Negotiating Authority: A Comparative Study of Reform in Medical Training Regimes

Abstract

Recently the medical profession has faced increasing outside pressure to reform postgraduate medical training programs to better equip young doctors for changing health care needs and public expectations. In this paper, we explore the impact of reform on professional self-governance by conducting a comparative historicalinstitutional analysis of postgraduate medical training reform in Britain and the Netherlands. In both countries, the medical training regime has shifted from professional self-regulation to co-regulation. Yet, there are notable differences in each country that cannot be solely explained by diverging institutional contexts. They also result from the strategic actions by the actors involved. Based on an assessment of the recent literature on institutional transformation, this paper shows how strategic actions set negotiating authority processes into motion, producing new and sometimes surprising institutional arrangements that can have profound effects on the distribution and allocation of authority in the medical training regime. The paper stresses the need to study the interactions between political context, the properties of institutions and negotiating authority processes, as they are crucially important to understanding institutional transformation.

Introducing incident reporting in primary care: a translation from safety science into medical practice

“…Thus, each care provider was held responsible for developing such competence and should become embedded in 272 D.L.M. Zwart and A.A. de Bont it -moving from the peripheral stage of the social interaction and knowledge to the centre (Wallenburg et al 2012). However, to be on the safe side, the practitioners in this centre agreed to change the ways in which corrosive fluid were stored, in order to minimise the possibility that such an error would happen again.…”

Psychometric evaluation of a direct observation of procedural skills assessment tool for ultrasound‐guided regional anaesthesia

“…The medical profession has long determined and regulated its own standards of excellence [1]. However, recent decades have seen increasing societal pressure for medical educators to validate their training methods [1][2][3][4].…”

“…However, recent decades have seen increasing societal pressure for medical educators to validate their training methods [1][2][3][4]. Increased concern for patient safety has driven medical education towards 'competencybased' assessments, leading to a demand for reliable, valid and feasible methods of clinical skills assessment [5][6][7][8][9].…”

Transformative thinkers needed for transformative postgraduate education

“…Reform of postgraduate medical education (PGME) is not a new phenomenon (Wallenburg et al 2012;Whitehead et al 2013). One recurrent theme in this area is a push for training generalists who can serve the public in whatever healthcare and geographical context, and an urge to avoid too many subspecialists, as that would inadvertently increase the number of specialists needed to staff the healthcare system (The Danish Ministry of Health 2000; Wallenburg et al 2012).…”

“…One recurrent theme in this area is a push for training generalists who can serve the public in whatever healthcare and geographical context, and an urge to avoid too many subspecialists, as that would inadvertently increase the number of specialists needed to staff the healthcare system (The Danish Ministry of Health 2000; Wallenburg et al 2012). There is a political wish to control workforce -both trainees and future specialists -with the purpose of ensuring service to the public throughout the country while keeping down the cost of healthcare.…”