Gersten Jonker

General introduction   17 1 to the virtual and variable space between the current developmental level and the level of potential development. Independent problem solving characterizes the actual developmental level, whereas in the zone of proximal development adequate guidance by an experienced person (e.g. teacher) is required for adequate performance [61, 62]. The zone also refers to the steps needed to get to the next level of capability. A final theory mentioned here in relation to competence development is Self- determination theory [63]. It is a major theory of motivation from experimental educational psychology and consists of a set of psychological mechanisms relating to the self [64]. Self-determination theory asserts that an individual’s natural propensity for development is stimulated when three psychological needs are satisfied. These are the needs for competence, for autonomy, and for relatedness. Competence refers here, in this theory, to the need to feel confident and effective, or - psychologically phrased - the perception of effectance. Autonomy relates to the perception of volition, participating in useful interactions out of free will. Relatedness reflects belonging to a social group or community [63, 64]. Satisfaction of the needs boosts intrinsic motivation, social development, and well-being, facilitating learning [63]. The abovementioned models, frameworks and theories regarding competence development play a role in thinking about shaping a continuum in medical education. For that reason, they will be applied in the research of this thesis. BUILDING AN EDUCATIONAL CONTINUUM Despite initiatives at the undergraduate and postgraduate levels of the educational trajectory to medical specialist, a misalignment of curricula across transitions still exists [16] and the trajectory can be seen as a series of linked but independent silos “haphazardly pieced together” [65]. Continuity within stages and integration of experiences across stages would reinforce learning and foster a seamless formation across the continuum [16, 66]. CBME offers a solid starting point to forge an educational continuum [3, 16, 18, 65-67]. It provides us with a common framework and language that could be used across the continuum [65], which fits well with the model of a novice-to-expert trajectory [53]. CBME puts the learner central and thus requires an active role of the learner to self-direct her progression toward competence in sequenced learning experiences [17, 65], which matches the theoretical frameworkof Deliberatepractice [55]. It requires supervisionand coaching to assist the learner in efficiently navigating the zone of proximal development to reach the next developmental level [61, 62, 64, 65]. Appropriate supervision has to