Gersten Jonker

General discussion   177 9 with non-ACTY students in the same rotations. This led to heterogeneity in local understanding of the ACTY track, variation in workplace uptake, and disparity in supervisor commitment (Chapter 3). As a result, ACTY rotation content did not differ from the normal rotation, despite the intended emphasis on acute care learning. In addition, the ACTY’s EPA-based approach preceded the local introduction of EPAs in undergraduate and postgraduate education. Faculty involved in supervising students were insufficiently instructed and prepared to deliver the ACTY. Faculty development is critical for the successful implementation of innovative clinical teaching and requires planning, preparation, and enduring commitment [37-41]. The imperfect implementation may have curtailed the ACTY’s potential for student competence development. An improved implementation should focus on increasing ACTY student participation in acute care in welcoming communities of practice with extended affordances. Combined with the high learner agency (Chapter 3), the needs for competence and autonomy could be satisfied and, consequently, competence development could be enhanced. A strengthened implementation could amplify the ACTY’s beneficial effect on the competence level of graduates. DEVELOPING A CONTINUUM FRAMEWORK OF ACUTE CARE EPAS The ACTY has learning objectives, framed as three interdisciplinary EPAs, to guide acute care competence development to make graduates meet the workplace expectations of the junior doctor workforce (Box 1). BOX 1: The three EPAs of the ACTY with a summary description * 1. Recognition and initial treatment of patients with vital instability Includes: Evaluating patient with the ABCD approach; Measuring and interpreting vital signs; Arriving at a clinical evaluation; Initiating Basic Life Support (including bag-mask-ventilation and airway maneuvers and starting intravenous fluid therapy). 2. Evaluation and initial management of patients with respiratory insufficiency Includes: Rapid evaluation with the ABCD approach; Performing a focused history of a patient with respiratory insufficiency in an Emergency Room, Coronary Care Unit, ward or urgent outpatient clinic; Performing a physical exam (including ABCD and vital signs); Ordering and interpreting basic diagnostic tests (blood, chest X-ray, ECG); Drafting a differential diagnosis; Start initial management and treatment plans. 3. Evaluation and initial management of patients with circulatory insufficiency [This includes the same components as for patients with respiratory insufficiency] *The fully elaborated descriptions are provided in Chapter 2.