title: Between trust and accountability: different perspectives on the modernization of postgraduate medical training in the Netherlands.
abstract: OBJECTIVE
  Postgraduate medical training was reformed to be more responsive to changing societal needs. In the Netherlands, as in various other Western countries, a competency-based curriculum was introduced reflecting the clinical and nonclinical roles a modern doctor should fulfill. It is still unclear, however, what this modernization process exactly comprises and what its consequences might be for clinical practice and medical work.
  
  
  METHODS
  The authors conducted a Q methodological study to investigate which different perspectives exist on the modernization of postgraduate medical training among actors involved.
  
  
  RESULTS
  The authors found four distinct perspectives, reflecting the different features of medical training. The accountability perspective stresses the importance of formal regulations within medical training and the monitoring of results in order to be more transparent and accountable to society. According to the educational perspective, medical training should be more formalized and directed at the educational process. The work-life balance perspective stresses the balance between a working life and a private life, as well as the changing professional relationship between staff members and residents. The trust-based perspective reflects the classic view of medical training in which role modeling and trust are considered most important.
  
  
  CONCLUSIONS
  The four perspectives on the modernization of postgraduate medical training show that various aspects of the modernization process are valued differently by stakeholders, highlighting important sources of agreement and disagreement between them. An important source of disagreement is diverging expectations of the role of physicians in modern medical practice.
authors.affiliation: Institute of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands.
authors.forename: Iris
authors.initials: I
authors.lastname: Wallenburg
authors.forename: Job
authors.initials: J
authors.lastname: van Exel
authors.forename: Elly
authors.initials: E
authors.lastname: Stolk
authors.forename: Fedde
authors.initials: F
authors.lastname: Scheele
authors.forename: Antoinette
authors.initials: A
authors.lastname: de Bont
authors.forename: Pauline
authors.initials: P
authors.lastname: Meurs
mesh_terms: D004503:Education, Medical, Graduate / Q000379:methods / Q000639:trends*; D009426:Netherlands; D012941:Social Responsibility; D035502:Trust