Advertisement

Summary

Graduate or postgraduate education is the period of formal specialization in a doctor’s life leading to issuance of a specialist diploma when successfully completed. From an educational point of view postgraduate education has often been perceived as a rather simple part of a doctor’s professional career and has attracted less research interest than undergraduate and continuing education. This is about to change as training objectives and curricula are being developed and working contracts are being improved, reduction of excessive working hours being one of the main goals.

Although the type of bodies responsible for postgraduate education and its organization differ from one country to another, service-based training and theoretical courses are core elements in most countries. The structure and process of the training have been much more focused during the last decade. Accreditation criteria have been developed and evaluation procedures of training sites have been systematized and improved. Increased emphasis has been placed on the learning environment (climate); and the processes of feedback, appraisal, supervision and mentoring are being studied and acknowledged as indispensable for quality training. Systematically used formative assessment has been slow to develop in most countries. A satisfactory final assessment (specialist examination) is a prerequisite for obtaining a specialist diploma in some countries, but not in others. The European Union represents the highest number of nations with mutual recognition of specialist diplomas, although the training varies considerably from one member state to another.

The competencies needed for successful training in the new millennium are being debated. The United States Accreditation Council for Graduate Medical Education (ACGME) has made the most radical move so far by endorsing general competencies in the areas of patient care; medical knowledge, interpersonal and communication skills; professionalism; practice-based learning and improvement; and system-based practice.

Numerous research questions need to be addressed in postgraduate education as health care undergoes significant reorganization and as the knowledge base for every specialty grows with unprecedented speed, while at the same time working hours decrease and the length ofspecialist training is already perceived as long. Postgraduate education needs more attention, being a crucial period ofa doctor’s continuous professionaldevelopment.

Keywords

Sleep Deprivation Junior Doctor Academic Medicine Postgraduate Training Postgraduate Education 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Akre, V., Ludvigsen, S. R. (1997). Hvordan lære medisinsk praksis? – En kvalitativ studie av legers oppfatning av egne læringsprosesser [How to learn medical practice? A qualitative study of physicians’ perceptions of their own learning processes].Tidsskr Nor Laegeforen 117, 2757–2761.Google Scholar
  2. Akre,V.,Ludvigsen, S. R. (1998). Profesjonslæring og kollektiv kunnskap. Leringsmilj0 i to norske sykehusavdelinger [Professional learning and collective knowledge. Learning environments in two Norwegian hospital departments].Tidsskr Nor Laegeforen 11848–52.Google Scholar
  3. Akre, V., Vikanes, A.,Hjortdahl, P. (1992). Profesjonalisering uten styring? En unders0kelse om det faglige innholdet i turnustjenesten [Professionalization without management? A study of the scientific content during internship].Tidsskr Nor Laegeforen 1122546–2551.Google Scholar
  4. Akre, V., Eikenaes, E., Ellingsen, L., Haffner, J., Hals, J. (2000). Learning environment in five clinical hospital departments. Unpublished evaluation of a new questionnaire.Google Scholar
  5. Alkhulaifr, A.(1995). New deal not satisfactory for cardiothoracic surgery.British Medical Journal 311953. Apter, A., Metzger, R.,Glassroth, J. (1988). Residents’ perceptions of their role as teachers.Journal of Medical Education 63900–905.Google Scholar
  6. Awoniyi, O., Awonuga, A. O., Dwarakanath, L. S., Khan, K. S., Taylor, R. (2000). Postgraduate obstetrics and gynaecology trainees’ views and understanding of evidence-based medicine.Medical Teacher22, 2729.Google Scholar
  7. Baldwin, P. J., Dodd, M.,Wrate, R. W. (1997). Young doctors’ health - I. How do working conditions affect attitudes, health and performance?Society of Scientific Medicine 4535–40.CrossRefGoogle Scholar
  8. Bazell, C.,Salsberg, E. (1998). The impact of graduate medical education financing policies on pediatric residency training.Pediatrics 101785–792.Google Scholar
  9. Borman, E., & O’Grady, P. (1997). Postgraduate training. Policy paper prepared by the Subcommittee on Postgraduate training: Permanent Working Group of European Junior Hospital Doctors.Medical Education31, 3–8.CrossRefGoogle Scholar
  10. Brinchmann-Hansen, A., Hoftvedt, B. O., Oien, I. J., & Skoglund, E. (1996). Gjensidig evaluering av utdanningsavdelinger ved sykehus [Mutual evaluation of teaching hospital departments. A way to improve the quality of specialist education].Tidsskr Nor Laegeforen 1162180–2182.Google Scholar
  11. Buckley, E. G. (1995). The European union and postgraduate medical education in Scotland.Health Bulletin (Edinburgh) 53189–191.Google Scholar
  12. Bunch, G. A., Bahrami, J., & Macdonald, R. (1998). SHO training in anaesthetics. How good is it?Anaesthesia 5386–88.CrossRefGoogle Scholar
  13. Bunch, W. H., Dvonch, V. M., Storr, C. L., Baldwin, D. C. J., & Hughes, P. H. (1992). The stresses of the surgical residency.Journal of Surgical Research53, 268–271.CrossRefGoogle Scholar
  14. Calman, K. C. (1995). Certification in postgraduate medical education.Medical Education, 29 Supplement1, 100–102.CrossRefGoogle Scholar
  15. Calman, K. C., & Donaldson, M. (1991). The pre-registration house officer year: A critical incident study.Medical Education25, 51–59.CrossRefGoogle Scholar
  16. Case, S., & Bowmer, I. (1994). Licensure and specialty board certification in North America: Background information and issues. hi D. Newble, B. Jolly, & R. Wakeford (Eds.)The certification and recertification of doctors. Issues in the assessment of clinical competence(pp. 19–27). Cambridge, UK: Cambridge University Press.Google Scholar
  17. Clunie, G. J. (1993). Postgraduate medical education - comparisons between the United Kingdom and Australia.Journal of the Royal College of Physicians of London27, 154–157.Google Scholar
  18. Coles, C. (1993). Education in practice: Teaching medical teachers to teach. In C. Coles & H. A. Holm (Eds.)Learning in medicine(pp. 45–65). Oslo: Scandinavian University Press.Google Scholar
  19. DeLisa, J. A., Jain, S. S., & Campagnolo, D. I. (1994). Factors used by physical medicine and rehabilitation residency training directors to select their residents.American Journal of Physical Medicine & Rehabilitation73, 152–156.CrossRefGoogle Scholar
  20. Denisco, R. A., Drummond, J. N., & Gravenstein, J. S. (1987). The effect of fatigue on the performance of a simulated anaesthetic monitoring task.Journal of Clinical Monitoring 322–24.CrossRefGoogle Scholar
  21. Ericsson, K. A., & Caress, N. (1994). Expert performance. Its structure and acquisition.American Psychologist 49725–747.CrossRefGoogle Scholar
  22. European Union. (1993).Council Directive 93/16/EEC.Brussels, Belgium: The European nion. European Union. (1993).Council Directive 104/93/EEC.Brussels, Belgium: The European Union.Google Scholar
  23. Firth-Cozens, J. (1992). The role of early family experiences in the perception of organisational stress: Fusing clinical and organisational perspectives.Journal of Occupational and Organizational Psychology65, 6175.Google Scholar
  24. Geurts, S., Rutte, C., & Peeters, M. (1999). Antecedents and consequences of work-home interference among medical residents.Social Science & Medicine 48(9)1135–1148.CrossRefGoogle Scholar
  25. Gibson, D. R., & Campbell, R. M. (2000). Promoting effective teaching and learning: Hospital consultants identify their needs.Medical Education 34126–130.CrossRefGoogle Scholar
  26. Gjerberg, E.&Aasland, O. G. (1999).Do doctors use too much time for post-graduate education (specialisation)?The Norwegian Medical Association Research Institute, 4 pp.Google Scholar
  27. Gold, M. R. (1996). Effects of the growth of managed care on academic medical centers and graduate medical education.Academic Medicine 71828–838.CrossRefGoogle Scholar
  28. Goldberg, D. P., & Hillier, V. F. (1979). A scaled version of the General Health Questionnaire.Psychological Medicine9, 139–145.CrossRefGoogle Scholar
  29. Graduate Medical Education Directory 1999–2000.(1999). Washington, DC: American Medical Association.Google Scholar
  30. Green, M. J. (1995). What (if anything) is wrong with residency overwork?Annals of Internal Medicine 123512–517.Google Scholar
  31. Gray J. D., & Ruedy, J. (1998). Undergraduate and postgraduate education in Canada.Canadian Medical Association Journal 1581047–1050.Google Scholar
  32. Handal, G., & Lauvås, P. (1987).Promoting reflective teaching: Supervision in action.Stratford: SRHE and Open University Educational Enterprises Limited.Google Scholar
  33. Haynes, D. F., Schwedler, M., Dyslin, D. C., Rice, J. C., & Kerstein, M. D. (1995). Are postoperative complications related to resident sleep deprivation?Southern Medical Journal 88283–289.CrossRefGoogle Scholar
  34. Headrick, L. A., Wilcock, P. M., & Batalden, P. B. (1998). Interprofessional working and continuing medical education.British Medical Journal 316771–774.CrossRefGoogle Scholar
  35. Health Policy and Economic Research Unit, B.C.S.o. 1.M.G. Anonymous. (1999). Financial cost to senior house officers of Royal College exams - Results from the BMA cohort study of 1995 medical graduates - August, 1999. British Medical Association.Google Scholar
  36. Hunt, D. D., MacLaren, C. F., & Carline, J. (1991). Comparing assessments of medical students’ potentials as residents made by the residency directors and deans at two schools.Academic Medicine 66340–344.CrossRefGoogle Scholar
  37. Jolly, B., & Grant, J. (1997).The Good Assessment Guide: A practical guide to assessment and appraisal for higher specialist training.London: Joint Centre for Education in Medicine.Google Scholar
  38. Jones, D. R., Dupras, D., & Ruffin, A. L. (1996). Importance of the perspective of residents in defining and maintaining quality in GME.Academic Medicine 71820–822.CrossRefGoogle Scholar
  39. Karle, H., & Nystrup, J. (1995). Comprehensive evaluation of specialist training: an alternative to Board examination in Europe.Medical Education 27452–460.Google Scholar
  40. Kassebaum, D. G., & Szenas, M. A. (1995). Specialty intentions of 1995 U.S. medical school graduates and patterns of generalist career choice and decision making.Academic Medicine 701152–1157.CrossRefGoogle Scholar
  41. Kay, L., Pless, T., & Brearley, S. (1996). Survey of surgical training in Europe.Medical Education 30201–207.CrossRefGoogle Scholar
  42. Kelty, C., Duffy, J., & Cooper, G. (1999). Out-of-hours work in cardiothoracic surgery: Implications of the New Deal and Calman for training.Postgraduate Medical Journal 75351–352.Google Scholar
  43. Ludmerer, K. M. (2000). Time and medical education.Annals of Internal Medicine 13225–28.Google Scholar
  44. Lycke, K. H. (1993). Promoting quality in professional learning through educational counselling. In C. Coles & H.A. Holm (Eds.)Learning in medicine(pp. 67–86). Oslo: Scandinavian University Press.Google Scholar
  45. Lycke, K. H., Enoksen, A., Refstad, S., & Brattebb, G. (1996). Anestesiprosjektet, Spesialistutdanning og lwringsmiljo ph anestesiavdelinger. [The anesthesiology project. Postgraduate training and learning environment in anesthesia departments]Skriftserie for leger: Utdanning og kvalitetssikring. Den norske lcegeforening(p. 5–80).Google Scholar
  46. Lycke, K. H., Hoftvedt, B. O., & Holm, H. A. (1998). Training educational supervisors in Norway.Medical Teacher 20337–340.CrossRefGoogle Scholar
  47. Maingay, J., & Goldberg, 1. (1998). Flexible training opportunities in the European Union.Medical Education 32543–548.CrossRefGoogle Scholar
  48. Maytan, M. (1999). Questioning U.S. residency training.Academic Medicine74, 89–89.CrossRefGoogle Scholar
  49. McCue, J. D. (1985). The distress of internship. Causes and prevention.New England Journal of Medicine 312449–452.CrossRefGoogle Scholar
  50. McKee, M., & Black, N. (1992). Does the current use of junior doctors in the United Kingdom affect the quality of medical care?Social Science & Medicine 34549–558.CrossRefGoogle Scholar
  51. Moynihan, D. P. (1998). On the commodification of medicine.Academic Medicine 73453–459.CrossRefGoogle Scholar
  52. O’Toole, R. V., Playter, R. R., Krummel, T. M., Blank, W. C., Cornelius, N. H., Roberts, W. R., Bell, W. J., & Raibert, M. (1999). Measuring and developing suturing technique with a virtual reality surgical simulator.Journal of the American College of Surgeons 189114–127.CrossRefGoogle Scholar
  53. Oxley, J. (Ed.). (1996).Appraising doctors and dentists in training - A SCOPME working paper for consultation.London, England: The Standing Committee on Postgraduate Medical and Dental Education. Paice, E. (1998). Is the New Deal compatible with good training? A survey of senior house officers.Hospital Medicine 5972–74.Google Scholar
  54. Paice, E., Pietroni, M., & Tinker, J. (1993). Future training of hospital doctors.British Journal of Hospital Medicine 50199–201.Google Scholar
  55. Petersdorf, R. G., & Bentley, J. (1989). Residents’ hours and supervision.Academic Medicine 64175–181. Pevehouse, B. C., & Colenbrander, A. (1994). The United States neurological surgery residency matching program.Neurosurgery35, 1172–1175.Google Scholar
  56. Reynard, K., & McGowan, A. (1997). Assessment of specialist registrars in A&E - Opportunities for change.Journal of Accident and Emergency Medicine 14107–109.CrossRefGoogle Scholar
  57. Richardson, G. S., Wyatt, J. K., Sullivan, J. P., Orav, E. J., Ward, A. E., Wolf, M. A.&Czeisler, C. A. (1996). Objective assessment of sleep and alertness in medical house staff and the impact of protected time for sleep.Sleep19, 718–726.Google Scholar
  58. Roberts, K. B., DeWitt, T. G., Goldberg, R. L., & Scheiner, A. P. (1994). A program to develop residents as teachers.Archives of Pediatric and Adolescent Medicine 148405–410.CrossRefGoogle Scholar
  59. Samkoff, J. S., & Jacques, C. H. (1991). A review of studies concerning effects of sleep deprivation and fatigue on residents’ performance.Academic Medicine 66687–693.CrossRefGoogle Scholar
  60. Schöldström, U. (1996).Quality assurance in specialist training: The Swedish experience of site visits 1989–96.Sveriges läkarförbund.Google Scholar
  61. Skeff, K. M., Stratos, G. A., Berman, J., & Bergen, M. R. (1992). Improving clinical teaching. Evaluation of a national dissemination program.Archives of Internal Medicine 1521156–1161.CrossRefGoogle Scholar
  62. Slotnick, H. B. (1996). How doctors learn: The role of clinical problems across the medical school-to-practice continuum.Academic Medicine71, 28–34.CrossRefGoogle Scholar
  63. Smith, J. W., Denny, W. F., & Witzke, D. B. (1986). Emotional impairment in internal medicine house staff. Results of a national survey.Journal of the American Medical Association255, 1155–1158.CrossRefGoogle Scholar
  64. Strunk, C. L., Bailey, B. J., Scott, B. A., Cummings, C. W., Lucente, F. E., Beatty, C. W., Neel, H. B., Pillsbury, H. C., Rice, D. H., & Bryan, M. D. (1991). Resident work hours and working environment in otolaryngology. Analysis of daily activity and resident perception.Journal of the American Medical Association 2661371–1374.CrossRefGoogle Scholar
  65. Swedish Medical Association. (1999).Paediatrics. Google Scholar
  66. Taylor, B., & Banner, S. R. (1989). The specialty match: A necessity in the equitable resident selection process.Canadian Medical Association Journal 141673–676.Google Scholar
  67. Thorpe, K. E. (1990). House staff supervision and working hours. Implications of regulatory change in New York State.Journal of the American Medical Association 2633177–3181.CrossRefGoogle Scholar
  68. Towle, A. (1998). Changes in health care and continuing medical education for the 21st century.British Medical Journal 316301–304.CrossRefGoogle Scholar
  69. Trontell, M. C., Carson, J. L., Taragin, M. I., & Duff, A. (1991). The impact of the night float system on internal medicine residency programs.Journal of General Internal Medicine 6445–449.CrossRefGoogle Scholar
  70. Tuggy, M. L. (1998). Virtual reality flexible sigmoidoscopy simulator training: Impact on resident performance.Journal of the American Board of Family Practitioners 11426–433.Google Scholar
  71. Vikanes, A., Akre, V., & Hjortdahl, P. (1992). Medisinsk grunnutdanning i utakt. Grunnutdanninga slik turnuskandidaten opplever ho [Medical undergraduate education is outdated. From the interns’ point of view (see comments)].Tidsskr Nor Laegeforen 1122541–2545.Google Scholar
  72. Wagoner, N. E., & Suriano, J. R. (1999). Program directors’ responses to a survey on variables used to select residents in a time of change.Academic Medicine 7451–58.Google Scholar
  73. Wall, D., & McAleer, S. (2000). Teaching the consultant teachers: Identifying the core content.Medical Education 34131–138.CrossRefGoogle Scholar
  74. Wartman, S. A., O’Sullivan, P. S., & Cyr, M. G. (1990). The service/education conflict in residency programs: A model for resolution.Journal of General Internal Medicine 5S59–S69.CrossRefGoogle Scholar
  75. White, J. A., & Anderson, P. (1995). Learning by internal medicine residents: Differences and similarities of perceptions by residents and faculty.Journal of General Internal Medicine 10126–132.CrossRefGoogle Scholar
  76. Wipf, J. E., Orlander, J. D., & Anderson, J. J. (1999). The effect of a teaching skills course on interns’ and students’ evaluations of their resident-teachers.Academic Medicine 74938–942.CrossRefGoogle Scholar
  77. Wipf, J. E., Pinsky, L. E., & Burke, W. (1995). Turning interns into senior residents: preparing residents for their teaching and leadership roles.Academic Medicine 70591–596.CrossRefGoogle Scholar
  78. Wright, S. (1996). Examining what residents look for in their role models.Academic Medicine 71290–292.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2002

Authors and Affiliations

  • Hans Asbjørn Holm
    • 1
  1. 1.Norwegian Medical AssociationNorway

Personalised recommendations