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This thesis is about International Medical Graduates or foreign doctors, trained outside the European Economic Area, who settle permanently in the Netherlands. From the early nineties the number of foreign doctors residing in the Netherlands either as refugees or as partners/spouses of Dutch citizens has risen steadily. Foreign doctors who wish to practise medicine in the Netherlands must obtain a declaration of professional competence, issued by the Department of Public Health, Welfare and Sports (VWS). A considerable number of foreign doctors received negative decisions by the Health Department. They were not allowed to practise medicine in the Netherlands. As a result, from the mid nineties, a growing number of foreign doctors applied to the medical faculties for admission as medical students in order to obtain a Dutch medical degree. Therefore, in 1995, it was decided to institute the Committee Influx Foreign Doctors (CIBA), a central placing committee. Between 1996 and 2007 the CIBA has processed over a 1000 admission requests. Until 2002, in spite of the imminent shortage of doctors, the Department of Health had done little to enhance the use of the expertise brought in by the foreign doctors for the benefit of Dutch society. The focus of this investigation has been: 1. How is it guaranteed that foreign doctors meet the medical quality standards (knowledge, skills, attitude), or how is the assessment of these qualities measured. And 2. After obtaining permanent residency in the Netherlands, do foreign doctors have access to the profession for which they had qualified before in their country of origin or another non-EEA country? Late 2001 the Department of Health and the medical schools were stimulated to cooperate in order to improve the additional training programmes for foreign doctors. It led to the new assessement procedure for foreign doctors that came into force in December 2005. This thesis contains two reports on the medical careers of foreign doctors. These investigations showed that nearly all ...

De afwijkende visie van de redacteur over het patent is gelegen in semantische verwarring in meerdere opzichten. Ten eerste het onderscheid tussen uitvinder en oorsprong enerzijds en patentrecht anderzijds. Met patent wordt het alleenrecht van de uitvinder om de uitvinding te exploiteren bedoeld. Een belangrijke nuance is dan ook dat er in de recensie wordt gesproken over blijvend patent. Het woord etnografie stamt van het Griekse ethnos (volkeren of bevolkingsgroepen) en graphein (schrijven). Het 'beschrijven van volkeren' vindt zijn oorsprong inderdaad in de antropologie, iets wat in de recensie allerminst betwist werd (zie supra). De van oorsprong antropologische etnografie wordt echter al meer dan honderd jaar ook door andere wetenschapsdisciplines gebruikt. Voor de toepassing van de etnografie binnen de sociale wetenschappen werd etnografisch onderzoek ge(her)definieerd als 'the study of groups of people in their natural setting, typically involving the researcher being present for extended periods of time in order to collect data systematically about their daily activities and the meanings they attach to them' (Noaks & Wincup, 2004: 93). De betekenis van etnografie binnen de sociale wetenschappen wijkt dus af van die in de klassieke antropologische literatuur. Deze definitie en de plaats die veldwerk daarin heeft is bovendien niet onbesproken. De methodologische literatuur wijst op de ambiguïteit van de definitie van etnografie (Noaks & Wincup, 2004: 92). Volgens Hammersley en Atkinson (1995: 2) is deze conceptuele onduidelijkheid te wijten aan haar 'noodzakelijk diffuse grenzen' en bestaat er binnen de sociale wetenschappen geen duidelijk onderscheid tussen etnografie en ander kwalitatief onderzoek. Deze onduidelijkheid wordt verder in de hand gewerkt door een aantal mythes en misverstanden. Etnografie wordt bijvoorbeeld vaak onterecht als synoniem van participerende observatie of veldwerk gebruikt (Noaks & Wincup, 2004: 92). Etnografie is geen dataverzamelingstechniek, maar een methodologische benadering of onderzoeksstrategie die gebruikmaakt van verschillende (gecombineerde) dataverzamelingstechnieken en onderzoeksmethoden, zoals (participerende) observatie, open interviews en discoursanalyse. In de meeste onderzoeken waar veldwerk wordt verricht, is langdurige participerende observatie echter wel de belangrijkste onderzoekstechniek (p. 8 van de bundel). Veldwerk vormt dus een substantieel onderdeel van de etnografische onderzoekstraditie.

POLITICS BY PROVINCE: Goal-oriented rational action or value-oriented rational action in closed debate on the Wadden region and public consultation on the ecological infrastructure General This thesis is a study of political conduct, and of provincial politics in particular. It is based on three research projects. The first two research projects are empirical studies that examine, respectively, the functioning of the discussion platform for government bodies relating to the Wadden Islands area and the relationship between the regional press and provincial political organs. Each of these two projects is based on a defined problem, a theoretical framework, methodology and conclusions. Although both case studies deal with provincial politics, they are completely separate from each other. The third case study is theoretical. It seeks to clarify the rationalization theories of Max Weber and Karl Mannheim, and place the concepts of goaloriented rational action and value-oriented rational action in their theoretical context. This theoretical chapter produces a number of research questions that can be used as a 'rationality grid' to be applied to the two empirical case studies in order to determine what form of action, goal-rational or value-rational, characterizes provincial politics. Chapter One describes the background to the studies and gives a short introduction to the research themes. This chapter also presents a view of contemporary provincial politics and discusses the scientific position from which this thesis has been written, emphasizing the unique role of the sociological vision. How does the government manage the Wadden Sea? The first section examines the way in which the government manages the Wadden Sea. The study is based on an evaluation study of the functioning of the Coördinatiecollege Waddengebied (CCW) in the period 1987 to 1994. The CCW (a platform for administrative consultation between the government, the Wadden provinces and the Wadden municipalities) was set up in 1980 for the purpose of "ensuring coherent administration and an coordinated policy by the government, provinces and municipalities with regard to the Wadden region." The study is based on a bottleneck analysis; in other words, by identifying problems, concrete solutions can be proposed. The evaluation study employed a combination of two popular lines of research in organizational sociology literature – the 'whole-system approach' and the 'parties approach'. In the whole-system approach, shared values or a feeling of solidarity are what unites the organization. In the parties approach, the organization is seen as a coalition of parties with different interests and aims. The parties work together for their own benefit, or because negative sanctions force them to do so. Both approaches are integrated in the 'parties-withina-system' perspective, which focuses on the relationships between the parties and the organization as a whole. This integral approach was used to evaluate the functioning of the CCW because the CCW places great emphasis on shared values and responsibilities, which are the core elements of the whole-system approach. At the same time, however, the CCW is composed of different parties which all have their own tasks, powers and interests – the core elements of the parties approach. This perspective has been tailored to the evaluation of the CCW using the following criteria: shared values, support base, differing interests, power structure, sense of purpose, and success/failure factors. The study is based on qualitative interviews with participants in the CCW platforms, telephone interviews with councillors and members of the States General, dossier analyses and reconstructions from minutes from the CCW consultations on the following cases: enlarging the scope of the Nature Conservation Act; delegation of powers with regard to inspection and control; co-ordination of international activities, problems relating to 'traditional brown shipping'; the review of the Waddenzee II Key Planning Decision, and gas extraction in the Wadden Sea. This treatment of the original research report emphasizes a systematic description of conduct within the context of the administrative co-ordination of the Wadden region, which is usually of a closed nature. The main problem areas are the following:  a lack of shared values due to the fact that the purpose of the Wadden consultation platform is given a different interpretation depending on the interests in question;  by way of preparation for the Wadden consultations, a process of harmonization takes place within the various authorities, thereby creating an administrative support base. However, this process of preliminary consultation and feedback reveals the other side of the bureaucratic coin – this circuit is, administratively and politically speaking, strongly inward-looking;  there are no substantial conflicts of interest between the layers of government. However, mutual suspicion exists with regard to the extent to which other parties are committed to the Wadden policy. Each party suspects that the other parties will ultimately allow economic interests to prevail;  with regard to the delegation of authority, the balance of power between the government and the provinces is seen as unacceptable. The continuous lack of consensus, whether manifest or otherwise, is a barrier to discussion on a equal footing;  there are various problems relating to the sense of purpose, including the role of the Chairman and the lack of a clear definition/delegation of tasks. This analysis shows that the problems are not related to the structure of the Wadden consultative platform but rather to its culture, and more specifically to the participants' perceptions of the role and responsibilities of the platform. In addition, there appears to be a distinct lack of leadership. The main conclusions are as follows:  harmonization within the various Wadden authorities (government, provinces and municipalities) hampers harmonization between the Wadden authorities;  the representatives from the three layers of government do not present the role and purpose of the consultative platform in a consistent and uniform way;  the CCW is hampered in its work by an ongoing debate about how powers are delegated between the layers of government. Because the analysis of success and failure factors revealed that clearly defined relationships between the government authorities are essential for successful consultation, possible solutions aim to create that clarity. Recommendations have been laid down, for example, relating to the role of the Chairman, drawing up the agenda, and clearly defining the tasks of the various bodies. Although, as far back as 1995, the CCW largely acknowledged the problem areas and supported the proposals for improvement, none of the recommendations will actually be implemented before 2001. Politics and the press on the ecological infrastructure in Friesland and Drenthe Section 2 describes a study of the relationship between the regional press and northern provincial politics. The basis for the study is the political decision-making regarding the establishment of the ecological infrastructure in the provinces of Friesland and Drenthe in the period 1989 to 1996. The conclusion of a survey of the relationship between the printed press and parliamentary democracy is that the main function of the press is to provide information, criticism and comment. The role of information-provider is examined on the basis of the following:  actual report of a meeting of the Provincial Councils;  a news report giving information about matters relating to the ecological infrastructure in both provinces;  a background article describing the context, history and/or different interpretations of matters relating to the ecological infrastructure. The role of critic is examined on the basis of the following:  editorial comment;  a column in which one of the editors gives his opinion under his own name;  opinions of third parties, in which a third party, who is not an editor, is given the opportunity to express an opinion. Using four recent examples, it is then argued that the central question relating to the relationship between politics and the press is one of management – who controls political communication or, put another way, is the relationship determined by 'party logic' or by 'media logic'? The study will compare decision-making on the ecological infrastructure (as this was perceived in decision-making meetings of the provincial councils) with reporting by the regional press in both provinces. The decision-making process of the provincial councils was reconstructed for this purpose. The result is not only an analytical reconstruction of the decision-making surrounding the ecological infrastructure in Friesland and Drenthe, but also a chronicle of provincial political customs and morals. A quantitative and qualitative analysis subsequently shows how the regional press fulfils its role as information provider and critic. The quantitative analysis addresses the question of how often the press fulfils its role as information provider and critic with regard to decision-making on the ecological infrastructure. The qualitative analysis addresses the question of how the press fulfils those roles. It is argued that the quality of the information provided is determined by the degree of objectivity, but that the best measure of quality is a clear standpoint. These conclusions were used to formulate an 'ideal' against which the quality of informative and critical articles can be measured. A factual report is as objective as possible when:  it deals not only with the decision itself, but also with the opinion-forming process;  it gives the opinion not only of the representatives of official bodies, but also of opponents or those outside such bodies;  the reporter does not give his own opinion. A news report or background article is as objective as possible when:  it presents more than one perspective and/or quotes more than one authority on the subject. An editorial or column makes a constructive critical contribution when:  the author adopts a clear standpoint;  the context (history, background or current event) of that standpoint is given;  the author describes how the standpoint was reached, and on which information or authorities it is based. Conclusions about the information function:  in almost half of the cases, the regional newspapers do not report on provincial council meetings relating to the ecological infrastructure. The people who live in the province, but fall outside a given environmental or agricultural target group, will not become informed about the ecological infrastructure by reading their local newspaper. Neither will they become informed about the role of the provincial government in this;  in the reports which do deal with meetings of the provincial councils, there is a lack of balance. Generally speaking, no effort is made in such reports to show the full palette of political colours represented in the provincial council;  there is only relatively wide newspaper coverage on occasions when political emotions are running high. Examples are: Friesland in 1993, when an agreement was reached with the agricultural sector, and Drenthe in 1993, when an amended programme of intent for the soil-protection areas was introduced (the agricultural lobby also played an important role in this). This attention from the press can be explained by incident politics. Political groups hold widely different opinions; they make no effort to hide their differences and journalists are keen to pick up on this. Another possible explanation is that, in these cases, ecological policy is heavily influenced by the farming lobby, which itself is strongly supported by influential political groups;  the news reports are usually brief and present an event from only one perspective, without a journalistic contribution from the author. This leads to the inevitable conclusion that press releases sent to the newspapers have been published without any further interpretation;  the most common simple perspective is that which opposes the ecological infrastructure;  there are very few background articles. Background articles that clarify the situation, and outline the problems confronting provincial politicians, are indispensable with regard to a far-reaching and complex plan such as the development of the ecological infrastructure of the two provinces;  it is notable that most of the background articles are only written from one perspective, with very little informative context. On the basis of these findings, it appears that the way in which the regional press fulfils its role as information provider leaves room for improvement. Scant attention is paid to council decision-making and the quality of reporting also leaves something to be desired. Little can be said about how the press fulfils the role as critic because so few articles appear in this context. The question Who controls political communication? cannot therefore be answered because the press pays too little attention to provincial politics. Goal-oriented or value-oriented rationality: which form of rationality determines political action? Section 3 examines which form of rationality (i.e. goal-oriented or value-oriented rationality) occurs most in the closed discussions between government bodies in the Wadden study, or in public discussions on the ecological infrastructure from the study of the relationship between politics and the press. For this purpose the rationalization theories from the work of Weber and Mannheim were used. Both Weber and Mannheim recognise increasing instrumental and formal rationality (Weber) and functional rationality (Mannheim) in all areas of life, and a decrease in material rationality (Weber) and substantial rationality (Mannheim). Weber and Mannheim identify the rise and influence of a specific form of instrumental rationality, particularly within economic, legal and bureaucratic institutions. Within such institutions, actions are characterized by goal-oriented rationality. This means that the prevalent institutional pattern of norms and values that more or less prescribes how people should act within the institutions (role-related behaviour) places great emphasis on goal-rational behaviour. In order to establish whether this also applies in provincial politics and administration, a study was made of the conception of rationality in the work of Weber and Mannheim. The question of whether goal-oriented or value-oriented rationality is dominant is addressed by a secondary analysis of the material. The secondary analysis takes the form of a 'rationality grid' that is applied to the material from the two empirical studies. The grid has a coarsely meshed structure that can separate out goal-oriented and value-oriented rationality. Following the study of Weber and Mannheim's concepts of rationality, goal-oriemted rational action is defined in this study as action that is geared towards finding the most appropriate means to achieve a goal that is considered as given. When action is successful in terms of the defined goal, we speak of goal-oriented rational action and formal rationality. Success or effectiveness is therefore the measure for goal-rational behaviour. The essence of this concept is expressed in the following questions:  is conduct geared towards resources and procedures within the given of administrative co-ordination or within the structured political (provincial) discussions?  are the goals open to discussion? If action is a logical extension of or derives from a higher value or ideal, we speak of 'valueoriented rational action' and 'material rationality'. The extent to which an action is valueoriented is therefore the measure for value-rationality. In this study, value-oriented rational action is defined as action that is based on the assessment of the desirability of a given goal by means of a party-political value system. The essence of the concept, as used in the present context, is expressed in the following question:  is the action geared towards assessing the desirability of a particular goal, based on a political value system? Conclusions: 1. With regard to discussion between government bodies on the subject of the Wadden region, the hypothesis was that, within the sphere of formalised and regulated administrative co-ordination in the Wadden region, actions are largely determined by goal-oriented rationality. The purpose of the discussion platform is, after all, to co-ordinate and realise goals defined elsewhere. The hypothesis is confirmed – the Wadden discussion platform is characterized by goal-oriented rational action. But this type of action is not related to the ultimate goal of the discussion platform but rather to another goal: the increasing of the influence and governance of the government layer in question. 2. With regard to the decision-making on the ecological infrastructure in Friesland and Drenthe, the hypothesis was that political decision-making debates are characterized by the discussion of values to be lived up to and aims to be realised. It is therefore to be expected that such debates are mainly characterized by value-oriented rationality. However, the findings do not confirm this hypothesis. The discussions of the provincial councils of Drenthe and Friesland are certainly not goal-rational in nature, yet neither can they be described as valuerational. Actions are indeed geared towards assessing the desirability of a particular goal, but that assessment is not based on a political value system. It is not party-political principles that determine political conduct; it would be more true to say that conduct is based on notions of consistency in terms of policy and support.