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Samenvatting
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Het algemene doel van het project “Health advocacy in preventive youth health physicians” is om inzicht te krijgen in hoe jeugdartsen en kinderartsen in Nederland de competentie maatschappelijk handelen uitvoeren en op welke manier de competentie maatschappelijk handelen wordt onderwezen in de opleiding geneeskunde en de opleidingen tot jeugdarts en kinderarts. Maatschappelijk handelen is een van de zeven kerncompetenties waarin Nederlandse basisartsen en medisch specialisten worden opgeleid. Deze competentie houdt in dat artsen hun kennis en invloed inzetten om samen met patiënten en populaties de gezondheid van patiënten en het gezondheidszorgsysteem te verbeteren.

Dit onderzoeksproject richt zich op twee onderzoekdoelen:

(1) Inzicht krijgen in wat jeugdartsen en kinderartsen doen aan maatschappelijk handelen, wat hierbij belemmerende en bevorderende factoren zijn en hoe maatschappelijk handelen past binnen de waarden die jeugdartsen en kinderartsen belangrijk vinden in hun werk.

(2) Inzicht krijgen in hoe de competentie maatschappelijk handelen wordt beschreven en onderwezen in de curricula van de basisopleiding geneeskunde in Nederland en de medische vervolgopleiding tot jeugdarts en kinderarts.

Voor onderdeel (1) zal een vragenlijst worden opgesteld over werkgerelateerde waarden en maatschappelijk handelen die zal worden afgenomen onder jeugdartsen en kinderartsen. Verschillen en overeenkomsten tussen beide beroepsgroepen zullen worden bekeken. Voor het opstellen van de vragenlijsten gebruiken we onder andere de input vanuit focusgroepen. Voor onderdeel (2) zal een curriculumanalyse worden gedaan van de curricula van de basisopleiding geneeskunde en de medische vervolgopleidingen tot jeugdarts en kinderarts. Hierbij worden formele documenten geanalyseerd en zullen interviews worden afgenomen met curriculumleiders.

Resultaten
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De eerste resultaten gaan over de curriculum-analyses. Er zullen resultaten komen over hoe de competentie maatschappelijk handelen wordt beschreven in de formele documenten van de verschillende curricula van de basisopleiding geneeskunde (van de 8 geneeskunde-faculteiten in Nederland) en van de vervolgopleidingen tot jeugdarts en kinderarts (verschillende opleidingsinstellingen). Om de onderdelen van de competentie maatschappelijk handelen goed terug te kunnen vinden in de formele documenten, hebben we eerst deze competentie geoperationaliseerd naar een indeling (taxonomie) waarin we de kennis, vaardigheden en attitudes die nodig zijn voor verschillende onderdelen van maatschappelijk handelen, hebben ondergebracht. Deze taxonomie is afgeleid van het CanMeds 2015 framework, waar de competentie maatschappelijk handelen in beschreven staat. Ook is gekeken naar de beschrijving van maatschappelijk handelen in de landelijke kaderdocumenten voor de basisopleiding geneeskunde en de vervolgopleiding tot jeugdarts en kinderarts. De inhoud van de taxonomie hebben we ook gebruikt om de vragen voor de interviews in de focusgroepen voor de vragenlijsten en de interviews met de curriculumleiders op te stellen.

Samenvatting van de aanvraag

Samenvatting
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Preventive youth health physicians (PYHPs), i.e. community physicians specialized in prevention in youth, should be effective health advocates to protect the fundamental health rights of children. All physicians are trained in health advocacy in their undergraduate training, advocacy being one of the seven CanMeds roles upon which medical education has been based. As Health Advocates, physicians assist patients and communities in navigating the healthcare system and accessing the appropriate health resources timely. The aim of this project is to gain insight into health advocacy among PYHPs. The project focuses on the performance of these physicians regarding health advocacy in their daily practice, and on the training of PYHPs regarding health advocacy, in the undergraduate and specialty stage. Moreover, PYHPs will be compared with paediatricians as other specialists solely focussing on children and their families, regarding both performance and specialty training in health advocacy.

 

This proposal is innovative because:

- It is the first to document the performance of health advocacy by PYHPs, their valuing of health advocacy compared to other tasks, and their perceived knowledge and skills in this;

- It compares PYHPs with paediatricians, thus covering specialists working in prevention, and in cure and care for children;

- It yields knowledge of how future physicians are prepared for practicing health advocacy in medical (undergraduate and specialty) curricula;

- It has a coherent approach, using elements of the capability approach to assess performance in daily practice, giving also clues for sustainable employment;

- It yields an instrument to assess the preceding, combined with health advocacy values, knowledge and skills;

- It has a potentially very large community impact by strengthening the societal role of PYHPs and physicians in general;

- It closely combines science and practice, allowing its performance by a medical specialist in training.

 

The project has been designed as leading to a PhD-thesis based on five papers, embedded in a general introduction and discussion. As such, its results will suffice the requirements for a PhD-thesis at the University of Groningen. The general aim of the project has therefore been translated into five objectives:

1. To investigate to which degree PYHPs act as health advocates for youth, what obstructing and promoting factors PYHPs experience regarding this and how health advocacy is positioned within the values that the PYHPs find important in their work.

2. To develop a questionnaire suitable for PHYPs (partially registered and fully registered) and pediatricians, to measure to which degree they act as health advocates for youth, what obstructing and promoting factors they experience regarding this, and how health advocacy is positioned within the values that they find important in their work.

3. To identify the differences and similarities between PYHPs and paediatricians with regard to health advocacy for youth.

4. To explore how health advocacy is described and taught in the undergraduate medical curricula.

5. To investigate how the competence health advocacy is described and taught in the specialist training of PYHP, and how this relates to the specialty training in paediatrics.

 

Regarding methods, the project consists of two major parts i.e. a part based on surveys and one on analyses of curricula. First, we will collect data with a survey among PYHPs (registered and in training, each 100) on the degree to which they act as health advocates for youth, what obstructing and promoting factors they experience regarding this and how health advocacy is positioned within the values that the PYHPs find important in their work (Objective 1), and will compare this with paediatricians (n=100) (Objective 3). As part of this, we will develop a questionnaire to measure these concepts among PYHPs and paediatricians, based on the capability approach of Sen (Objective 2).

 

Second, we will analyse curricula of undergraduate and specialty trainings regarding health advocacy. The undergraduate curricula will concern all eight Dutch medical schools, based on a mapping of the formal programme and interviews with key stakeholders such as leaders of the Bachelor and Master-programme (Objective 4). The specialty curricula will regard the two PYHPs’ specialty trainings that exist in the Netherlands, and three paediatricians’ specialty trainings (Objective 5).

 

The results of this project have relevance for preventive youth health physicians (PYHPs) and their professional society; for teachers involved in the training of physicians and PYHPs (i.e. undergraduate and specialty); for policy makers; and for scientists. Activities for knowledge transfer will be undertaken for each of these target groups separately and combined if possible. The project team has ample experience in supervising practitioner PhD-students, and is strongly embedded in the networks relevant for an excellent knowledge transfer.

 

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