Gersten Jonker

122   Chapter 5 CBDs Through one-on-one structured questioning and discussion, assessors evaluated the process of information gathering, clinical reasoning and know-how of case management. ACTY faculty devised four cases describing patients requiring urgent attendance at the Emergency Department. Faculty and GJ fine-tuned cases iteratively. Each case had a specific detailed checklist following the chronology of the consultation, with anchors describing essential steps or expected actions. Examiners scored the performance on a three-point scale (done adequately – done incompletely or not timed well – done insufficiently or omitted). Specific aspects, such as appropriate prioritization, completeness, or clinical overview, could be awarded with extra points, where indicated on the checklist. Assessors completed the paper-based scoring checklist during and directly after the discussion. Participants did two CBDs of 10 minutes duration, with two different assessors, on patients requiring urgent attendance at the Emergency Department. We used two sets of two cases. OSCEs This part of the assessment consisted of 5 to 7 skills stations of 5 minutes duration. ACTY faculty devised several stations in OSCE format for skills mentioned in the learning objectives. Each station had a specific detailed checklist made up of the consecutive steps in the execution of the skill. Assessors rated performance on a three-point scale (done adequately – done incompletely or not timed well – done insufficiently or omitted. Assessors completed the paper-based scoring checklist during and directly after skill performance. Simulations The part, resembling clinical work most, consisted of three real-time simulation scenarios, each lasting approximately 12 minutes, run by anesthesiologists and anesthetic nurses who were all EUSim or CMS certified simulation facilitators (https:// eusim.org and harvardmedsim.org ). Anesthesiologists from the simulation center developed scenarios in collaboration with ACTY faculty and one of the authors (GJ). Scenarios used a standardized script and were enacted to occur in the emergency room or ward and were tasks that a physician-not-in-training could encounter. The participant enacted the role of the first responding doctor and a nurse was present who acted only on instruction. The simulator room mimicked a room in a clinical environment and deployed a 2010 Laerdal Sim Man (Laerdal Benelux B.V., Amersfoort, the Netherlands). The high-fidelity