Abstract Purpose The primary aim of this study was to investigate the effect of including the Dutch National Pharmacotherapy Assessment (DNPA) in the medical curriculum on the level and development of prescribing knowledge and skills of junior doctors. The secondary aim was to evaluate the relationship between the curriculum type and the prescribing competence of junior doctors. Methods We re-analysed the data of a longitudinal study conducted in 2016 involving recently graduated junior doctors from 11 medical schools across the Netherlands and Belgium. Participants completed three assessments during the first year after graduation (around graduation (+/−4 weeks), and 6 months, and 1 year after graduation), each of which contained 35 multiple choice questions (MCQs) assessing knowledge and three clinical case scenarios assessing skills. Only one medical school used the DNPA in its medical curriculum; the other medical schools used conventional means to assess prescribing knowledge and skills. Five medical schools were classified as providing solely theoretical clinical pharmacology and therapeutics (CPT) education; the others provided both theoretical and practical CPT education (mixed curriculum). Results Of the 1584 invited junior doctors, 556 (35.1%) participated, 326 (58.6%) completed the MCQs and 325 (58.5%) the clinical case scenarios in all three assessments. Junior doctors whose medical curriculum included the DNPA had higher knowledge scores than other junior doctors (76.7% [SD 12.5] vs. 67.8% [SD 12.6], 81.8% [SD 11.1] vs. 76.1% [SD 11.1], 77.0% [12.1] vs. 70.6% [SD 14.0], p<0.05 for all three assessments, respectively). There was no difference in skills scores at the moment of graduation (p=0.110), but after 6 and 12 months junior doctors whose medical curriculum included the DNPA had higher skills scores (both p<0.001). Junior doctors educated with a mixed curriculum had significantly higher scores for both knowledge and skills than did junior doctors educated with a theoretical curriculum (p<0.05 in all assessments). Conclusion Our findings suggest that the inclusion of the knowledge focused DNPA in the medical curriculum improves the prescribing knowledge, but not the skills, of junior doctors at the moment of graduation. However, after 6 and 12 months, both the knowledge and skills were higher in the junior doctors whose medical curriculum included the DNPA. A curriculum that provides both theoretical and practical education seems to improve both prescribing knowledge and skills relative to a solely theoretical curriculum.
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The use of robots as educational tools provide a stimulating environment for students. Some robotics competitions focus on primary and secondary school aged children, and serve as a motivation factor for students to get involved in educational robotics activities. But, in most competitions students are required to deal with robot design, construction and programming. Although very appealing, many students cannot participate on robotics competitions because they cannot afford robotics kits and their school do not have the necessary equipment. Because of that, several students have no access to educational robotics, especially on developing countries. To minimize this problem and contribute to education equality, we present a proposal for a new league for the robotics competitions: The Junior Soccer Simulation league (JSS). In such a league, students program virtual robots in a similar way that they would program their real ones. Because there is no hardware involved, costs are very low and participants can concentrate on software development and robot's intelligence improvement. Finally, because soccer is the most popular sport in the world, we believe JSS will be a strong motivator for students to get involved with robotics. In this paper we present the simulator that was developed (ROSOS) and discuss some ideas for the adoption of a Junior Soccer Simulation competition.
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Aim: The aim of this study was to investigate how the prescribing knowledge and skills of junior doctors in the Netherlands and Belgium develop in the year after graduation. We also analysed differences in knowledge and skills between surgical and nonsurgical junior doctors. Methods: This international, multicentre (n = 11), longitudinal study analysed the learning curves of junior doctors working in various specialties via three validated assessments at about the time of graduation, and 6 months and 1 year after graduation. Each assessment contained 35 multiple choice questions (MCQs) on medication safety (passing grade ≥85%) and three clinical scenarios. Results: In total, 556 junior doctors participated, 326 (58.6%) of whom completed the MCQs and 325 (58.5%) the clinical case scenarios of all three assessments. Mean prescribing knowledge was stable in the year after graduation, with 69% (SD 13) correctly answering questions at assessment 1 and 71% (SD 14) at assessment 3, whereas prescribing skills decreased: 63% of treatment plans were considered adequate at assessment 1 but only 40% at assessment 3 (P < .001). While nonsurgical doctors had similar learning curves for knowledge and skills as surgical doctors (P = .53 and P = .56 respectively), their overall level was higher at all three assessments (all P < .05). Conclusion: These results show that junior doctors' prescribing knowledge and skills did not improve while they were working in clinical practice. Moreover, their level was under the predefined passing grade. As this might adversely affect patient safety, educational interventions should be introduced to improve the prescribing competence of junior doctors.
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Aims: Prescribing errors among junior doctors are common in clinical practice because many lack prescribing competence after graduation. This is in part due to inadequate education in clinical pharmacology and therapeutics (CP&T) in the undergraduate medical curriculum. To support CP&T education, it is important to determine which drugs medical undergraduates should be able to prescribe safely and effectively without direct supervision by the time they graduate. Currently, there is no such list with broad-based consensus. Therefore, the aim was to reach consensus on a list of essential drugs for undergraduate medical education in the Netherlands. Methods: A two-round modified Delphi study was conducted among pharmacists, medical specialists, junior doctors and pharmacotherapy teachers from all eight Dutch academic hospitals. Participants were asked to indicate whether it was essential that medical graduates could prescribe specific drugs included on a preliminary list. Drugs for which ≥80% of all respondents agreed or strongly agreed were included in the final list. Results: In all, 42 (65%) participants completed the two Delphi rounds. A total of 132 drugs (39%) from the preliminary list and two (3%) newly proposed drugs were included. Conclusions: This is the first Delphi consensus study to identify the drugs that Dutch junior doctors should be able to prescribe safely and effectively without direct supervision. This list can be used to harmonize and support the teaching and assessment of CP&T. Moreover, this study shows that a Delphi method is suitable to reach consensus on such a list, and could be used for a European list.
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Rational prescribing is essential for the quality of health care. However, many final-year medical students and junior doctors lack prescribing competence to perform this task. The availability of a list of medicines that a junior doctor working in Europe should be able to independently prescribe safely and effectively without supervision could support and harmonize teaching and training in clinical pharmacology and therapeutics (CPT) in Europe. Therefore, our aim was to achieve consensus on such a list of medicines that are widely accessible in Europe. For this, we used a modified Delphi study method consisting of three parts. In part one, we created an initial list based on a literature search. In part two, a group of 64 coordinators in CPT education, selected via the Network of Teachers in Pharmacotherapy of the European Association for Clinical Pharmacology and Therapeutics, evaluated the accessibility of each medicine in his or her country, and provided a diverse group of experts willing to participate in the Delphi part. In part three, 463 experts from 24 European countries were invited to participate in a 2-round Delphi study. In total, 187 experts (40%) from 24 countries completed both rounds and evaluated 416 medicines, 98 of which were included in the final list. The top three Anatomical Therapeutic Chemical code groups were (1) cardiovascular system (n = 23), (2) anti-infective (n = 21), and (3) musculoskeletal system (n = 11). This European List of Key Medicines for Medical Education could be a starting point for country-specific lists and could be used for the training and assessment of CPT.
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In this chapter, I look back at the implementation of W12-16, a major reform of mathematics education in the lower grades of general secondary education and pre-vocational secondary education in the Netherlands including all students aged 12–16. The nationwide implementation of W12-16 started in 1990 and envisioned a major change in what and how mathematics was taught and learned. The content was broadened from algebra and geometry to algebra, geometry and measurement, numeracy, and data processing and statistics. The learning trajectories and the instruction theory were based on the ideas of Realistic Mathematics Education (RME): the primary processes used in the classroom were to be guided re-invention and problem solving. ‘Ensuring usability’ in the title of this chapter refers to the aim of the content being useful and understandable for all students, but also to the involvement of all relevant stakeholders in the implementation project, including teachers, students, parents, editors, curriculum and assessment developers, teacher educators, publishers, media and policy makers. Finally, I reflect on the current state of affairs more than 20 years after the nationwide introduction. The main questions to be asked are: Have the goals been reached? Was the implementation successful?
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Teaching history requires clear, detailed and subject specific language. History teachers teaching in a second language are confronted with students' second language limitations, which likely have an aggravating impact on their application of pedagogical content knowledge (PCK). We analysed and compared 12 Dutch spoken and 12 English spoken paired history lessons in junior grades 7 and 9. Contrary to our expectation, we found a strong similarity of the teachers’ PCK application in both grades 7 and 9, irrespective of the used language. The PCK application in both grades and languages was of average quality, while the PCK used in grade 9 was more advanced.
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Teaching history requires clear, detailed and subject specific language. History teachers teaching in a second language are confronted with students' second language limitations, which likely have an aggravating impact on their application of pedagogical content knowledge (PCK). We analysed and compared 12 Dutch spoken and 12 English spoken paired history lessons in junior grades 7 and 9. Contrary to our expectation, we found a strong similarity of the teachers’ PCK application in both grades 7 and 9, irrespective of the used language. The PCK application in both grades and languages was of average quality, while the PCK used in grade 9 was more advanced.
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Learning environment designs at the boundary of school and work can be characterised as integrative because they integrate features from the contexts of school and work. Many different manifestations of such integrative learning environments are found in current vocational education, both in senior secondary education and higher professional education. However, limited research has focused on how to design these learning environments and not much is known about their designable elements (i.e. the epistemic, spatial, instrumental, temporal and social elements that constitute the learning environments). The purpose of this study was to examine manifestations of two categories of integrative learning environment designs: designs based on incorporation; and designs based on hybridisation. Cross-case analysis of six cases in senior secondary vocational education and higher professional education in the Netherlands led to insights into the designable elements of both categories of designs. We report findings about the epistemic, spatial, instrumental, temporal and social elements of the studied cases. Specific characteristics of designs based on incorporation and designs based on hybridisation were identified and links between the designable elements became apparent, thus contributing to a deeper understanding of the design of learning environments that aim to connect the contexts of school and work.
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Across the globe, linguistically heterogeneous populations increasingly define school systems at the same time that developing the ability to communicate cross-culturally is becoming essential for internationalized economies. While these trends seem complimentary, they often appear in paradoxical opposition as represented in the content and execution of nationwide education policies. Given the differing geopolitical contexts within which school systems function, wide variation exists with regard to how policymakers address the challenges of providing language education, including how they frame goals and design programs to align with those goals. Here we present a cross-continental examination of this variation, which reveals parallel tensions among aims for integrating immigrant populations, closing historic achievement gaps, fostering intercultural understanding, and developing multilingual competencies. To consider implications of such paradoxes and parallels in policy foundations, we compare language education in the US and in the EU, focusing on the Netherlands as an illustrative case study.
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