Gersten Jonker

174   Chapter 9 • What is the structure, or are the structures, of Europeanpostgraduateanesthesiology training and to what degree have training programs transitioned to CBME and to EPAs? • What is the foundation or justification of the ultimate entrustment decision of certification granted to trainees at completion of training in anesthesiology in Europe? • How can CBME, operationalized with EPAs, be applied to postgraduate anesthesiology training, and what research is required to assist competency-based anesthesiology training with EPAs? MAJOR FINDINGS The thesis describes an elective final year of medical school focused on the domain of acute care (Chapter 2). This track has a beneficial effect on competence development and preparedness for work in acute care, as its graduates score higher on performance tests and resemble junior doctors better than other graduates (Chapter 5). Students’ sense of belonging to a learning community and their agency are important determinants of the relative success of the innovation, although an incomplete implementation confronts students with little affordances in the workplace (Chapter 3). In addition, a simulation pre-test beyond the competence level of graduates instills their motivation for learning (Chapter 4). The thesis then turns to current postgraduate anesthesiology training, finding substantial variation in European approaches to assessment and certification (Chapter 6). The certification systems do not always offer a solid foundation for the decision to certify, which leads to the certification of trainees who are not fully competent (Chapter 7). EPAs may offer a solution, but further research is needed (Chapter 8). THE BENEFICIAL EFFECT OF A FINAL YEAR DEVOTED TO ACUTE CARE ON COMPETENCE AND PREPAREDNESS At UMC Utrecht, students choose clinical rotations and a research block to compile an individual program for the final year of medical school. This year is called a transitional year, which means that students are being prepared to work as a doctor by bearing increasing responsibilities in patient care under appropriate supervision [14]. Chapter