Walking the line between assessment, improvement and learning: a qualitative study on opportunities and risks of incorporating peer discussion of audit and feedback within quality improvement in general practice.

Objectives: There is a broad call for change towards 'new era' quality systems in healthcare, in which the focus lies on learning and improving. A promising way to establish this in general practice care is to combine audit and feedback with peer group discussion. However, it is not known what different stakeholders think of this type of quality improvement.

Ethnic minority GP trainees at risk for underperformance assessments: a quantitative cohort study.

Background: Recent studies suggest that ethnic minority students underperform in standardised assessments commonly used to evaluate their progress. This disparity seems to also hold for postgraduate medical students and GP trainees, and may affect the quality of primary health care, which requires an optimally diverse workforce.

Aims: To address the following: 1) to determine to what extent ethnic minority GP trainees are more at risk of being assessed as underperforming than their majority peers; 2) to investigate whether established underperformance appears in specific competence areas; and 3) to explore first- and second-generation ethnic minority trainees' deviations.

What are the characteristics of excellent physicians and residents in the clinical workplace? A systematic review.

Objectives: In order to recognise and facilitate the development of excellent medical doctors (physicians and residents), it is important to first identify the characteristics of excellence. Failure to recognising excellence causes loss of talent, loss of role models and it lowers work ethos. This causes less than excellent patient care and lack of commitment to improve the healthcare system.

Implementation of motivational interviewing in the general practice setting: a qualitative study.

Background: General Practitioners (GPs) and Practice Nurses (PNs) collaboratively play an important role in preventing and monitoring chronic diseases. They are trained in Motivational Interviewing (MI), which is a communication style to intrinsically motivate patients to a healthier lifestyle. However, being trained in MI skills does not necessarily mean that it is implemented in daily practice so patients actually benefit.

Complaint-driven preferences & trust: patient's views on consulting GP trainees.

Background: Work-based learning depends on patients' consent to have trainees involved in their care. However, patients can refuse trainees, which might lead to the loss of learning experiences. Improved understanding of patients' views on consulting trainees may provide useful insights to further optimise learning for trainees.

Feasibility, and validity aspects of Entrustable Professional Activity (EPA)-based assessment in general practice training.

Introduction: Entrustable Professional Activities (EPAs) are developed to support the practical application of competency frameworks in postgraduate medical education (PGME) programmes. EPAs are used for the assessment of the trainees' competence development, which takes place by means of an entrustment decision, aiming to stimulate learning and independent practice in trainees. In this pilot study, we explore the feasibility and validity of EPA-based assessment in a General Practice (GP) training programme.

Assessment of motivational interviewing with the VASE-(Mental) Healthcare: Mixed-methods study to examine feasibility and validity in the general practice setting.

Objective: The VASE-(M)HC is an instrument to evaluate Motivational Interviewing (MI) skills. We adjusted the previous version for use in the broader (mental) healthcare context, incorporated new MI insights, expanded the scoring system and created a parallel version. Feasibility and validity evidence in the general practice setting was explored.

Assessment of motivational interviewing: Psychometric characteristics of the MITS 2.1 in general practice.

Objective: Motivational Interviewing (MI) is increasingly used in healthcare. The Motivational Interviewing Target Scheme 2.1 (MITS) can be used to assess MI in short consultations.

Professionals' perspectives on factors affecting GP trainees' patient mix: results from an interview and focus group study among professionals working in Dutch general practice.

Introduction: Seeing and treating patients in daily practice forms the basis of general practitioner (GP) training. However, the types of patients seen by GP trainees do not always match trainees' educational needs. Knowledge about factors that shape the mix of patient types is limited, especially with regard to the role of the professionals who work in the GP practice.

What motivates general practitioners to change practice behaviour? A qualitative study of audit and feedback group sessions in Dutch general practice.

Objectives: Adopting an attributional perspective, the current article investigates how audit and feedback group sessions contribute to general practitioners' (GPs) motivation to change their practice behaviour to improve care. We focus on the contributions of the audit and feedback itself (content) and the group discussion (process).

Methods: Four focus groups, comprising a total of 39 participating Dutch GPs, discussed and compared audit and feedback of their practices.

Trainers' and trainees' expectations of entrustable professional activities (EPAs) in a primary care training programme.

Introducing Entrustable Professional Activities (EPAs) into primary care postgraduate medical education (PGME) programmes may be challenging, due to the general nature of primary care medicine, but trainers and trainees both stand to benefit from their use. We investigated the expectations of trainers and trainees in a primary care PGME programme regarding the use of EPAs. We held two focus group discussions with trainers and four with trainees from the Dutch General Practice training programme, to explore their views on the use of EPAs in their training programme.

Intervention Descriptions in Medical Education: What Can Be Improved? A Systematic Review and Checklist.

Purpose: Many medical education studies focus on the effectiveness of educational interventions. However, these studies often lack clear, thorough descriptions of interventions that would make the interventions replicable. This systematic review aimed to identify gaps and limitations in the descriptions of educational interventions, using a comprehensive checklist.

Assessment of motivational interviewing: a qualitative study of response process validity, content validity and feasibility of the motivational interviewing target scheme (MITS) in general practice.

Background: The Motivational Interviewing target Scheme (MITS) is an instrument to assess competency in Motivational Interviewing (MI) and can be used to assess MI in long and brief consultations. In this qualitative study we examined two sources of the Unified Model of Validity, the current standard of assessment validation, in the context of General Practice. We collected evidence concerning response process validity and content validity of the MITS in general practice.

The implementation of a quality system in the Dutch GP specialty training: barriers and facilitators; a qualitative study.

Background: Quality assurance programs in medical education are introduced to gain insight into the quality of such programs and to trigger improvements. Although of utmost importance, research on the implementation of such programs is scarce. The Dutch General Practice (GP) specialty training institutes used an implementation strategy to implement a quality system (QS), and we aimed to study the success of this strategy and to learn about additional facilitators and barriers.

The development of a collective quality system: challenges and lessons learned; a qualitative study.

Background: The ongoing professionalization of medical education means that quality systems (QSs) aimed at improving medical education also continuously have to improve. The aim of this paper is to describe the development of a collective QS for eight Dutch General Practitioner (GP) specialty training institutes to provide insights into the considerations that are involved in developing a QS in medical education.

Methods: Experts in the field of GP education and quality assurance developed the QS.

Using a retrospective pretest instead of a conventional pretest is replacing biases: a qualitative study of cognitive processes underlying responses to thentest items.

Background: The thentest design aims to detect and control for recalibration response shift. This design assumes (1) more consistency in the content of the cognitive processes underlying patients' quality of life (QoL) between posttest and thentest assessments than between posttest and pretest assessments; and (2) consistency in the time frame and description of functioning referenced at pretest and thentest. Our objective is to utilize cognitive interviewing to qualitatively examine both assumptions.

Differential growth in doctor-patient communications skills.

Context: Although doctor-patient communication is considered a core competency for medical doctors, the effect of training has not been unequivocally established. Moreover, knowledge about the variance in the growth of different skills and whether certain patterns in growth can be detected could help us to develop more efficient programmes. We therefore investigated the growth in general practitioner (GP) trainees' doctor-patient communication skills in their first year and whether the growth was different for distinct categories of skills.

A systematic review of the relationship between patient mix and learning in work-based clinical settings. A BEME systematic review: BEME Guide No. 24.

Background: Clinical workplace-based learning has been the means to becoming a medical professional for many years. The importance of an adequate patient mix, as defined by the number of patients and the types of medical problems, for an optimal learning process is based on educational theory and recognised by national and international accreditation standards. The relationship between patient mix and learning in work-based curricula as yet remains unclear.

Which barriers affect morbidity registration performance of GP trainees and trainers?

Background: Diagnosis coding percentages in the specialty training of general practitioners (GPs) are generally high, but not perfect, indicating barriers against coding still exist, possibly influencing the validity of data based on electronic patient records (EPRs).

Objective: To study the relationship between barriers to coding diagnoses with the International Classification of Primary Care (ICPC) of GP trainees and trainers and their self-reported and actual coding performance.

Methods: A questionnaire was developed, and returned by 71 (of 73, 97%) GP trainees and 103 (of 108, 95%) GP trainers, affiliated to the GP Specialty Training of the Academic Medical Center, University of Amsterdam.

Steering the patient mix of GP trainees: results of a randomized controlled intervention.

Background: In studies exploring the patient mixes of general practitioner (GP) trainees, gaps were repeatedly found, as there were disparities between the patient mixes of GP trainers and trainees. This reduces the opportunities of trainees to acquire enough competence.

Aims: To investigate whether steering the patient mix can be effectuated by instructing medical receptionist, trainer and trainee, and to study the effects of this intervention on trainee's self-efficacy (SE) and knowledge.

Two-dimensional structure of the MAAS-Global rating list for consultation skills of doctors.

Background: The MAAS-Global (MG) is widely used to assess doctor-patient communication skills. Reliability and validity have been investigated, but little is known about its dimensionality. Assuming physicians tend to adopt certain styles or preferences in their communication with patients, a multi-dimensional structure of the MG can be hypothesized.

SMART, SMARTER, SMARTEST: the influence of peer groups compared to practice visits on the quality of action plans.

Background: It has been reported that appraisal by peers can be effective.

Aim: To investigate whether feedback from a peer group (PG) compared to that by a staff member during a practice visit (PV) is as effective in improving the quality of action plans.

Methods: Seventy-three general practitioner (GP) trainers randomized into either a PG or PV were instructed to draw up action plans using the SMART criteria to realize the goals set in their personal development plans (PDPs).

Do GP trainers use feedback in drawing up their Personal Development Plans (PDPs)? Results from a quantitative study.

Background: General practice (GP) trainers play a key role GP trainees' education. To stimulate development of trainer competencies a Personal Development Plan (PDP) can be helpful, especially when feedback is incorporated.

Aims: To investigate to what extent GP trainers use feedback in PDPs.

The role of recalibration response shift in explaining bodily pain in cancer patients undergoing invasive surgery: an empirical investigation of the Sprangers and Schwartz model.

Objective: This study aims to explain bodily pain using the Sprangers and Schwartz theoretical model (1999) on quality of life (QL) and response shift in its entirety. Response shift refers to the phenomenon that the meaning of a person's self-evaluation changes over time. In this model, response shift mediates effects of changes in health status (catalysts), stable characteristics of the person (antecedents), and coping mechanisms (mechanisms) on QL.