Editors’ note: During 2006 we will publish coverage of hospital practices in other countries. This is the second article in that effort. Our first article, on the state of hospital medicine in Afghanistan, was published in the Jan. issue on p. 1.
Explore this issue:March 2006
For the first time in the Netherlands, the Free University of Amsterdam has appointed three professors in two non-university hospitals with a specific assignment for teaching. Until now, professors in such hospitals were appointed only for a specific research task that they perform in—or in close collaboration with—the university. In this article we describe the reasons and expectations for these appointments.
Medical Training in the Netherlands
Both undergraduate and postgraduate training in the Netherlands takes place in eight university medical centers. Although preclinical teaching is mainly a university domain, around two-thirds of the clinical training for interns and residents takes place in “affiliated” non-university teaching hospitals.
Until recently, medical education consisted of four years of preclinical studies and two years of clinical training. Now students are gradually admitted into the clinic during their first or second year of medical education. Further, the Dutch government has ruled that the number of first-year medical students must increase by 40. Both measures will result in a significant increase in the number of interns in the coming years.
Because university hospitals presently accommodate the maximum number of interns they can take, the participation of non-university hospitals will rise considerably. However, their role must take into consideration not only quantity, but also quality. Because more than 90% of care in the Netherlands is delivered in non-university hospitals, these institutions provide the most proper setting for contextual learning. Adequate training is a prime barrier against accidents, so more resources must be invested in the quality of training programs in non-university hospitals to ensure the quality of future health care in the Netherlands.1,2 (See “Barriers Against Accidents,” p. 41.)
Teaching in Non-University Hospitals
By definition, medical education should be a core objective for teaching hospitals. (See “Requirements for Teaching Hospitals,” at right) This requires wide involvement by hospitals. Doctors in university hospitals generally have a contractual obligation to participate in teaching as part of their appointment. For most doctors in non-university hospitals, teaching is not part of their contract. Yet many of them do so on a voluntary basis. The advantage is that they are intrinsically motivated; however, the consequence is that they are not professional teachers, but rather well-meaning amateurs. This problem was recently addressed by the Central College for Medical Specialists, the ruling committee for specialist training in the Netherlands. Program directors and other specialists involved in teaching now take special courses to develop their teaching abilities.