the individual level, we discerned three types of beliefs regarding HV3C. At the training program level, perceived determinants of learning included resident-supervisor interactions, involvement in decision-making over time, and exposure to variation in care delivery. At the workplace level, learning depended on the availability of professional healthcare expertise and the presence of institutional policy. Insights: Residents struggle to seize high-value, cost-conscious care learning opportunities in the workplace setting. Both residency training programs and workplaces can contribute to creating these learning opportunities. An important starting point is being aware of the different personal beliefs of residents and the approaches to high-value, cost-conscious care on the level of the training program and workplace. Show less
Phenomenon: Rising healthcare expenditures threaten the accessibility and affordability of healthcare systems. Research has demonstrated that teaching (junior) physicians to deliver high-value,... Show morePhenomenon: Rising healthcare expenditures threaten the accessibility and affordability of healthcare systems. Research has demonstrated that teaching (junior) physicians to deliver high-value, cost-conscious care can be effective when learning is situated in a supportive environment. This study aims to offer insight into how residents learn to provide high-value, cost-conscious care in the workplace and how the postgraduate training environment influ- ences this learning. Approach: Six homogeneous focus groups were held between August 2015 and July 2016 with 36 residents from six residency programs (dermatology, n 1⁄4 5; eld- erly care, n1⁄48; family medicine, n1⁄45; internal medicine, n1⁄46; orthopedic surgery, n1⁄46; surgery, n 1⁄4 6). An iterative grounded theory approach was used to analyze the qualitative data. Findings: Influential factors in learning of high-value, cost-conscious care delivery oper- ated on three levels: individual resident, training program, and the workplace. On the indi- vidual level, we discerned three types of beliefs regarding HV3C. At the training program level, perceived determinants of learning included resident–supervisor interactions, involve- ment in decision-making over time, and exposure to variation in care delivery. At the work- place level, learning depended on the availability of professional healthcare expertise and the presence of institutional policy. Insights: Residents struggle to seize high-value, cost-con- scious care learning opportunities in the workplace setting. Both residency training pro- grams and workplaces can contribute to creating these learning opportunities. An important starting point is being aware of the different personal beliefs of residents and the approaches to high-value, cost-conscious care on the level of the training program and workplace. Show less
Bustraan, J.; Dijkhuizen, K.; Velthuis, S.; Post, R. van der; Driessen, E.; Lith, J.M.M. van; Beaufort, A.J. de 2019
Objective To gain insight into factors involved in attrition) from) hospital-based medical specialty training and future career plans of trainees who prematurely left their specialty training... Show moreObjective To gain insight into factors involved in attrition) from) hospital-based medical specialty training and future career plans of trainees who prematurely left their specialty training programme.Design Nationwide online survey study.Setting Postgraduate education of all hospital-based specialties in the Netherlands.Participants 174 trainees who prematurely left hospital-based medical specialty training between January 2014 and September 2017.Main outcome measures Factors involved in trainees' decisions to leave specialty training and their subsequent career plans.Results The response rate was 38 /0. Of the responders, 25% left their programme in the first training year, 50% in year 2-3 and 25% in year 4-6. The most frequently reported factors involved in attrition were: work-life balance, job content, workload and specialty culture. Of the leaving trainees, 66% switched to another specialty training programme, of whom two-thirds chose a non-hospital -based training programme. Twelve per cent continued their career in a non-clinical role and the remainder had no specific plans yet.Conclusions This study provides insight in factors involved in attrition and in future career paths. Based on our findings, possible interventions to reduce attrition are: (1) enable candidates to develop a realistic view on job characteristics and demands, prior to application; (2) provide individual guidance during specialty training, with emphasis on work-life balance and fit with specialty. Show less
Driessen, E.; Abbass, A.A.; Barber, J.P.; Gibbons, M.B.C.; Dekker, J.J.M.; Fokkema, M.; ... ; Cuijpers, P. 2018
