Gersten Jonker

116   Chapter 5 requires a comprehensive curriculum of experiential learning and articulated goals [31-33]. Students will get opportunities to pursue personal interests, explore specialty preferences, and gain confidence in graduated responsibilities in patient care [31]. And, this final phase will offer opportunities to promote optimal preparation for clinical practice [5, 26, 31-33]. The ACTYmeetsmany of the requirements of a transformative final phase. Still, awarding graduated responsibilities in acute care tasks is limited by legal and practical restrictions. Student training must not endanger the critically ill patient or delay needed treatment. Growing into bearing acute care responsibility starts with experiential learning in a supervised setting. However, hands-on learning opportunities in time-pressured and infrequent clinical situations are scarce. Lack of opportunities poses a pivotal problem in undergraduate acute care training, with final year medical students reporting one to two hands-on experiences in providing acute care [34, 35]. Even in ACTY, we found that students have limited opportunities for frontline acute care experiences [24]. Affording acute care experiential learning, with progressive responsibilities in a supervised setting, may improve ACTY’s preparatory efficacy. The ACTY EPAs would have been suitable tools to apply progressive responsibilities in workplace learning. However, the introduction of the ACTY and ACTY EPAs in 2015 preceded the adoption of the core undergraduate EPAs by UMC Utrecht medical school. The unfamiliarity of clinical supervisors with EPAs at the time may have impeded the exploitation of ACTY EPAs [24]. EPAs are a way to make accumulating clinical experience and competence visible from medical school to postgraduate training, including the ‘intercurricular’ period of working as a PNIT. Demonstrable competence could be taken into account in the individualization of PGT learning plans and could result in shortening of PGT time [15]. Since the implementation, the ACTY curriculum has been essentially unchanged. The ACTY design inspired the development of more thematic final years locally. This study and related research [24] call for a prominent role of the EPAs in ACTY workplace learning. Limitations As part of a programevaluation, the quasi-experimental assessment data provide insight in graduates’ acute care performance. The study was not a controlled trial to prove the superiority of the intervention over the traditional curriculum. We did not control for