Kiki Lombarts

Almost 20 years ago, the Netherlands began thinking about the individual performance assessment of medical specialists (IFMS). After years of focusing on quality assurance by and within professional groups —culminating in a solid system of visitatie (peer reviews)—it became clear that the individual medical specialist could no longer be left out of the equation. In line with international developments, a system of IFMS was also introduced in the Netherlands. Thoughtfully developed, well-considered, and based on scientific evidence and consensus. The latter was achieved through a two-year project involving multiple medical societies and pilot studies in both large and small hospitals. The recommendations for introducing IFMS, written by the so-called IFMS Committee (commissioned by the Dutch Order of Medical Specialists), was published in the report "Persoonlijk Beter". As project advisor, I co-authored most of this report together with the then-chairman, Professor Dr. Berry Kremer.
Although ‘development’ often—and in this case too—progresses faster than ‘implementation’, IFMS gradually found its way into practice in the years following the report’s publication in 2007. Fast forward to 2025: all medical specialists are now familiar with the system of (guided) reflection on their own performance, including the 360-degree feedback that is collected for this purpose, and the subsequent reflection dialogue. This “100% participation” is not surprising, as since 2020, participation has been mandatory for individual (once every five year) recertification purposes.
We can now state that IFMS is here to stay. As one of the IFMS facilitators—those who conduct the reflection conversations with medical specialists—I am pleased about this. Humbly, I believe I have had many meaningful conversations with medical specialists. Meaningful in the sense of creating a positive experience by taking two full hours to truly listen (nonjudgmentally—that’s what I try at least), to exchange ideas, and to think constructively and appreciatively about a personal development goal. Meaningful also in terms of a tangible result: when we together formulate a goal and action points that are important and achievable for the physician, and for which they are genuinely motivated.

I consider it an honor when specialists choose to have these conversations with me. I am consistently impressed by the immense talent working at Amsterdam UMC and the strong commitment to providing excellent care for patients, and to supporting colleagues. At the same time, I also observe much distress: organizational struggles—with leadership, social safety, the consequences of the merger—as well as personal struggles with insecurity, ambitions, and life questions.
There is a lot to be said about IFMS. And it is good that we start saying it, based on research. What forms have developed? What do specialists think about it? How do they experience receiving feedback from colleagues? What touches them, what paralyzes them, what motivates them to act—or to refrain from action? Are all facilitators as positive as I am? And, of course, the key question: what does it all lead to?
My new PhD candidate, Eva Theodoropoulou, will be exploring these questions in the coming years. After 20 years, it is time.

With all the attention and innovations in residency training , program directors (PD) and supervisors have taken on a significant number of additional tasks and responsibilities. This could not—and cannot—happen without considerable focus on faculty development: activities that teaching faculty undertake to improve their knowledge, skills, and behaviors as educators, teachers and supervisors. These activities have been strongly supported by the emergence of learning centers (Leerhuizen), the expanding range of professional development offerings, and numerous thematic conferences—including the assessment and evaluation of the knowledge and skills gained (think of site visits, training climate surveys, feedback from residents, etc.).

Nevertheless, increasingly more is being asked and expected of teaching faculty. As is typical for doctors, they do their best to meet these expectations—as well as they can. The result is impressive: as of 2025, terms such as competency-based education, portfolios, EPAs (Entrustable Professional Activities), mini-CEXs (Korte Klinische Beoordelingen), individualization, and training plans have become familiar vocabulary for medical specialists with a teaching role.

But there are limits.

While the professionalization of didactic expertise is, of course, never “finished,” additional demands are being placed on teaching faculty on top of their current commitments. After all, high-quality training is influenced by workforce shortages, the threatened (and experienced) work-life balance, insufficient alignment between education and clinical care, part-time work and scaling up, increasing bureaucratization, healthcare digitalization, and financial constraints. Faculty cannot (unfortunately) keep all of these developments out of residents' learning environment. And so, they must deal with them.

But "they" does not refer solely to the individual trainer—or perhaps even to the trainers' group. PD's and supervisors can only function optimally if they are optimally supported in their educational role and tasks. That is why it is time to shine a spotlight on the teaching climate, a concept we coined in the accompanying article in Academic Medicine. In Defining a Supportive Teaching Climate for Clinical Supervisors in Residency Training, researchers Anne van Graafeiland et al. present what (head) trainers consider to be a constructive teaching climate.