The doctor’s coat with extra pockets

17 June 2026

The Dutch Medical Training Framework 2020 outlines the most recent key competencies for medical students to meet the (future) challenges of the healthcare sector. Each medical faculty updates its curriculum according to the latest version of this Framework. Over the past few revisions, social responsibility, prevention, and health promotion have become increasingly important due to the well-known pressure on the healthcare system. This revision may conflict with the current routine in medicine, in which doctors primarily provide individual care to sick patients.

Up to Maastricht University, a health education innovator from the start, to implement the first internship in the Netherlands where students participate for 8 weeks in a team within a societal or healthcare organisation, without their white coat.

Think outside the box

Emmaline Brouwer, Elianne Moene and Marion van Lierop are part of the educational planning group that designed the mandatory Elective Health, Prevention and Society (Dutch: Gezondheid, Preventie en Samenleving – GPS) three years ago. The group witnessed that the narrative evaluation from students is shifting from questioning the value of the elective to realising that this makes them better doctors.

“A medical student’s first response to respiratory problems of a patient, for example, can be to advise the patient to quit smoking. After the GPS elective, other societal determinants of health, such as the state of housing and the chances of mould exposure, become important factors as well. The first response places the responsibility with the patient, the second incorporates systemic issues.” This is just one of the examples that shows how the elective enriches our future doctors by providing a societal view on individual care. “Of course, departments within the hospital are also attentive to societal issues. But we decided to immerse our students in organisations related to healthcare, mostly outside of the hospital walls, which they’ll also have to collaborate with later in their professional career.”

Societal determinants of health

The Dutch Medical Training Framework 2020 inspired the revision. It was the educational planning group that organised a mandatory elective of 8 weeks for all master’s students in response. “The master’s programme Medicine consists of 120 weeks rotations, of which 18 weeks are reserved for extramural activities: the rotation in family medicine, social medicine, and psychiatry. And now each student has an additional 8 weeks for GPS. We call it an elective because students can choose from our faculty’s offer of organisations, domestic or abroad, or arrange a workplace themselves. Students have freedom of choice, but it must be an elective where they meet the competency goals for GPS.” During the elective, students spend four days a week at the workplace and spend one day working on assignments or attending teaching activities at the university, to reflect and share their experiences with their peers.

The elective’s intent is to introduce the student to an organisation where there is no direct patient care. “For example, working on prevention interventions within a municipality, or policy work for a hospital or organisation such as Doctors without Borders.” Or in the case of Elianne Moene, member of the planning group and a current master’s student, a General Practice, focused on complex care for unhoused people in Amsterdam: “I studied the different health determinants for unhoused people and helped write a subsidy proposal for preventive foot care, tailored to this population.” Even after her elective ended, Elianne stayed involved with the organisation.

Benefits for organisations

It isn’t always easy to find an organisation where a medical student can be an integrated part of a team. “Organisations are sometimes hesitant because they don’t know how to evaluate the student's medical knowledge. But that’s not what we ask of them: we don’t grade the student in a classic way. Competencies such as interprofessional collaboration, communication or health advocacy are also important skills that are part of the assessment of the student. And that’s something that can be evaluated by the organisation.”

The organisation benefits as well from a master’s student in their team. “Our students bring a medical and analytical perspective on an academic level, which the organisation can use for their projects. On the other hand, some organisations are eager to show exactly what they do to future doctors, to improve collaboration.”