Table 2 Overview of the quality aspects mentioned by clinicians

Match

1. Supervision and feedback

X

X

X

X

X

X

Quality and effectiveness of supervision and feedback; and accessible and dedicated supervisors were main topics

2. Safe learning environment

X

X

X

X

X

X

A safe culture and an anti-hierarchical environment were fundamental conditions for training

“Hierarchy is a dangerous system.” (SupervisorNL02)

3. Training program structure

X

X

X

X

X

X

The training program should be relevant and fit for purpose. It should also be well-integrated with healthcare, continuous professional development and undergraduate education

4. Clinical exposure

X

X

X

X

X

X

Clinical experience in terms of exposure to diverse diagnoses and patient mix were important

5. Knowledge and skills

X

X

X

X

X

X

All clinicians focused on this theme, but trainees especially underlined CanMEDS roles

6. Assessment

X

X

X

X

X

Assessments should be legitimate and fit for purpose, especially if they are summative. The Australian supervisors have the strongest focus on assessment compared to all other groups

7. Regulation and governance

X

X

X

X

X

Supervisors in both countries emphasized the importance of hospital administration understanding and valuing teaching and learning. Without managerial support of a hospital, having a training program would be difficult. In addition, a regulatory framework with an external review of the program is necessary

8. Collaboration

X

X

X

X

X

Australian stakeholders focus on international collaboration, whereas Dutch stakeholders highlight regional collaboration

9. Education

X

X

X

X

Trainees demanded protected time for formal education. A focus on life-long learning, and a variety of learning methods, were important aspects according to accreditors. “(…) it needs to be able to set up a culture of continual learning. So it is important that once someone has qualified in that specialty that that isn’t the end of their learning as long as their career pathway goes.” (AccreditorAU03)

Mismatch

10. Balance between service provision and training

X

X

X

X

This is a major issue for clinicians. This balance must be weighted to training according to trainees. Both standards did not cover this aspect

11. Trainee empowerment

X

X

Trainees plead not to abuse their position and take advantage from their dependency. They need positive supportive behavior from their supervisors. “(…) generally people that enter into these things are smart and motivated and will do what they need to do to succeed and it’s all about making sure that they're not taken advantage of in that time.” (TraineeAU01)

Differences between jurisdictions

12. Resources

X

X

*

X

X

X

Without proper resources, no proper training was the maxim of the most stakeholders. Dutch standards did cover facilities, but did not capture time and finances, which were the aspects especially underlined by Dutch clinicians

13. Job satisfaction

X

X

X

X

*

Different aspects such as happiness, well-being and good mutual relations were pointed out. Trainee well-being is covered by Australian standards

14. Adaptive professionals and training programs

X

X

Continuous renewal of training programs and professionals adaptive to changing circumstances and future care were essential

15. Outcome focused

X

X

X

In this theme program and graduate outcomes were emphasized. For Dutch accreditors more focus on outcomes was desirable

16. Community needs

X

X

In Australia, alignment to community needs was a key issue in designing and delivering the training program. However, how to approach this meaningfully is a question mark. “Often trained consumer representation could be too optimistic.” (AccreditorAU05)

17. Access and selection

X

X

This theme referred to fair selection procedures and access to several training sites

18. Trainee-centered program

X

X

X

X

Training programs could be tailored based on individual talents and competences