Gersten Jonker

A better transition with the ACTY   115 5 DISCUSSION We implemented a thematic transitional year focused on acute care (ACTY) and collected data in a multimodal assessment to evaluate whether ACTY graduates meet postgraduate expectations of junior doctors to provide acute care. Students graduating from ACTY performed better in the assessment than non-ACTY students with an interest in acute care, especially on performance test modalities (i.e. skills and simulations). Moreover, ACTY students had higher odds than non-ACTY students of meeting the expectations of a PNIT, as determined by GRS. Thus, ACTY graduates show better resemblance to PNITs than non-ACTY graduates, suggesting they are better prepared for junior doctor acute care challenges. However, PNITs with a mean of 5.5 months of clinical experience did better than students graduating from ACTY on simulations, both in scores and GRS. This suggests that PNITs have a steep learning curve in the first six months of ‘real’ clinical work following graduation. Their clinical experience helped in showing an“organized, orderly approach” [28]. Furthermore, PNITs starting in a first acute care job often take additional acute care training. Certification as an advanced life support provider has a medium-size effect on performance in a simulation test of acute care competence [28]. Of interest, a few GRS awarded to PNITs were below assessor expectations of PNITs with six months of experience. This may indicate the recent graduates’ incomplete preparedness for acute care and imperfect or inhomogeneous competence development. However, also failure of an occasional test station in a standardized test may explain this finding. In times of great need for labor force, such as currently (2020 – 2021) with the Covid-19 pandemic [29, 30], demonstrable competence, obtained as a student in the transitional year, is a way to select the right graduates for critical junior doctor positions. We postulate that ACTY graduates, performing approximately on a midpoint between non- ACTY graduates and acute care PNITs, have a head start for deployment in such jobs. The ACTY is an example of a thematic transitional year. Many other elective transitional years, offering multidisciplinary perspectives on a certain theme, are conceivable. Similar to the ACTY, these could attract students motivated to develop a specific profile of competence while exploring career options within an area of medicine. Elective thematic final years present a promising way to design the transition phase from student to doctor. This phase has the potential for professional transformation if learning opportunities are fully exploited [5, 31]. To seize opportunities, this phase