Gersten Jonker

12   Chapter 1 a “coherent whole” that typifies a continuum [16]. Put differently, the stages do not have an overarching single goal – to train doctors fit for healthcare needs –, but instead each stage has its own goals. A better alignment of stages could lead to a developmental pathway of learning across the continuum from undergraduate medical education to postgraduate training and into practice [17, 18]. It would strengthen the connection between the basic sciences and clinical medicine, between medical education and patient care, and the pathway would facilitate transitions and foster the progression of a learner’s professional and personal development [17]. Ultimately, this could lead to an effective and efficient trajectory to train competent doctors that provide safe and high quality patient care. IMPROVING CONNECTIONS BETWEEN STAGES Prior to postgraduate training: a spectrum of initiatives Around the globe, at all stages of education and training, programs make efforts to facilitate transitions and to align one stage with the next. In undergraduate medical education, curricula combine teaching basic sciences with clinical application and reasoning, as well as with skills and communication training, followed by early clerkships in a vertically integrated curriculum [19, 20]. Some clerkship programs introduced longitudinal, integrated clinical experiences [21]. Another approach emphasizes the role of electives to support and monitor development [22], with specialty streaming, i.e. undergraduate pre-residency training within a specialty being a marked example [23]. In addition, medical educators advocated to improve final year design to optimize graduate readiness [10, 11, 24-26]. After graduation, the United Kingdom has two foundation years, in which the recent graduates obtain full licensure after one year. In the United States of America and Canada all graduates proceed through an internship year, sometimes preceded by rigorously focused preparatory bootcamp courses [6, 27], before starting specialty training [28]. In postgraduate training: competency-based medical education Whereas many different initiatives aimed to improve the undergraduate part of the trajectory, in postgraduate training all initiatives were dwarfed by one dominant force that has been making an advance over the last two decades: competency-based medical education (CBME). This theoretical framework has induced a major shift in thinking about specialty training.