Gersten Jonker

General introduction   11 1 MEDICAL EDUCATION: A SERIES OF STAGES In medical education, learners develop through a series of stages to become doctors [1]. In medical school, students move from classroom education to workplace learning in clinical clerkships. A phase of increased responsibilities follows graduation frommedical school in several countries to lay the foundation of practicing as a physician [1]. In other countries, graduates move directly into postgraduate specialty training (residency) 1 . After completion of postgraduate training and certification as a medical specialist, doctors may move into fellowship training or into unsupervised practice. The move from one educational stage to another comes with challenges and difficulties and is referred to as a transition. A transition is defined as the (process of ) change, passage, or development from one form, state, or stage to another (Cambridge Dictionary, dictionary.cambridge.org, and Merriam-Webster Dictionary, merriam- webster.com) . Applied to medical education, a transition is a period of change, in which individuals experience some form of discontinuity forcing a response to cope with the new situation [2]. Because of the associated challenges, transitions have attracted considerable attention in the medical education literature [3, 4]. In general terms, learners struggle to adapt to the expectations of the role in the new stage [5-9]. For example, students, who transition to the junior clerkship phase, experience difficulties in participating and learning in the workplace, due to lack of practical skills, unfamiliarity with clinical routines and incongruous learning strategies [5, 7]. The transition from student to doctor has received ample attention. In several studies, students, graduates, and faculty perceive this significant transition as problematic and they identify gaps in graduates’ preparedness to carry patient care responsibility at the start of postgraduate training [10-13]. Also after postgraduate training, newly certified specialists entering subspecialty fellowship training are reported to have insufficient expertise and skill for autonomous work [8, 14] and fresh specialists are suboptimally prepared for managerial, financial and teaching tasks that belong to their new role [9, 15]. Taken together, rather than a continuum, the educational trajectory tomedical specialist is a series of stages, in which one stage does not seamlessly prepare for the next. The trajectorymay be continuous in time and arrangement, but it is deficient in representing 1 The stage of medical school, with graduation leading to licensure as a doctor is in this thesis referred to as undergraduate medical education. The stage after medical school leading to certification as a medical specialist is referred to as postgraduate (specialty) training.