Walther Nicolaas Karel Anton van Mook

Objectives: This scoping review synthesises peer-reviewed and grey literature on supported access to medical care for hospital employees with existing physical health complaints to understand how it may reduce sickness absenteeism by promoting sustainable employability and to identify gaps and opportunities to inform the design and implementation of organisational supported care frameworks. Design: We conducted this scoping review following the Arksey and O’Malley framework and Levac et al ’s methodological recommendations, reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensions for Scoping Reviews (PRISMA-ScR). Data sources: MEDLINE (Ovid), Embase (Elsevier), CINAHL (EBSCO) and Web of Science were searched from database inception to 8 November 2024. The search was updated on 18 May 2026. This was supplemented by forward and backward citation tracking of included peer-reviewed articles and targeted hand searching of Dutch grey literature in Medisch Contact , a leading Dutch professional journal for the medical profession, focusing on clinical practice, medical policy and professional issues. Eligibility: English-language or Dutch-language peer-reviewed publications and well-argued opinion pieces on healthcare workers’ access to care (COVID-19 and beyond) in hospital or transferable settings were included. Sources focused on mental health or health promotion, financial aspects, personal protective equipment, patient access or healthcare worker utilisation, as well as non-English/Dutch sources, webpages and papers without full text, were excluded. Data extraction: ASReview was used for title and abstract screening following the SAFE procedure and full-text screening was conducted with team consensus. Results: 27 publications were included from 36 685 identified records. The literature was predominantly qualitative in nature and COVID-19-focused, yielding four themes (ethical considerations, multilevel challenges, target groups and strategies and outcomes). It also highlighted limited evidence on evaluated supported-access interventions and workforce outcomes beyond crises. Conclusions: Although supported access to medical care for hospital employees appears a promising multilevel, system-embedded strategy to reduce sickness absenteeism and promote sustainable employability in general, the evidence to substantiate and justify such strategies beyond acute crises is limited. Moreover, current literature lacks clear conceptualisation, operationalisation as well as robust implementation and evaluation frameworks. Addressing these gaps is a priority for future research to scientifically scaffold policies and frameworks to sustain a healthy and stable future hospital workforce.

Introduction: Simulated patients (SPs) play a key role in medical communication training, yet their contribution to feedback dialogues during post-simulation feedback sessions remains underexplored. This study explored how SPs contribute to meaningful feedback dialogues among students during feedback sessions after simulation-based consultations. Methods: Using an interpretivist qualitative approach, video-recorded feedback sessions with first-year technical medical students and SPs were analyzed. Episodes identified as meaningful feedback dialogues were thematically analyzed, focusing on SP contributions. Results: Of the 120 one-minute episodes during feedback sessions, 36 episodes were classified as meaningful feedback dialogue. These were characterized by one or more of the following aspects: SPs’ guidance on task performance, shifting positions of SPs, and SPs supporting the contribution of students by facilitating and creating space. Discussion: SPs’ guidance on task performance appears to respond to students’ need for direction. While such guidance can support learning, it also risks reducing student reflection. Therefore, SPs need awareness of when and how to provide guidance. Although instructed to remain in the patient positions, SPs adopt multiple positions: the patient’s position, the expert’s position, and the meta-position during the feedback dialogue, which can enrich learning if managed consciously. Increasing SPs’ awareness of these different ways of contributing to students’ learning may enhance their educational impact in communication training.

Purpose: Clinical reasoning struggles are a leading cause of remediation referrals in postgraduate medical education. Most remediation efforts, like much of the clinical reasoning literature, focus on diagnostic reasoning. Errors in management reasoning can have serious consequences for patients, yet no framework exists for recognizing how learners struggle in this domain or for guiding remediation when they do.Methods: We conducted a multi-institutional qualitative interview study within a constructivist paradigm using the critical incident technique to explore how postgraduate medical trainees struggle with management reasoning in clinical practice, how those struggles are recognized, and how programs respond. Participants were residency program directors and clinical competency committee chairs from U.S. internal medicine and pediatrics programs. Data were analyzed using a systematic cross-case approach to identify phenotypes of management reasoning struggle.Results: We interviewed 20 program directors and clinical competency committee chairs from 15 programs about 15 trainees remediated for management reasoning difficulties. Cross-case analysis identified four phenotypes: (1) limited management scripts (inability to generate or contextualize a plan despite reaching a diagnosis), (2) can’t change course (inability to integrate new clinical information into an existing management plan), (3) impaired task triage and execution (difficulty prioritizing and coordinating management within a complex clinical environment), and (4) failure to calibrate (misjudgment of how much intervention a situation warrants). Contextual (i.e., situational) factors including clinical complexity, patient acuity, diagnostic uncertainty, and reduced supervision increased the likelihood of these phenotypes, and team structures often compensated for struggles before they were recognized. Struggles were frequently misattributed to problems with time management, organization, or communication, and remediation strategies were largely nonspecific across phenotypes.Conclusion: These four phenotypes offer program leaders and frontline educators an empirically grounded vocabulary for recognizing patterns of management reasoning struggle earlier and designing more targeted support.

Intensive care unit (ICU) patients with COVID-19 are isolated until two subsequent SARS-CoV-2 PCR tests have become negative. The question is whether the viral RNA detected here represents intact or compromised viral particles. A viability PCR method detects only intact infectious viruses and disregards RNA from incomplete non-infectious viruses or RNA remnants. We hypothesize that the time to a negative PCR is shorter using the viability PCR compared to conventional SARS-CoV-2 PCR. Patients admitted to the ICU in the Maastricht University Medical Center within an ongoing prospective cohort were included, and respiratory samples were collected three times weekly. Samples were aliquoted for viability PCR into two aliquots, one of which was treated with propidium monoazide (PMA) to eliminate incomplete viruses. The PMA-untreated sample corresponded to the traditional SARS-CoV-2 PCR used in routine diagnostics. A mean time difference between viability and conventional PCR was estimated, assuming a negative binomial distribution. One hundred two ICU patients were included in the analysis. The time to a negative PCR test result differed significantly between viability PCR and conventional PCR (Paired Prentice-Wilcoxon test P -value = 0.0001). On average, the first negative viability PCR test result occurred 2.4 days (95% CI 1.5–4.2) before the first negative conventional PCR test result. The application of a viability PCR technique for SARS-CoV-2 provided an earlier indication of the absence of intact virus, suggesting reduced infectivity, potentially enabling earlier de-isolation of ICU patients. IMPORTANCE: This study demonstrated that, within patients, on average, viability PCR became negative 2.4 days earlier than conventional PCR, indicating that viability PCR could potentially assist in de-isolating patients 2.4 days earlier. Future use of this assay could thus aid in improving routine COVID-19 diagnostics and prognostics related to the timing of de-isolation. Additionally, future development of a similar approach for other respiratory viruses could be of interest.

Integrating military training with academic education at military academies presents a significant challenge. Consequently, officer cadets often develop skills and academic abilities through separate learning tracks. This disjointed approach can hinder their capability to apply both domains cohesively in real-world contexts. To address this, an innovative integrated instructional design model was developed to align military training and academic education. A mixed methods study was conducted to gather validity evidence for this model, involving surveys and focus group sessions with officer cadets of the ROYAL NETHERLANDS MARECHAUSSEE (i.e. a Gendarmerie Corps) at the NETHERLANDS DEFENCE ACADEMY. The findings of this study indicate that this integrated instructional design model successfully fulfills the requirements of both military training and academic education, and they provide insights for its potential implementation. Future research could explore the model’s applicability in other professional domains, such as police education, where similar integration challenges exist.

Background: Previous studies have focused on the role of simulated patient (SP) feedback on students’ learning outcomes after an SP-student encounter, whereas more recent studies have aimed to unravel meaningful learning during the encounter. We gain a more detailed understanding of students’ meaningful learning by examining the perspectives of students and SPs during the SP-student encounter. The research question was as follows: What are characteristics of meaningful learning moments for students during SP-student encounters and what are the perceptions of SPs during these moments? Methods: Twelve second-year Technical Medicine students conducted a medical consultation with SP presenting the same patient case. Each consultation was followed by qualitative, video-stimulated recall (SR) sessions, first with the student and then with the SP. During these sessions, students were prompted to articulate the thoughts they had during the consultation to identify meaningful learning moments. Video-fragments of the meaningful learning moments identified by the student were subsequently shown to the SP to explore their perceptions. All verbatim-transcribed recall data were thematically analyzed. Results: Student-identified meaningful learning moments were characterized by experiences that offered new insights, evoked emotions, and/or involved feedback-in-action from the SP. The SP’s perspectives of the same moments were compared to those of the students, revealing that these perspectives aligned approximately as often as they differed. SP experienced the moments as if they were the actual patient, fully embodying the patient’s role, while simultaneously maintaining an overview and being aware of the student’s learning position. Conclusions: This stimulated recall study enhanced our understanding of students’ learning during SP-student encounters. For students, meaningful learning moments involved new insights, emotional responses, and feedback-in-action from the SP. When SP fully engage in their patient role while maintaining awareness of the student’s learning context, they can respond authentically and supportively. Preparing SP to balance authentic role portrayal with educational awareness can enhance their contribution to students’ learning.

Background: Physicians have become more responsible for pursuing healthcare efficiency. However, contemporary literature uses multiple terminologies to describe healthcare efficiency. To identify which term is best suitable for medical education to equip physicians to contribute to healthcare efficiency delivery in clinical practice, we performed a narrative review to elucidate these terms' meanings, commonalities, and differences. Methods: The PubMed-database was searched for articles published in 2019–2024 describing healthcare efficiency terminology. Eligible articles conceptually described and applied relevant terminologies for physicians, while empirical studies and practice-specific articles were excluded. The screening was supported by an open-source artificial intelligence tool (ASReview), which prioritizes articles through machine learning. Two reviewers independently screened the resulting articles, resolving disagreements by consensus. Final eligibility was determined through predefined inclusion criteria. Results: Out of 3,655 articles identified, 26 met the inclusion criteria. Key terminologies: cost-effectiveness, high-value care, low-value care, and value-based healthcare, were identified, and explored into more depth. ‘Value’ is central in all terms, but our findings reveal that the perspectives herein differ on what constitutes value. Within cost-effectiveness, resource allocation to the population’s needs drives decision-making—maximizing value at population-level. Within value-based healthcare, patient-centricity guides decision-making—maximizing value at individual patient-level. High-value and low-value care are somewhat ambiguous, depending solely on cost-effectiveness results or patient preferences to determine whether care is considered as low or high value. Conclusions: Cost-effectiveness may be too rigid for patient-physician interactions, while value-based healthcare might not ensure sustainable care. As physicians are both stewards of finite societal resources and advocates of individual patients, integrating cost-effectiveness (resource allocation for population needs) and value-based healthcare (individualized care plans) seems necessary. Both terms emphasize delivering high-value care and avoiding low-value care. We suggest that medical education: (1) train (future) physicians to apply healthcare efficiency principles through case-based discussion, (2) use the cost-effectiveness plane to evaluate treatments, (3) deepen knowledge of diagnostic and treatment procedures’ costs within evidence-based guidelines, and (4) enhance communication skills supporting a healthcare efficiency-driven open shared decision-making with patients.