Albert J J A Scherpbier’s research while affiliated with Maastricht University and other places


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Publications (263)


How culture affects validity: understanding Japanese residents’ sense-making of evaluating clinical teachers
  • Article
  • Full-text available

August 2021

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45 Reads

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2 Citations

BMJ Open

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Takahiro Matsuguchi

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Albert J J A Scherpbier

Objectives Traditionally, evaluation is considered a measurement process that can be performed independently of the cultural context. However, more recently the importance of considering raters’ sense-making, that is, the process by which raters assign meaning to their collective experiences, is being recognised. Thus far, the majority of the discussion on this topic has originated from Western perspectives. Little is known about the potential influence of an Asian culture on raters’ sense-making. This study explored residents’ sense-making associated with evaluating their clinical teachers within an Asian setting to better understand contextual dependency of validity. Design A qualitative study using constructivist grounded theory. Setting The Japanese Ministry of Health, Labour and Welfare has implemented a system to monitor the quality of clinical teaching within its 2-year postgraduate training programme. An evaluation instrument was developed specifically for the Japanese setting through which residents can evaluate their clinical teachers. Participants 30 residents from 10 Japanese teaching hospitals with experience in evaluating their clinical teachers were sampled purposively and theoretically. Methods We conducted in-depth semistructured individual interviews. Sensitising concepts derived from Confucianism and principles of response process informed open, axial and selective coding. Results Two themes and four subthemes were constructed. Japanese residents emphasised the awareness of their relationship with their clinical teachers (1). This awareness was fuelled by their sense of hierarchy (1a) and being part of the collective society (1b). Residents described how the meaning of evaluation (2) was coloured by their perceived role as senior (2a) and their experienced responsibility for future generations (2b). Conclusions Japanese residents’ sense-making while evaluating their clinical teachers appears to be situated and affected by Japanese cultural values. These findings contribute to a better understanding of a culture’s influence on residents’ sense-making of evaluation instruments and the validity argument of evaluation.

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Fig. 1 Framework for developing CME activities based on the self-determination theory that effectively motivate physicians to work and remain in LASs
Attracting and retaining physicians in less attractive specialties: the role of continuing medical education

May 2021

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205 Reads

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14 Citations

Human Resources for Health

Background Less attractive specialties in medicine are struggling to recruit and retain physicians. When properly organized and delivered, continuing medical education (CME) activities that include short courses, coaching in the workplace, and communities of practice might offer a solution to this problem. This position paper discusses how educationalists can create CME activities based on the self-determination theory that increase physicians’ intrinsic motivation to work in these specialties. Main content The authors propose a set of guidelines for the design of CME activities that offer physicians meaningful training experiences within the limits of the available resources and support. First, to increase physicians’ sense of professional relatedness, educationalists must conduct a learner needs assessment, evaluate CME’s long-term outcomes in work-based settings, create social learning networks, and involve stakeholders in every step of the CME design and implementation process. Moreover, providing accessible, practical training formats and giving informative performance feedback that authentically connects to learners' working life situation increases physicians’ competence and autonomy, so that they can confidently and independently manage the situations in their practice contexts. For each guideline, application methods and instruments are proposed, making use of relevant literature and connecting to the self-determination theory. Conclusions By reducing feelings of professional isolation and reinforcing feelings of competence and autonomy in physicians, CME activities show promise as a strategy to recruit and retain physicians in less attractive specialties.


Nationwide survey of patients’ and doctors’ perceptions of what is needed in doctor - patient communication in a Southeast Asian context

October 2020

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126 Reads

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11 Citations

BMC Health Services Research

Background Asian countries are making efforts to apply the partnership model in doctor-patient communication that has been used effectively in Western countries. However, notable differences between Western and Asian cultures, especially the acceptance of a hierarchical order and little attention to individuality in Asian cultures, could mean that the application of the partnership model in Vietnam requires adaptation. The study aimed to investigate whether communication models used in the Western world are appropriate in Southeast Asia, and to identify key items in doctor-patient communication that should be included in a doctor-patient communication model for training in Vietnam. Methods In six provinces, collaborating medical schools collected data from 480 patients using face-to-face surveys with a structured guideline following a consultation session, and from 473 doctors using a cross-sectional survey on how they usually conduct consultation sessions with patients. Data collection tools covered a list of communication skills based on Western models, adapted to fit with local legislation. Using logistic regression, we examined whether doctor patient communication items and other factors were predictors of patient satisfaction. Results Both patients and doctors considered most elements in the list necessary for good doctor-patient communication. Both also felt that while actual communication was generally good, there was also room for improvement. Furthermore, the doctors had higher expectations than did the patients. Four items in the Western model for doctor-patient communication, all promoting the partnership relation between them, appeared to have lower priority for both patients and doctors in Vietnam. Conclusion The communication model used in the Western world could be applied in Vietnam with minor adaptations. Increasing patients’ understanding of their partner role needs to be considered. The implications for medical training in universities are to focus first on the key skills perceived as needing to be strengthened by both doctors and patients. In the longer term, all of these items should be included in the training to prepare for the future.


Fig. 1 Needs of preventive medicine graduates
Fig. 2 Flowchart of participant recruitment process
Study instrument and internal consistency of the subscales after conducting exploratory factor analysis and deleting items
Participants' characteristics, timing of career decision, and places of work
Why do graduates choose to work in a less attractive specialty? A cross-sectional study on the role of personal values and expectations

May 2020

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280 Reads

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10 Citations

Human Resources for Health

Background: Primary health care (PHC), of which preventive medicine (PM) is a subspecialty, will have to cope with a deficiency of staff in the future, which makes the retention of graduates urgent. This study was conducted in Vietnam, where PM is an undergraduate degree in parallel to medical training. It aims to identify facilitating and hindering factors that impact recruitment and retention of PM graduates in the specialty. Methods: A cross-sectional study enrolled 167 graduates who qualified as PM doctors from a Vietnamese medical school, between 2012 and 2018. Data were collected via an online questionnaire that asked participants about their motivation and continuation in PM, the major life roles that they were playing, and their satisfaction with their job. Multiple regression analyses were used to identify which life roles and motivational factors were related to the decision to take a PM position and to stay in the specialty, as well as how these factors held for subgroups of graduates (men, women, graduates who studied PM as their first or second study choice). Results: Half of the PM graduates actually worked in PM, and only one fourth of them expressed the intention to stay in the field. Three years after qualification, many graduates had not yet decided whether to pursue a career in PM. Satisfaction with opportunities for continuous education was rated as highly motivating for graduates to choose and to stay in PM. Responsibility for taking care of parents motivated male graduates to choose PM, while good citizenship and serving the community was associated with the retention of graduates for whom PM was their first choice. Conclusions: The findings demonstrate the importance of social context and personal factors in developing primary care workforce policy. Providing opportunities for continued education and enhancing the attractiveness of PM as an appropriate specialty to doctors who are more attached to family and the community could be solutions to maintaining the workforce in PM. The implications could be useful for other less popular specialties that also struggle with recruiting and retaining staff.


How clinical teaching teams deal with educational change: ‘we just do it’

October 2019

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127 Reads

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17 Citations

BMC Medical Education

Background: In postgraduate medical education, program directors are in the lead of educational change within clinical teaching teams. As change is part of a social process, it is important to not only focus on the program director but take their other team members into account. The purpose of this study is to provide an in-depth insight into how clinical teaching teams manage and organize curriculum change processes, and implement curriculum change in daily practice. Methods: An explorative qualitative semi-structured interview study was conducted between October 2016 and March 2017. A total of six clinical teaching teams (n = 6) participated in this study, i.e. one program director, one clinical staff member, and one trainee from each clinical teaching team (n = 18). Data were analysed and structured by means of thematic analysis. Results: The analysis yielded to five factors that positively impact change: shared commitment, reinvention, ownership, supportive structure and open culture. Factors that negatively impact change were: resistance, behaviour change, balance between different tasks, lack of involvement, lack of consensus, and unsafe culture and hierarchy. Overall, no clear change strategy could be recognized. Conclusions: Insight was gathered in factors facilitating and hindering the implementation of change. It seems particularly important for clinical teaching teams to be able to create a sense of ownership among all team members by making a proposed change valuable for their local context as well as to be capable of working together as a team. Cultural factors seem to be particularly relevant in a team's ability to accomplish this.


Recruitment and retention of healthcare professionals in rural areas is a major, worldwide concern. Medical education has integrated community-oriented medical education strategies to help address these challenges. This study explored medical trainees' preferences regarding place of work and choice of specialty after completing training using either the traditional or mixed Problem-Based Learning/Community-Based Education and Service curriculum in Ghanaian medical schools

September 2019

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575 Reads

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1 Citation

Rural and Remote Health


Concentric onion model of essential elements of teacher qualities (Korthagen 2004, adapted)
From critic to inspirer: four profiles reveal the belief system and commitment to educational mission of medical academics

July 2019

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173 Reads

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8 Citations

Background: The educational beliefs of medical academics influence how they act in class and thus influence student learning. One component of these are beliefs academics hold about the qualities of teachers themselves. These teacher qualities range from behaviours and competencies to more personal attributes such as the teacher's identity and mission. However, it is unclear what medical academics believe to be key teacher qualities. Therefore, this study explored the variety of medical academics' beliefs about 'teacher qualities', aiming to identify and characterise profiles of academics with similar beliefs. Methods: We interviewed 26 expert academics from two medical schools to explore their beliefs about teacher qualities. A concentric onion-model focusing on teacher qualities was used to analyse and categorise the data deductively. Within each theme we developed subthemes inductively. To gain insight into the variety of beliefs we then clustered the participants into teacher profiles according to the themes. To better understand each of the profiles we carried out a quantitative study of the differences between profiles regarding subthemes, contextual and personal factors, and analysed statistical significance using Fisher's exact- and Student's t-tests for categorical and continuous data, respectively. Results: Four profiles of medical academics were identified, corresponding to the most central theme that each participant had reflected on: the 'Inspirer', 'Role-model', 'Practitioner', and 'Critic'. The focus of the profiles varied from external constraining factors within the 'Critic' profile to affective personal qualities within the 'Role-model' and 'Inspirer' profiles. The profiles could be regarded as hierarchically ordered by inclusiveness. Educational institute was the only significant factor related to the profiles. Conclusions: Besides the relevance of affective teacher qualities, the 'Inspirer' profile demonstrates the importance of developing a clear mission as a teaching academic, centred around student learning and professional development. In our view, academics who inspire their students continue to be inspired themselves. The practical implications are described for faculty development programmes, and for the potential value of using these profiles within medical schools. In the discourse on educational beliefs, the authors argue that more attention should be paid to affective qualities, in particular to explicating the educational mission of academics.


Fig. 1 Interaction effects of level in the curriculum and interest in PM on students' realistic perceptions of PM practice (a: Perceptions of PM knowlegde and skills; b: Perceptions of PM daily work's characteristics; c: Perceptions of PM working stress)
Modification of the study instrument and internal consistency reliability of the subscales
Relevance of characteristics of PM in daily work as perceived by students, compared with perceptions of practicing doctors
Effect of level in the curriculum and interest in PM on student's realistic perception of PM
Effect of willingness to work in PM and interest in PM on student's perception of PM
Working in preventive medicine or not? Flawed perceptions decrease chance of retaining students for the profession

May 2019

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109 Reads

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5 Citations

Human Resources for Health

Background: Recruiting and retaining students in preventive medical (PM) specialties has never been easy; one main challenge is how to select appropriate students with proper motivation. Understanding how students perceive PM practice differently from practicing doctors is necessary to guide students, especially for those for whom PM is only a substitute for medicine as their first study preference, properly during their study and, later, the practice of PM. Methods: One thousand three hundred eighty-six PM students in four Vietnamese medical schools and 101 PM doctors filled out a questionnaire about the relevance of 44 characteristics of working in PM. ANOVAs were conducted to define the relationship between students' interest, year of study, willingness to work in PM, and the degree to which students had realistic perceptions of PM practice, compared to doctors' perceptions. Results: Overall, compared to doctors' perceptions, students overestimated the importance of most of the investigated PM practice's characteristics. Moreover, students' perception related to their preference and willing to pursue a career in PM after graduation. In particular, students for whom PM was their first choice had more realistic perceptions of community practice than those who chose PM as their second choice. And, second-choice students had more realistic perceptions than first-choice students in their final years of study, but expected higher work stress in PM practice. Students who were willing to pursue a career in PM rated the importance of community practice higher than those who were not. We also found that students' perception changed during training as senior students had more realistic perceptions of clinical aspects and working stress than junior students, even though they overemphasized the importance of the community aspects of PM practice. Conclusions: To increase the number of students actually entering the PM field after graduation, the flawed perceptions of students about the real working environment of PM doctors should be addressed through vocation-oriented activities in the curriculum targeted on groups of students who are most likely to have unrealistic perceptions. Our findings also have implications for other less attractive primary health care specialties that experience problems with recruiting and retaining students.


Future doctors' perspectives on health professionals' responsibility regarding nutrition care and why doctors should learn about nutrition: A qualitative study

May 2019

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45 Reads

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13 Citations

Education for Health Change in Learning & Practice

Background: Improved dietary and nutrition behavior may help reduce the occurrence of noncommunicable diseases which have become global public health emergencies in recent times. However, doctors do not readily provide nutrition counseling to their patients. We explored medical students' perspectives on health professionals' nutrition care responsibility, and why doctors should learn about nutrition and provide nutrition care in the general practice setting. Methods: Semistructured interviews were conducted among 23 undergraduate clinical level medical students (referred to as future doctors). All interviews were recorded and transcribed verbatim with data analysis following a comparative, coding, and thematic process. Results: Future doctors were of the view that all health professionals who come into contact with patients in the general practice setting are responsible for the provision of nutrition care to patients. Next to nutritionists/dieticians, future doctors felt doctors should be more concerned with the nutrition of their patients than any other health-care professionals in the general practice setting. Reasons why doctors should be more concerned about nutrition were as follows: patients having regular contacts with the doctor; doctors being the first point of contact; patients having more trust in the doctors' advice; helping to meet the holistic approach to patient care; and the fact that nutrition plays an important role in health outcomes of the patient. Discussion: Future doctors perceived all health professionals to be responsible for nutrition care and underscored the need for doctors to learn about nutrition and to be concerned about the nutrition of their patients.


Faculty's work engagement in patient care: Impact on job crafting of the teacher tasks

December 2018

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188 Reads

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10 Citations

Background High levels of work engagement protect against burnout. This can be supported through the work environment and by faculty themselves when they try to improve their work environment. As a result, they can become more engaged and better performers. We studied the relationship between adaptations by physicians to improve their teaching work environment, known as job crafting, and their energy levels, or work engagement, in their work as care provider and teacher. Job crafting encompasses seeking social (i) and structural (ii) resources and challenges (iii) and avoiding hindrances (iv). Methods We established a cross-sectional questionnaire survey in a cohort of physicians participating in classroom and clinical teaching. Job crafting and work engagement were measured separately for physicians’ clinical and teaching activities. We analyzed our data using structural equation modelling controlling for age, gender, perceived levels of autonomy and participation in decision making. Results 383 physicians were included. Physicians’ work engagement for patient care was negatively associated with two job crafting behaviors in the teaching roles: seeking structural resources (classroom teaching: ß = − 0.220 [95% CI: -0.319 to − 0.129]; clinical teaching: ß = − 0.148 [95% CI: -0.255 to − 0.042]); seeking challenges (classroom teaching: ß = − 0.215 [95% CI: -0.317 to − 0.113]; clinical teaching:, ß = − 0.190 [95% CI: -0.319 to − 0.061]). Seeking social resources and avoiding hindrances were unaffected by physicians’ work engagement for patient care. Conclusions High engagement for teaching leads to job crafting in teaching. High engagement for patient care does not lead to job crafting in teaching. Electronic supplementary material The online version of this article (10.1186/s12909-018-1411-z) contains supplementary material, which is available to authorized users.


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Citations (90)


... Once relevant stakeholders are identified, the question arises of how and through which instruments they can be involved, what aspects and level of education they can best evaluate, followed by the question of best timing of involving them and approaching them. Depending on context and timing, each stakeholder might have their own situated knowledge and lived experience as well as contribution to offer in the process of enhancing educational quality (Kikukawa et al. 2021). All these questions need to be considered within the light of the local context in which stakeholders will be involved as appropriate involvement may take different shapes depending on institutional, accreditation or even cultural standards. ...

Reference:

Continuous enhancement of educational quality – fostering a quality culture: AMEE Guide No. 147
How culture affects validity: understanding Japanese residents’ sense-making of evaluating clinical teachers

BMJ Open

... However, global concerns regarding the shortage and misdistribution of a qualified public health workforce exist [5], which affect almost all countries, particularly those that are relatively poor [6,7]. The tendency of public health physicians in China to visit urban areas causes a shortage in rural areas, leading to insufficient health coverage and poor health conditions among rural people [8,9]. ...

Attracting and retaining physicians in less attractive specialties: the role of continuing medical education

Human Resources for Health

... This study found that when patients interact with medical staff with senior professional titles, they show a high power distance tendency such as nervousness, unnaturalness, and even have nothing to talk about, while they show a low power distance tendency such as high willingness to communicate with junior doctors.The reasons can be summarized as follows: on the one hand, medical staff with high professional titles have high authority, and patients have communication anxiety due to the fear of authority.A study has shown that the respect of a top social person in a hierarchical society strongly in uences communication (Tran et al., 2020).Patients believe that physicians with a high status, but do not consider physicians as their partners. However, in Western countries, patients actively engage in consultation, and doctors and patients are equal (Makoul & Clayman, 2006). ...

Nationwide survey of patients’ and doctors’ perceptions of what is needed in doctor - patient communication in a Southeast Asian context

BMC Health Services Research

... On the supply side, an insufficient number of students expect health careers, and many medical school graduates are undecided about pursuing a career in health. In Vietnam, only one-fourth of medical school graduates intend to stay in the field [4]. Approximately 13.7% of Chinese undergraduate medical students intend to withdraw from the profession [5]. ...

Why do graduates choose to work in a less attractive specialty? A cross-sectional study on the role of personal values and expectations

Human Resources for Health

... These studies underscore the need to address these barriers to enhance the effectiveness of both nutrition and PA initiatives. Additionally, healthcare professionals often report significant gaps in their knowledge and skills related to promoting both diet [42][43][44] and PA [39][40][41]45,46], highlighting the urgent need for targeted educational programs to build their confidence and competence in this area. There is an urgent need for the integration of public health principles and consideration of behavioral and psychosocial factors within hospital-based healthcare systems. ...

Future doctors' perspectives on health professionals' responsibility regarding nutrition care and why doctors should learn about nutrition: A qualitative study
  • Citing Article
  • May 2019

Education for Health Change in Learning & Practice

... The implementation of curricular changes within PGME is a complex process, that is typically examined from the perspective of clinical teaching hospitals [9][10][11]. However, the perspective of PGME programs in Public Health (hereinafter: PGME-PH) remains underexplored, despite their distinct educational context and environment. ...

How clinical teaching teams deal with educational change: ‘we just do it’

... The traditional classroom teaching model can no longer meet the needs of modern medical education. Therefore, the reform of teaching models, with question-based learning (2)(3)(4), case-based learning (CBL) (5), team-based learning (TBL) (6), and flipped classroom (FC)-based learning (7) continues to emerge. FC was first proposed by Lage et al. (8) in 2000 . ...

Recruitment and retention of healthcare professionals in rural areas is a major, worldwide concern. Medical education has integrated community-oriented medical education strategies to help address these challenges. This study explored medical trainees' preferences regarding place of work and choice of specialty after completing training using either the traditional or mixed Problem-Based Learning/Community-Based Education and Service curriculum in Ghanaian medical schools

Rural and Remote Health

... FD may be more effective if it also promotes the development of other essential qualities, including an educator's educational identity (Steinert et al. 2019;van Lankveld et al. 2021) and 'mission.' The concept of mission refers to the source of personal inspiration that underlies an educator's identity (Ottenhoff-de Jonge et al. 2019). ...

From critic to inspirer: four profiles reveal the belief system and commitment to educational mission of medical academics

... __________________________ блемы в медицинском образовании, низкий социальный статус врачей, высокая рабочая нагрузка, условия труда и низкий уровень заработной платы [5]. Кроме абсолютного дефицита регистрируется и неравномерное распределение медицинского персонала по специальностям и географическим районам [6,7]. ...

Working in preventive medicine or not? Flawed perceptions decrease chance of retaining students for the profession

Human Resources for Health

... On the one hand, job demands included, but were not limited to, workload, task complexity, and task interdependence misft [42][43][44][45]. On the other hand, job resources included, but were not limited to, autonomy (support and congruence), perceived organizational support, sense of control, in-role work engagement, and playful work design [46][47][48][49]. Personal resource (e.g., proactive personality and resilience [50,51]) and biographical (e.g., age and gender identity [52,53]) factors were other signifcant clusters in the individual domain. ...

Faculty's work engagement in patient care: Impact on job crafting of the teacher tasks