Scientific research Buitengewoon Baanbrekend

Buitengewoon Baanbrekend

Aim of the Buitengewoon Baanbrekend Project

The Buitengewoon Baanbrekend project aims to provide joint training for general practice and pediatrics residents, focusing on the care of acutely ill children and interdisciplinary collaboration. A key aspect of this initiative is mutual learning, where residents learn from, with, and about each other within and across their respective training environments. By stepping outside their traditional educational contexts, participants engage in each other’s “training orbit,” fostering a deeper understanding of their roles in collaborative pediatric care.

This project aligns with the objectives of the Federation of Medical Specialists (FMS), as outlined in the Training 2025 vision document.

Background of the Buitengewoon Baanbrekend Project

Effective collaboration between general practice and pediatrics residents in the care of acutely ill children is of paramount importance. Within minutes and often under high-pressure conditions, clinicians must jointly assess potential diagnoses and determine appropriate management strategies. This process requires not only the efficient exchange of medical information but also well-developed skills in alignment, coordination, and contextual thinking to ensure high-quality, well-coordinated pediatric care.

Despite the critical role of collaboration in pediatric care—and in patient care more broadly—residents receive little formal training in interprofessional teamwork. Furthermore, reciprocal learning opportunities are often lacking; residents typically remain within their own disciplines or transition into another specialty in a one-sided manner. Recognizing this educational gap, the Buitengewoon Baanbrekend project was developed as an intraprofessional training initiative to enhance interdisciplinary cooperation and mutual learning.

The Project in Brief

The Buitengewoon Baanbrekend project was launched in 2020 as a pilot at training general practice (GP) clinics in Nijmegen, the Nijmegen GP out-of-hours service, and the pediatrics department of Canisius Wilhelmina Hospital (CWZ). Following the successful pilot phase, the project was expanded to include the pediatrics departments of Rijnstate Hospital Arnhem and Jeroen Bosch Hospital (JBZ) Den Bosch, as well as affiliated GP outpatient clinics and training GP practices.

In this project, general practice and pediatrics residents form a DUO, collaboratively assessing acutely ill children in each other’s clinical settings—both in emergency care and routine practice. In addition to these clinical encounters, the program includes structured educational activities:

• DUO Meetings – Three reflective sessions where resident pairs discuss their collaborative experiences in managing pediatric cases.
• Optional Online Sessions ("Pediatric Topics") – Covering both medical aspects and interdisciplinary collaboration in the care of acutely ill children.
• Biannual Case Conferences – Joint discussions involving all general practice and pediatrics residents, along with their trainers/supervisors, focusing on (complex) pediatric cases.

By integrating cross-disciplinary clinical exposure with structured learning opportunities, the Buitengewoon Baanbrekend project enhances collaborative skills and mutual understanding in pediatric acute care.

The research

During the pilot phase, research was integrated into this project to evaluate its impact on the development of intraprofessional collaboration skills among general practice and pediatrics residents in the care of acutely ill children. The first study has been completed and demonstrated that both groups of residents gained a better understanding of their own roles in the collaborative process, developed greater appreciation for each other’s responsibilities, and experienced increased enjoyment in working together. Additionally, the project inspired new ideas on how to improve and streamline the coordination of care for acutely ill children.

However, the findings also indicated that intraprofessional learning is more effective when residents work together more frequently and over an extended period within each other’s clinical contexts. This sustained interaction provided better opportunities for targeted feedback and deeper reflection on optimizing the collaborative process.

Furthermore, residents found educational sessions on transmural and intraprofessional collaboration highly valuable. They reported that these sessions helped them conceptualize and apply collaborative thinking more concretely in clinical practice.

Based on these insights, modifications were made to the project. It is now being implemented at multiple locations, with active monitoring and ongoing evaluation to further enhance its effectiveness.

Interested in Participating or Learning More?

Each year, all first- and third-year general practice residents are invited to participate in the project. Registration is done by responding to the invitation email and signing up for the introductory session. Pediatrics residents from participating hospitals are invited by their supervisors.

A new group of residents joins the Buitengewoon Baanbrekend project every January.

For registration or more information, please contact Milou Croes or Rosalin van Schie

Agenda

The agenda for 2025:

• January 21, 2025 - 16:30-18:00 DUO Session 1 CWZ
• February 4, 2025 - 16:30-18:00 DUO Session 1 Rijnstate Hospital
• March 11, 2025 - 17:00-18:00 Pediatric Topic Dermatology (Online)
• April 8, 2025 - 16:30-18:00 DUO Session 1 JBZ
• April 22, 2025 - 16:00-16:45 DUO Session 2 CWZ (Online)
• April 22, 2025 - 17:00-18:00 Pediatric Topic Allergology (Online)
• May 6, 2025 - 17:00-17:45 DUO Session 2 Rijnstate Hospital (Online)
• May 20, 2025 - 17:00-18:00 Pediatric Case Discussion 1 (Online)
• June 3, 2025 - 17:00-18:00 Pediatric Topic Neonatology (Online)
• July 1, 2025 - 15:00-18:00 DUO Session 3 Joint Educational Afternoon
• October 7, 2025 - 17:00-18:00 Pediatric Topic Youth healthcare (Online)
• October 14, 2025 - 16:30-17:00 DUO Session JBZ (Extra) (Online)
• November 18, 2025 - 17:00-18:00 Pediatric Case Discussion 2 (Online)
• December 9, 2025 - 17:00-18:00 Pediatric Topic Pain & Anxiety (Online)

Jointly Assessing Sick Children

1. ‘Pediatric shift’ at the out of hours General Practitioner Post
    The duo informs the medical assistants at the start of their shift that they will be handling pediatric cases. Children are selected from the patient pool at the general practitioner post by the assistants. The duo jointly assesses these children. In case of uncertainty regarding the assessment of a child, the general practice supervisor will be asked to review the case, and their judgment will be decisive. A prerequisite for this service is that the general practice supervisor is present at the GP post.
    
2. Pediatric Shift at the Emergency Department/Pediatrics Department
   The general practice resident accompanies the pediatric resident during their shift at the hospital’s emergency department or pediatrics department.
    
3. In the General Practice Setting
   The pediatric resident spends a day (or part of the day) at the general practice of the general practice resident. It is advised to schedule as many pediatric cases as possible for this consultation to ensure a sufficient caseload for the duo.
    
4. At the Pediatric polyclinic
   The general practice resident spends a day (or part of the day) at the pediatric polyclinic together with the pediatric resident.
    

Conditions:

For all four components that take place on location, the condition is that the supervisors are present or easily reachable for consultation. In case of doubts about diagnosis or management, the supervisor's opinion will be decisive.

Discussing Learning Experiences After Joint Assessments

To give meaning to the learning experiences gained during joint assessments for their future roles as general practitioners and pediatricians, the experiences are discussed using a debriefing form. This form is tailored to interprofessional collaboration skills. This encourages evaluation not only of medical content but also of the interprofessional collaboration. The debriefing forms can also be used and added to the training portfolio. Participating residents will receive these debriefing forms via email.

Educational Sessions

A general introduction session regarding the project will be held in November for potential participating general practice residents. When the project begins in a new hospital, this introduction session will also be provided to pediatric residents. Since pediatric residents do not rotate "as a group," the explanation of the project for new pediatric residents will be given by the coordinating pediatric resident and pediatric supervisor.

DUO Sessions

Within a month of the formation of the new duos, a meeting will be organized. During these DUO sessions, the AIOS will get to know each other better, and intraprofessional topics and skills will be discussed and practiced. A second and third DUO session will be held with an interval of 3 to 4 months. These sessions will also provide an opportunity for the residents to exchange experiences they have gained while jointly assessing children.

Pediatric Case Discussions

Twice a year, an online case discussion will be organized, to which all second-phase general practice residents (including those who do not participate in the project components and form a duo), all general practice supervisors, all pediatric residents, and pediatricians from participating hospitals and Radboudumc will be invited. The case discussions may include cases submitted by participating residents or supervisors, or they may be provided by the ‘Baanbrekend team’. Accreditation points will also be requested for these case discussions.

Pediatric Topics

Four to five times a year, pediatric topics will be offered for general practice residents, focusing on subjects within pediatrics. These sessions will include relevant pediatric case discussions for primary care. In addition to medical knowledge, the central question of each session will be whether further diagnostics or management should take place in primary or secondary care, and what the considerations are for this decision. The pediatric topics are also open to all general practice residents, including those who do not participate in the project, as well as pediatric residents from the participating hospitals.

Coordination and Training Team Buitengewoon Baanbrekend

Project Coordination

General Practice Training, Department of Primary Care, Radboudumc Nijmegen

• Rosalin van Schie, Head Coordinator of the Project, General Practice Instructor with a focus on pediatric care and PhD candidate in intraprofessional training in acute pediatrics.
• Milou Croes, Project Coordinator, General Practice Instructor with a focus on pediatric care.
• Claudia Lobo, Head of General Practice Training.

Pediatrics Training, Amalia Children’s Hospital, Radboudumc Nijmegen

• Ester Coolen, Pediatrician and Deputy Trainer in Pediatrics.

Pediatrics Training, Canisius Wilhelmina Hospital, Nijmegen

• Paul Voorhoeve, Pediatrician and Deputy Trainer in Pediatrics.

Pediatrics Training, Rijnstate Hospital, Arnhem

• Hanneke Dekker, Pediatrician.

Pediatrics Training, Jeroen Bosch Hospital

• Cathelijne van Feen, Pediatrician and Trainer in Pediatrics.

Resident Coordinators

At each training location, a resident is involved in co-coordinating the project, ensuring that the perspective of the resident is maintained.

Instructors and Trainers in the Project

In addition to the aforementioned project coordinators, pediatric trainers and general practice trainers working at the listed locations are essential, as a significant portion of this project occurs in the workplace. Various general practice instructors and behavioral science instructors from the general practice training program, with expertise in intraprofessional training, also teach during the DUO sessions of the project.