How the Netherlands Association of Pulmonologists Successfully Implemented a National EPA-Based Program

How is the Dutch training program for Pulmonology set up?

“The program consists of preliminary and advanced training stages. The preliminary stage takes place at the Department of Internal Medicine and spans 20 months, followed by 52 months of advanced training, totaling six years on average. The preliminary stage covers the foundations of general internal medicine, cardiology, and intensive care. The advanced stage involves mandatory rotations of varying lengths, including wards, outpatient clinics, and consultations. There is also an academic or peripheral exchange for at least six months, to experience working in varying organizations. Additionally, there is a flexible component for specialization, such as in interstitial lung diseases, that is also documented in the portfolio. The goal is to individualize the training as much as possible.”

Why Were EPAs Introduced into the Program?

“The primary goal was to individualize the training. The EPAs are specific to pulmonology, and chosen to relate to areas of focus such as Asthma or COPD. There are mandatory EPAs and some optional EPAs for specialization that are linked to different phases or rotations. The aim is to show trainees what they are expected to master independently by the end of their training and how to get there.

The degree of independence throughout the training varies in practice; some trainers insist on independent work after completing an EPA, while others are more cautious, still requiring consultation in some cases. However, as a national association, we set the bar for the level of independence required to complete an EPA. While clinics have some freedom in their local requirements, trainees must at least demonstrate their competencies through Workplace-Based Assessments, referral letters, and knowledge of medical guidelines over the course of their training.”

What Are the Benefits and Challenges of an EPA-Based Program?

“EPAs provide a good structure for the training program, especially when combined with progress interviews, serving as a useful framework to identify underrepresented topics. Also, EPAs allow us to take a more individualised approach with trainees, both in terms of areas of interest as well as the time needed to master certain topics.

While, in theory, all members of staff should weigh in before signing off on an EPA, in practice, approval from the entire staff is often less stringent. It usually involves the trainer and a direct supervisor, sometimes involving others to make that decision.

In developing the program, there was also the challenge of designing good EPAs: should they be medically content-focused or more context-oriented, such as focusing on outpatient clinics? Our choice of content-focused EPAs has worked well for us, but we know of other specialties that took a different approach, which has worked for them as well.”

Why Did You Switch to the Reconcept EPA Portfolio?

“To effectively launch our new training program, we wanted to provide a clearly designed portfolio that follows the EPA structure. We felt that it should make the requirements of the program clear to trainees and trainers alike. We needed a portfolio with enough features but without those features becoming distractions. It should give an immediate overview of a trainee’s progress and the attention required. Reconcept EPA Portfolio was a major improvement in these areas.

The app is also very user-friendly, allowing for quick Workplace-Based Assessments in the workplace and easy access to overviews. The portfolio excels in clarity and simplicity, which is crucial for busy doctors who can’t afford to spend too much time figuring out how things work. It integrates well with the preliminary training at the Department of Internal Medicine, which is using the same platform nationwide.”

How Did People Respond to the New EPA Portfolio?

“There is always some hesitance when it comes to new things. However, we managed to get a few enthusiastic trainers and trainees on board early on in the process. Overall, there was excitement about these new developments. The idea of consolidating everything into a clear, comprehensive portfolio was quickly embraced. In the first year, we worked together with Reconcept on some minor adjustments to make the app fit with our practice even better. There were never any structural problems or significant resistance during the implementation.”

How Do You Envision the Future of the Training Program?

“In The Netherlands, teaching hospitals are moving towards better regional collaboration and quality visitations. The portfolio already facilitates the regional mobility of trainees by allowing them to involve trainers in different locations. We feel that EPA-based training is serving our needs well. Regarding the portfolio itself, I don’t foresee any major changes needed in the future.”