“The pandemic placed a bomb under the organisation of the foundation programme,” says Fop van Kooten, the co-ordinator of EUR’s Master’s programme in medicine. “Waiting times for students have become longer due to the pandemic.” At the start of the pandemic, Master’s degree programmes in medicine ground to a halt throughout the Netherlands, and the resulting back logs are still causing problems.

‘Very good cohort’

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Image credit: Pauline Wiersema

Moreover, there were relatively many students that year who were ready to embark on their foundation programme, precisely in a year during which having a large number of students for whom internship positions had to be found was rather tricky. “This is a very good cohort, so not many of them had fallen behind in their studies,” says Van Kooten. “In addition, because of the pandemic, far fewer students took a gap year than usual. And there were more students from previous years who had fallen behind in their studies and more people switching to medicine from other degree programmes than in other years.” So essentially, there was a bow wave that resulted in a huge back log.

At the start of this academic year, students were complaining about the long waiting times for the foundation programme. Some had to wait nearly two years before being allowed to get started and were angry about it. “And rightly so, because I’d be pretty miffed too if I had to wait for ninety weeks,” says Van Kooten. “We’re very sorry for them. But I understand that won’t help them much.”

Before the pandemic, students generally had to wait for four weeks before embarking on their foundation programme. However, this academic year, students on average have to wait for fourteen weeks. Van Kooten says that they have got rid of the worst back logs. “Except for two students, no one will have to wait for longer than a year.”

Using next year’s spots

Two temporary measures have allowed the department to reduce the waiting times to some extent. Students can embark on a foundation programme five times per year. Normally, 72 students are allowed to get started each time; now this number has been raised to 84. It was 84 last year, as well, but the increase now applies to this year’s students and next year’s, as well. “As a result, for the next three years, we’ll be able to allow 420 students per year to start their foundation programme, rather than 360.”

In addition, the burden will be distributed: “We’re basically using next year’s spots. We’ve assigned the places available in the first round, which we normally reserve for students who wish to start next year, to students who’ve had to wait for a long time this year.”

Helping out at the hospital

The co-ordinator also seeks to help students who do have to wait a long time for their turn. “While students wait for the start of their foundation programme, they can work at the hospital. Hospitals are currently establishing teams of students, where students can help out on busy days and get paid to do so, thus allowing them to learn while waiting. We also refer students to the vacancies posted by the MFVR study society. In this way we’re trying to provide them with some alternatives.”

Van Kooten explains that simply assigning more students to those hospital units that train foundation doctors (medical interns) would not work. Even before the pandemic, some units were a little short on people who could supervise foundation doctors. “Now they’re all quite busy.” Moreover, hospital staff have had a rough time of it. “For instance, we send students to Brabant, to the Amphia Hospital, where the coronavirus nightmare began. We’re very proud that the foundation programme can actually go ahead during this period. Staff are exhausted. If we ask them to supervise too many students, the quality of the foundation programme will eventually be affected. That’s the balance we have to take into account.”

Illustraties EM magazine illustrator

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Impossible to predict

Should the department have realised that waiting times were going to be this long? “Obviously, we ask ourselves the same question. But no, it’s impossible for us to predict how many students will want to take part in the foundation programme. We really don’t know until after the final re-sits in August how many students will want to be included in that month’s draw. Every cohort is different in terms of how long it takes students to complete their degree programme, how many people fall behind in their studies and how many people join us from other degree programmes.”

A working group has been established to come up with ideas for long-term changes. Van Kooten does not think that long-term solutions will be required. “We think we’ll have fewer students next year and then the problem will solve itself.” The same working group is also looking into measures that may be implemented if the number of students does stay high, also with a view to improving the curriculum in the coming years. “We want to do something about the way in which the programme is structured, so as to give people a little more flexibility. But it’s too early days to go into more detail.”

Four-day working week

What is clear is that a four-day working week, which is often presented as a viable option to make the foundation programme more flexible, will not solve anything. “This is only useful in situations where there are four foundation doctors in one unit. In such cases, [implementing a four-day working week] would allow for one additional student to be placed there. But there are quite a few units with just the one foundation doctor. A four-day working week would result in a loss of 20 per cent of supervision time there.”

The National Education Programme (a fund established to reduce the impact of the coronavirus crisis) has been endowed with funding to reduce the amount of time students have to wait for their internships. However, that money won’t solve the problem, says Van Kooten. “Money isn’t the issue. The issue is a lack of available training positions. If there aren’t enough supervisors, or not enough patients to practise your skills on, you won’t learn enough.”