Gersten Jonker

A better transition with the ACTY   117 5 confounding variables. For example, a study showed that students and interns who had taken an intensive care clinical elective performed better in a simulated test of acute care competence [28]. However, we applied strict inclusion criteria for all groups and measured pre-intervention performance, to constitute relevant comparisons. Group sizes were relatively small. We had particular difficulty in recruiting comparison group students in the pre- and post-test set-up and reverted to including students for just the post-test, creating a larger but mixed control group. Student controls who did both pre- and post-tests did not score differently in the post-test compared to group ACTY, but this subgroup analysis lacks the power to conclude the absence of differences. Depending on clinicians volunteering as assessors, we were unable to deploy multiple raters per station. Multiple raters might have reduced any bias and improved reliability. However, different raters evaluated participants at different stations, so we assume the influence of rater bias on overall test results to be small. Although we extensively briefed each examiner prior to the assessment, we did not use an examiner team calibration training to prepare assessors. The three-point global rating scale had the levels “does not meet expectations – borderline acceptable – meets expectations”(that faculty have of a PNIT with six months of clinical experience). An extra level for performance that “exceeded expectations” could have provided more discrimination between participants. Lastly, the assessment was labor-intensive and costly, limiting sustainability and transferability. This assessment study provides data on graduates’ acute care performance. In an ongoing study, we are surveying graduates’ perceptions of preparedness, on specialty orientation, and on the potential of the ACTY to shift career trajectories (i.e. shorter periods of working as a PNIT, shortening of residency training). CONCLUSION In pursuit of a better transition to postgraduate expectations, we reported on a final year of medical school dedicated to acute care and found that graduates from this program show better resemblance to junior doctors with clinical experience than other graduates. This final year dedicated to acute care enhances learning and preparedness for challenges that junior doctors in this area will face.