Gersten Jonker

General discussion   173 9 Medical education consists of a series of associated but detached stages [1]. The stages contribute to a collective ultimate goal: the training of doctors able to provide safe, effective patient-centered care [2]. However, the stages are usually not aligned to create a collective effort to reach this ultimate goal. Each stage concentrates on interim goals and falls short of optimally preparing learners for the subsequent stage. Therefore, the educational trajectory to medical specialist is riddled with transitions that learners experience as difficult. If learners arrive well-prepared, the transitions are no threat or problem, but rather an opportunity that may catalyze development [3]. If the various stages are well aligned and form a coherent whole, they could shape a developmental pathway across a seamless continuum frommedical student to medical specialist [4, 5]. It could strengthen the relation between basic sciences and clinical medicine, between medical education and patient care, and concomitantly improve the training of doctors [4]. Competency-based medical education (CBME) is well-suited to build an education continuum with its ultimate goal of providing society with professionals who have met predefined outcomes to be able to deliver safe and effective care [1, 2, 6-10]. CBME can be powerfully linked to clinical practice with entrustable professional activities [11, 12]. Entrustable professional activities (EPAs) are essential tasks of a discipline that can be entrusted to an individual to perform without direct supervision once competence has been demonstrated [11-13]. A set of EPAs describes the scope of practice of a discipline and therefore also describes the outcomes a learner within that discipline should attain [11]. A learner gradually develops to become a medical specialist by attaining the EPAs that cover her specialty. We set out to study the facilitation of competence development by forging a continuum by use of CBME and EPAs and phrased our research questions in Chapter 1 as: • Does an elective final year focused on acute care have a beneficial effect on the development of competence and preparedness for the next stage, i.e. working as a doctor in an acute care specialty? • If the innovation has effect, can its effect be understood by looking at learning theory, like Communities of practice, and motivational theory, such as Self- determination theory? And if the innovation does not sort effects, do these theories require adaptation? • What is the psychosocial and educational effect on students of simulation pre- testing beyond the competence level of graduates?