Gersten Jonker

General discussion   175 9 2 discusses an optional variant of the individual transitional year: an elective track with a multidisciplinary approach to the theme of acute care, that we came to call the Acute Care Transitional Year (ACTY). The ACTY aims to enhance competence development and prepare learners for work as a doctor, and postgraduate training, in the domain of acute care. Chapter 5 shows that graduating ACTY students did better on performance test modalities, i.e. skills and simulations, than non-ACTY students, but junior doctors did better on simulations than ACTY students. In addition, ACTY students had higher odds than non-ACTY students of meeting postgraduate acute care expectations, expressed as global rating scores in the multimodal assessment (Chapter 5). Taken together, the ACTY meets its aims as its graduates resemble doctors with clinical experience better than other graduates, suggesting better preparedness for work in acute care jobs. There is a paucity of literature on interventions comparable to the ACTY track. One study described a postgraduate longitudinal simulation course to prepare junior trainees for calls to acutely deteriorated inpatients, which was valued highly by participants and used summative simulation assessment to establish that outcomes were met [15]. Instead, there is a body of literature on preparatory bootcamp courses, operated by over half of the US medical schools to ease the transition to postgraduate work [16], including a meta-analysis finding increased short-term post-course knowledge and skill levels, and self-reported confidence [17]. COHERENCE, MOTIVATION, AND EXPERIENTIAL LEARNING EXPLAIN THE ACTY’S BENEFICIAL EFFECT The beneficial effect of the ACTY can be explained referring to learning theory and motivational theory. The ACTY supported competence development through coherence, augmentation of motivation, and a degree of experiential learning in subinternships. First, coherence stimulated focused learning. Coherence was created by clearly articulated learning objectives that covered tasks that junior doctors in acute care will face, multimodal pre-testing of those objectives, and a learning community with teaching sessions (Chapters 2 and 3). The multidisciplinary approach to the theme of acute care horizontally integrated learning [4] while students did rotations in various clinical specialties to develop competence [5].