Learning in a clinical education programme in primary care: the Maastricht Adoption Programme.
BACKGROUND
At Maastricht University, the integration of knowledge, skills and attitudes in preclinical medical education is promoted by an 'Adoption Programme', where students carry out assignments in a general practice setting. The assignments are explained and discussed in practical medical coaching groups. The aim of this study was to examine the relationships between the elements that affect learning in the programme.


METHODS
Data from the evaluation questionnaires of 188 medical students were used to test a causal model of learning in the programme. A distinction was made between 'action' and 'reflection on action'. We examined the relationships between perceived instructiveness (the programme's value as a learning experience) and the following variables: comprehensibility; feasibility and execution of the assignments; time spent on the assignments, and the direct and indirect influences of the hosting general practitioner (GP) and the practical medical coaching group.


RESULTS
Performing the assignments had little effect on perceived instructiveness. Coaching by the hosting GP influenced the execution of assignments mainly by its effect on feasibility. Coaching by the GP and in the practical medical coaching groups barely affected perceived instructiveness.


CONCLUSIONS
The model gives insight into the contribution of aspects of the Adoption Programme to student learning. The results are probably negatively influenced by the insufficient priority given to the Adoption Programme in the practical medical coaching groups and by inadequate instruction given to the GPs for the purposes of their coaching role. More careful planning of patient-related assignments is recommended. Reflection on assignments and feedback on procedures are needed to lift practical experience onto a higher educational level.
Mainhard
M Tim
MT
Centre for the Innovation of Education (CINOP), The Netherlands.
van den Hurk
Marianne M
MM
van de Wiel
Margaretha W J
MW
Crebolder
Harry F J M
HF
Scherpbier
Albert J J A
AJ
D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000592:standards; D004521:Educational Measurement / Q000592:standards*; D006801:Humans; D010821:Physicians, Family / Q000458:organization & administration; D011320:Primary Health Care / Q000379:methods; D015397:Program Evaluation; D015203:Reproducibility of Results