IntroductionThe Dutch Medical Doctor-Global Health (MD-GH) prepares to work in low-resource settings (LRS) by completing a hybrid postgraduate training program of 2 years and 9 months, with clinical and public health exposure in the Netherlands and a Global Health residency in LRS. The objectives of the program include acquiring clinical skills to work as a physician in a setting with different (often more severe) pathology and limited resources. In public health teaching, emphasis is given, among other, to adapting to a culturally different environment. After graduation, MD-GH work in a wide variety of countries and settings for variable time. As part of a curriculum review, this study examines MD-GHs' perception of the quality of the training program and provides recommendations for improvement.MethodsA qualitative study was performed. Thematic analysis was applied to semi-structured interviews with 23 MD-GH who graduated between 2017 and 2021.ResultsMD-GHs predominantly worked as clinicians; several were (also) involved in management or capacity building. The clinical training program adequately addressed general skills, but did not sufficiently prepare for locally encountered, often severe, pathology. During the training, adequate supervision with clear learning goals was found pivotal to a positive learning experience. Gaps included clinical training in Internal Medicine (particularly infectious diseases and non-communicable diseases) and Paediatrics. Public Health teaching as well as cultural awareness should be intensified and introduced earlier in the program. The Global Health residency was considered important, but tasks and learning outcomes varied. Teaching, supervision, and capacity building were considered increasingly important key elements of working in LRS. Consensus favoured the current duration of the training program without extension.DiscussionWhile the generalist nature of the MD-GH training was appreciated, the program would benefit from additional clinical training in infectious diseases, non-communicable diseases, and Paediatrics. Moving forward, emphasis should be placed on structured mentorship, enhanced public health teaching, and standardized residency programs with clearly delineated objectives to better equip MD-GH professionals for their multifaceted roles in LRS. Moreover, future revisions of the training program should incorporate the perspectives of host institutes in LRS and tailor the training needs.
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Built environments are increasingly vulnerable to the impacts of climate change. Most European towns and cities have developed horizontally over time but are currently in the process of further densification. High-rise developments are being built within city boundaries at an unprecedented rate to accommodate a growing urban population. This densification contributes to the Urban Heat Island phenomenon and can increase the frequency and duration of extreme heat events locally. These new build-up areas, in common with historic city centres, consist mainly of solid surfaces often lacking open green urban spaces.The Intervention Catalogue is the third publication in a series produced by the Cool Towns project and has been designed as a resource for decision makers, urban planners, landscape architects, environmental consultants, elected members and anyone else considering how to mitigate heat stress and increase thermal comfort in urban areas. Technical information on the effectiveness of the full array of intervention types from trees to water features, shading sails to green walls, has been assessed for their heat stress mitigation properties, expressed in Physiological Equivalent Temperature (PET). The results shown in factsheets will help the process of making an informed, evidence based, choice so that the most appropriate intervention for the specific spatial situation can be identified.
The present study focuses on the level of stress male and female teachers perceive when dealing with the most behaviorally challenging student in his or her classroom. To measure stress in Dutch elementary classrooms, a sample was drawn of 582 teachers. First, they rated the most challenging student in their classroom on six different behavioral components: Against the grain, Full of activity/Easily distractible, Needs a lot of attention/Week student, Easily upset, Failuresyndrome/Excessively perfectionist, and Aggressive/Hostile. Teachers then scored perceived stress as a result of this challenging behavior. Two questions concerning gender relations in class rooms will be addressed. Do female and male teachers select the same type of behaviorally challenging students as the most challenging? And: do they perceive the same level of stress? Our data shows that female teachers do indeed report significantly more incidence of challenging behavior, but no evidence is found for differences between stress levels of male and female teachers.
