Comparison of expectations and beliefs about good teaching in an academic day release medical education program: a qualitative study.

Background: In a professional learner-centered(ness) educational environment, communication and alignment of expectations about teaching are indispensable. Professional education of residents could benefit from an analysis and comparison of teachers' and residents' educational expectations and beliefs. Our purpose is to identify success factors and barriers related to aligning expectations and beliefs and building a supportive professional learner-centered educational environment.

Factors influencing trainers' feedback-giving behavior: a cross-sectional survey.

Background: The literature provides some insight into the role of feedback givers, but little information about within-trainer factors influencing 'feedback-giving behaviours'. We looked for relationships between characteristics of feedback givers (self-efficacy, task perception, neuroticism, extraversion, agreeableness and conscientiousness) and elements of observation and feedback (frequency, quality of content and consequential impact).

Methods: We developed and tested several hypotheses regarding the characteristics and elements in a cross-sectional digital survey among GP trainers and their trainees in 2011 and 2012.

Qualitative study about the ways teachers react to feedback from resident evaluations.

Background: Currently, one of the main interventions that are widely expected to contribute to teachers' professional development is confronting teachers with feedback from resident evaluations of their teaching performance. Receiving feedback, however, is a double edged sword. Teachers see themselves confronted with information about themselves and are, at the same time, expected to be role models in the way they respond to feedback.

Quality of written narrative feedback and reflection in a modified mini-clinical evaluation exercise: an observational study.

Background: Research has shown that narrative feedback, (self) reflections and a plan to undertake and evaluate improvements are key factors for effective feedback on clinical performance. We investigated the quantity of narrative comments comprising feedback (by trainers), self-reflections (by trainees) and action plans (by trainer and trainee) entered on a mini-CEX form that was modified for use in general practice training and to encourage trainers and trainees to provide narrative comments. In view of the importance of specificity as an indicator of feedback quality, we additionally examined the specificity of the comments.

Measuring continuity of care: psychometric properties of the Nijmegen Continuity Questionnaire.

Background: Recently, the Nijmegen Continuity Questionnaire (NCQ) was developed. It aims to measure continuity of care from the patient perspective across primary and secondary care settings. Initial pilot testing proved promising.

The process of feedback in workplace-based assessment: organisation, delivery, continuity.

Objectives: Feedback in workplace-based clinical settings often relies on expert trainers' judgements of directly observed trainee performance. There is ample literature on effective feedback, but in practice trainees in workplace-based training are not regularly observed. We aimed to examine external conditions that impact feedback in observational workplace-based assessment (WBA).

Nurse telephone triage in Dutch out-of-hours primary care: the relation between history taking and urgency estimation.

Objective: In the Netherlands, a patient's first contact with a general practitioner cooperative, an out-of-hours primary-care center, is usually with a triage nurse. Previous research has shown that nurses sometimes underestimate the level of urgency, which may be caused by incomplete history taking. The aim of this study was to examine the relation between comprehensiveness of history taking and appropriateness of urgency estimation.

Nijmegen Continuity Questionnaire: development and testing of a questionnaire that measures continuity of care.

Objective: To develop and pilot test a generic questionnaire to measure continuity of care from the patient's perspective across primary and secondary care settings.

Study Design And Setting: We developed the Nijmegen Continuity Questionnaire (NCQ) based on a systematic literature review and analysis of 30 patient interviews. The questionnaire consisted of 16 items about the patient-provider relationship to be answered for five different care providers and 14 items each on the collaboration between four groups of care providers.

Quality of after-hours primary care in The Netherlands: adherence to national guidelines.

Objective: To assess the quality of after-hours clinical care as delivered by general practitioner (GP) cooperatives in The Netherlands.

Methods: A cross-sectional analysis was undertaken of patient health records of five GP cooperatives during 1 year. We used quality indicators derived from national guidelines for the appropriate prescription of pain medication and antibiotics, clinical performance in emergency cases and referral to medical specialists.

Rude or aggressive patient behaviour during out-of-hours GP care: challenges in communication with patients.

Objective: GPs in out-of-hours care report that they feel at risk of rude or aggressive patient behaviour. We tried to get information about the incidence, types and patient characteristics of rude or aggressive behaviour.

Methods: Retrospective, observational study involving the analysis of medical records of all patients who contacted a Dutch GP cooperative between June 2001 and June 2002.

Routine oral examinations in primary care: which predictors determine what is done? A prospective clinical case recording study.

Objectives: Elements of a routine oral examination (ROE) in dental practice may be determined by patients' oral status, as recommended by prevailing knowledge, as well as by other factors. Our aim was to identify patient and GDP characteristics associated with aspects of oral health assessment (OHA) and clinical management (CM) in patients with various oral conditions.

Methods: A prospective observational study was performed, based on clinical case recording of 1059 ROEs by 128 GDPs.

Routine oral examination: clinical performance and management by general dental practitioners in primary care.

The aim of this clinical study was to explore the contents of routine oral examinations (ROE), carried out by Dutch general dental practitioners (GDPs), in relation to the oral health status of regularly attending patients. An observational study was performed, based on clinical case recording. Using The Data Station Project of the Dutch Dental Association as the study base, 215 GDPs were recruited, of whom 131 participated in the study.

Safety of telephone triage in general practitioner cooperatives: do triage nurses correctly estimate urgency?

Background: In recent years, there has been a growth in the use of triage nurses to decrease general practitioner (GP) workloads and increase the efficiency of telephone triage. The actual safety of decisions made by triage nurses has not yet been assessed.

Objectives: To investigate whether triage nurses accurately estimate the urgency level of health complaints when using the national telephone guidelines, and to examine the relationship between the performance of triage nurses and their education and training.

Hypertension patients participating in trials differ in many aspects from patients treated in general practices.

Objective: To determine to what extent participants in randomized controlled hypertension trials (RCTs) could be compared to patients with hypertension in general practices.

Study Design And Setting: We analyzed RCTs that had been used in hypertension guidelines or were available for future hypertension guidelines. The characteristics of the participants of these RCTs were compared with those of the patients with hypertension in general practices.

General practice cooperatives: long waiting times for home visits due to long distances?

Background: The introduction of large-scale out-of-hours GP cooperatives has led to questions about increased distances between the GP cooperatives and the homes of patients and the increasing waiting times for home visits in urgent cases. We studied the relationship between the patient's waiting time for a home visit and the distance to the GP cooperative. Further, we investigated if other factors (traffic intensity, home visit intensity, time of day, and degree of urgency) influenced waiting times.

The effects of a team-based continuous quality improvement intervention on the management of primary care: a randomised controlled trial.

Aim: To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management.

Design Of Study: Randomised controlled trial.

Setting: Twenty-six intervention and 23 control primary care practices in the Netherlands.

Patients evaluate accessibility and nurse telephone consultations in out-of-hours GP care: determinants of a negative evaluation.

Objective: The shift towards large-scale organization of out-of-hours primary healthcare in different western countries has created an important role for the nurse telephone consultation. We explored the association between negative patient evaluation of nurse telephone consultations and characteristics of patients and GP cooperatives.

Methods: A cross-sectional study using postal patient questionnaires sent to patients receiving a nurse telephone consultation from one of 26 GP cooperatives in the Netherlands.

Patient satisfaction with large-scale out-of-hours primary health care in The Netherlands: development of a postal questionnaire.

Background: Since the turn of the millennium, out-of-hours primary health care in The Netherlands has faced a substantial change from small locum groups towards large GP cooperatives. Improving the quality of care requires evaluation of patient satisfaction.

Objective: To develop a reliable postal questionnaire for wide-scale use by patients contacting their out-of-hours GP cooperative and to present the results of a national survey.

Which data source in clinical performance assessment? A pilot study comparing self-recording with patient records and observation.

Objective: A pilot study aimed to determine the extent to which each of three data sources could provide complete and reliable data for valid assessment of clinical performance.

Design: Clinical decisions taken in 168 consultations by seven family physicians were reviewed against guidelines for 15 clinical conditions. In total, 206 criteria were reviewed using three sources: medical records, observation in surgery, and structured self-recording by the physicians.

Communication at the interface: do better referral letters produce better consultant replies?

A study of the quality of 637 referral letters from general practitioners (GPs) and corresponding reply letters from medical specialists showed that both types of letters can be improved, and that specific requests by GPs were addressed explicitly by the specialists in only a limited number of cases. Better referral letters resulted only partly in better reply letters. A letter is considered to be of higher quality when a specialist commences a letter with a reference to the specific request by the GP.

The effect of small peer group continuous quality improvement on the clinical practice of midwives in The Netherlands.

Objective: To study the effects of small group continuous quality improvement (CQI) on the clinical practice of midwives in the Netherlands.

Design: Randomised pre-/post-test (balanced block).

Intervention: The CQI groups were assigned to either the set of peer review topics including 'perineal repair' and 'artificial rupture of the membranes (ARM)', or to the set of topics including 'airway aspiration' and 'measuring blood pressure'.

Characteristics of effective clinical guidelines for general practice.

Background: The use of clinical guidelines in general practice is often limited. Research on barriers to guideline adherence usually focuses on attitudinal factors. Factors linked to the guideline itself are much less studied.