Taks Nadieh J L M, van Rossum Tiuri R, Warris Lidewij T, Reurslag Ellen C, Sadrzadeh Sheda
Research Group 'Research & Innovation in Public Health Practice Based Learning' (RIPPLE), Netherlands School of Public and Occupational Health, 10th Floor, Churchilllaan 11, Utrecht, GV, 3527, The Netherlands.
School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
BMC Med Educ. 2024 Dec 18;24(1):1434. doi: 10.1186/s12909-024-06431-w.
Postgraduate medical education (PGME) relies on structured training rotations and workplace-based learning (WBL) to provide comprehensive clinical training and professional development. Emphasizing WBL, PGME integrates theoretical knowledge with practical skills through direct patient care involvement, underscoring the pivotal role of training institutes in supporting these initiatives. While curricular changes in PGME have been extensively studied in clinical teaching hospitals, PGME programs in public health (PGME-PH) remain underexplored, yet their multidisciplinary nature post-COVID-19 underscores the urgency for effective curricular reforms. This study explores how training institutions offering PGME-PH navigate the adoption of structured training rotations and a transition to a national employer by examining organizational perspectives to enhance sustainability and integration of educational innovations in this unique context.
Semistructured interviews were conducted with 14 participants from 8 training institutions offering PGME-PH in the Netherlands between October and November 2022 to explore their experiences with the implementation of a rotational training structure. The interviews were guided by the Consolidated Framework for Implementation Research (CFIR).
The analysis identified three pivotal themes influencing sustainable implementation and ownership: influence, communication, and motivation. Participants expressed concerns about reduced influence in organizing PGME-PH and noted significant communication challenges, such as ambiguity in roles, program frameworks, and financial aspects. Despite these obstacles, participants showed strong motivation for education and underscored the importance of collaboration and shared responsibility.
The successful implementation of structured training rotations was negatively impacted by training institutions' experience of limited influence and communication challenges. This led to diminished ownership of the new PGME-PH curriculum, potentially affecting its long-term sustainability. Despite these challenges, participants maintain high motivation for educational delivery. Enhancing sustainable implementation requires fostering ownership, promoting collective responsibility, establishing clear communication channels, and nurturing motivation. These factors are crucial for ensuring the success and longevity of educational programs such as PGME-PH.
研究生医学教育（PGME）依赖于结构化培训轮转和基于工作场所的学习（WBL）来提供全面的临床培训和专业发展。PGME强调WBL，通过直接参与患者护理将理论知识与实践技能相结合，突出了培训机构在支持这些举措方面的关键作用。虽然PGME的课程改革在临床教学医院中已得到广泛研究，但公共卫生领域的PGME项目（PGME-PH）仍未得到充分探索，然而，COVID-19疫情后其多学科性质凸显了有效课程改革的紧迫性。本研究通过审视组织层面的观点，探讨提供PGME-PH的培训机构如何采用结构化培训轮转并向国家雇主过渡，以增强在这一独特背景下教育创新的可持续性和整合性。
2022年10月至11月期间，对荷兰8家提供PGME-PH的培训机构的14名参与者进行了半结构化访谈，以探讨他们在实施轮转培训结构方面的经验。访谈以实施研究综合框架（CFIR）为指导。
分析确定了影响可持续实施和自主性的三个关键主题：影响力、沟通和动机。参与者对组织PGME-PH时影响力降低表示担忧，并指出了重大的沟通挑战，如角色、项目框架和财务方面的模糊性。尽管存在这些障碍，参与者对教育表现出强烈的动机，并强调了合作和共同责任的重要性。
培训机构影响力有限的经历和沟通挑战对结构化培训轮转的成功实施产生了负面影响。这导致对新的PGME-PH课程的自主性降低，可能影响其长期可持续性。尽管存在这些挑战，参与者对教育交付仍保持高度积极性。加强可持续实施需要培养自主性、促进集体责任、建立明确的沟通渠道和激发动机。这些因素对于确保PGME-PH等教育项目的成功和长久至关重要。
