Gersten Jonker

A better transition with the ACTY   105 5 INTRODUCTION Transitions within the medical education continuum have enjoyed the attention of medical educators for a long time [1, 2]. Learners experience difficulties in adapting to the expectations of the new phase when moving from classroom education to clinical clerkships [3], from medical school to residency [4, 5], and from postgraduate training to fellowship or practice [6-8]. Overall, as learners advance to the next phase, they frequently experience an incomplete set of competencies for that phase. In particular, the undergraduate to postgraduate transition has received attention and schools and countries have dealt with this transition in different ways [9, 10]. The UK has introduced a two-year Foundation period, whereas the USA and Canada do not apply any transitional phase but require all graduates to start residency with an internship year, and many other countries require one or more years of clinical service experience [11]. Medical schools struggle to seek the best curricular structures to ease the transition to residency. Introducing longitudinal, integrated clinical experiences [12] and creation of an education continuum within a single specialty [13] are examples. In the Netherlands, most graduates start their careers working as a physician-not-in- training (PNIT), assuming clinical responsibilities and expanding clinical experience as a licensed doctor, before entering residency [14-16]. This voluntary phase of practice without formal education [14], is of variable duration – from less than one to over three years – and originated from a surplus of graduates for residency positions. On average, graduates work 34 months as a PNIT before starting postgraduate training [17]. Residency selection procedures happen in an open market model, and committees have become accustomed to experienced candidates. This competitive process has urged applicants to expand their clinical experiences, and even adding doctoral research degrees, to maximize their chances to be selected for highly sought residencies. Dutch medical schools, as well as the government, have become aware of the need to better align medical school and residency, to decrease the total length of preparatory training and clinical practice before residency, and thus shorten the whole trajectory of specialization. Dutch medical school reforms in the 2000 decade have led to an elective-based final, ‘transitional’ year model [14, 18, 19]. The primary goal of the transitional year is to improve graduates’ readiness for work, and in addition it potentially reduces the duration of the PNIT period by decreasing the need to learn carrying clinical responsibilities. This final, transitional year contains substantial elective opportunities to help students grow toward the responsibilities of a doctor under appropriate supervision, obtain clinical experience and expertise, explore career options, and improve chances on the job market [19, 20]. At University Medical Center (UMC) Utrecht, final year students assemble an individual program [14, 19]. Students