Table 1 ; Theme descriptions, assigned domains and applicability. Description: A list of all 15 themes, their definitions as derived from the data, the domains to which the themes are assigned to, and all competencies described as their potential applicability in the Netherlands
Theme | Definition | Domain | Reported applicability / Examples | |
|---|---|---|---|---|
1 | Broad medical perspective | Thinking and acting beyond the silo of singular medical disciplines | Professional | – Experience with acute healthcare delivery and medical triage. – Recognition of diseases outside a specific discipline with a broadened differential diagnosis. Allowing understanding of various disciplines and relevant information in communicating with specialists. – Having knowledge of uncommon (infectious) diseases such as TB, Ebola, Measles, Malaria, Kala Azar or Cholera. |
2 | Holistic perspective | Holistic view of the patient, including determinants of health, beyond the medical issue of the patient only | Professional, cultural | – Taking into account the influences of cultural, societal and socio-economic factors to health (determinants of health) and tailoring treatment to various determinants of health. – Being able to see relations and interconnections between different disciplines. Seeing the patient as a whole, without solely focusing on one organ(system). – Having insight and being aware of healthcare delivery outside the hospital. – Thinking from a patient’s perspective, including their reasons to seek, or not seek help as well as considering their long term goals. |
3 | Adaptive communication skills | A way of adapting interaction with others with respect to their context or position | Professional, personal, cultural | – Acknowledging the importance of good communication to realise efficient organisation and facilitation of healthcare, e.g. in stressful situations (both team and patient). Learning to communicate goal-oriented and non-offensively. – Assuming an open attitude and learning to listen as well as communicating one’s own boundaries. – Being conscious of various methods of communication and their importance (e.g. body language or being direct). – Learning to communicate with people with different backgrounds (such as superiors in hierarchical systems or patients with a language barrier) and adjust accordingly. |
4 | Creativity | Thinking of alternatives to get to the desired outcome, improvising, thinking beyond ‘normal’ use of something | Professional, personal | – Learning to improvise when facing challenges, e.g. scarcity of (wound)material or medication. – Thinking out-of-the-box, e.g. employing sport psychologists to provide psychological support to healthcare workers. – Tailoring solutions for individual patients by considering their wishes and needs, such as employing a patient’s social safety net into the patient’s treatment plan. |
5 | Flexibility | Adapting to changing situations, being compliant and deployable in diverse settings | Professional, personal | – Learning to quickly adapt and familiarise to unknown situations (such as a new team, working culture, country, disease or healthcare system). – Sustaining high work pressure, long workdays and responsibilities as well as learning to delegate tasks or responsibilities. – Learning pragmatic or solution-oriented thinking and working with limited resources. – Being widely/variably employable at different departments and disciplines, as well as assuming various roles such as a pharmacist or manager. |
6 | Cultural awareness | Being culturally aware and competent | Cultural, professional, personal | – Knowledge in differences in practices, traditions and wishes within other cultures such as interpersonal relations. Respecting and adjusting to differences in backgrounds into account when diagnosing and treating patients. For example, taking on a more paternalistic role as physician in the patient-physician relationship when needed. – Having affinity to and valuing work in diverse settings (places and people). Working flexibly with people from other backgrounds/cultures. – Developing consciousness of the varying ways of communication and expression of feelings and ideas other cultures, such as (body)language or illness experience. Reflecting on these similarities and differences. Overcoming these language and cultural barriers. |
7 | Self-reliance | Being able to work independently when required | Professional, personal | – Having less need of supervision, with knowledge of one’s own capabilities and limits, such as learning to do rounds or make decisions independently. Being able to take over tasks of supervisors if needed. – Valuing the opportunity of supervision when possible. |
8 | Clinical competence | Improved clinical skills concerning interpretation of clinical signs, diagnosis and treatment | Professional | – Having multiple years of general work experience with a demanding patient load. Experience in diagnosing based on clinical eye and reasoning, triaging, recognition of acutely ill patient and acting adequately. – Improved surgical and gynaecological skills as well as physical examination and history taking. – Having knowledge and recognition of various stages of diseases (such as eclampsia). Recognising rare diseases/situations (such as breech births). Hands-on experience with a broad spectrum of diseases instead of solely knowing them from literature and their presentations on different skin colours. |
9 | Cost awareness | Being conscious of the costs of healthcare interventions and treatments | Professional | – Having experience in working with scarcity of (medical) material and consciousness of healthcare costs, such as materials and beds. – Learning to be judicious and cost-effective in use of resources such as material, beds, routine diagnostics as well as unnecessary extension of life. – Learning deliberate practice: switching to suitable care when a treatment is likely to be of little health gain. |
10 | Public health | Being motivated to strive for health equity within the whole population in a society, including vulnerable groups | Cultural, professional, personal | – Gaining insight into the broader scope of public healthcare and its importance, including communications, sustainability, accessibility, travel medicine, determinants of health, privatisation and infectious diseases. – Acknowledging/emphasising the value of preventive medicine, alongside curative medicine, within a healthcare system. – Affinity with vulnerable groups/migrants and being motivated to provide them access to the healthcare system (such as working in a refugee centre or general practice in a multi-ethnic area). – Learning the importance of and gaining experience in needs assessments in effective developmental aid. |
11 | Leadership | Working in a team and motivating the team to work toward a common goal | Professional, personal | – Taking care of the team and its members. Conflict-resolving and giving others comfort in situations that are unknown to them. – Experience and confidence in leading or supervising a team: keeping an overview, delegation, prioritization, responsibility, making decisions and being conscious of their consequences. – Being mindful to a team’s long-term goals, motivating and keeping them goal-oriented. Assessing and managing individual skillsets. – Being experienced with educating and training people. Paying attention to the education of others. |
12 | Open-mindedness | Being open to different perspectives without considering one point of view as absolute | Personal, cultural, professional | – Being able to relate to other perspectives and to think from their point of view (both patient and colleague). Giving attention to what is deemed important by someone else and being disinclined from making value judgements. Being humble and respectful towards opinions, situations, or wishes of others. – Learning the relevance of discrimination/racism and its influence on people. – Having an open attitude toward alternative/complementary medicine and different ways of individual healthcare delivery. – Giving attention and value to the process of the end of life. |
13 | Organisation of care | Insight into organisation of care and healthcare systems | Professional, cultural | – Being experienced with the logistics, policy-making, cooperation and process improvement within the organisation of healthcare both within as outside of the hospitals (such as the government, public health institutes or NGOs). – Having experience with different aspects of epidemics, including prevention, measures, necessary attitude and organisation of healthcare. Being able to take consulting roles with regard to an epidemic in high-resource settings. – Having experiences with working in situations with limited resources, such as shortage of hospital beds and prioritising healthcare delivery. – Adopting a sustainability-oriented view considering organization of a healthcare system regarding climate change or recycling of materials. |
14 | Self-development | Process of conscious improvement of personal and professional aspects of life | Personal, professional | – Resilience to stress in both private and professional matters. Being used to high-pressure work environments, such as long working days and substantial responsibility. – Development of self-confidence in various situations, such as acute clinical cases, difficult decisions or uncertainty. – Learning to differentiate between major and minor issues in personal and professional spheres, putting them into perspective. – Having experience with mortality and accepting that death is part of life. Acknowledging the importance and learning to cope with these situations. – Appreciation of services/facilities considered normal in a HRS, such as taking showers with warm drinking water. |
15 | Teamwork | Collaborating, communicating, working and understanding as a team | Professional, personal, cultural | – Understanding the importance of a safe learning environment as well as shared motivation/team spirit within a team. Adapting communication and work ethic to various kinds of people and hierarchical levels. Learning to work towards a common goal with a conflict resolving, inclusive and structured work ethic. – Being attentive to the mental health of colleagues and learning to cope with stress, uncertainties and frustrations of others. – Improved perspective-taking in communication with other disciplines/roles through experience. – Closing the gap between various disciplines, hospitals and levels of healthcare as well as society and medicine. |