Gersten Jonker

178   Chapter 9 Undergraduate EPAs may be categorized as core, specialty-specific, and elective EPAs [42]. Core EPAs are activities to be entrusted to all graduates on postgraduate day one in any junior doctor job, such as ‘Gather a history and perform a physical examination’ [43, 44]. Specialty-specific undergraduate EPAs are tasks to be entrusted on day one of postgraduate jobs in a certain specialty, could feature as outcomes for final year electives, and thus pertain to a subset of learners. Elective undergraduate EPAs are optional, advanced EPAs at postgraduate training level [42]. The interdisciplinary ACTY EPAs (Box 1) fall in the latter category. In the Netherlands, these acute care tasks are regularly delegated to junior doctors in the participating specialties without deliberate entrustment decision and this led the designers of the ACTY to designate them learning objectives of the track. However, the ACTY EPAs did not build on a core undergraduate EPA, were incorrectly gauged as specialty-specific EPAs, and did not connect to postgraduate EPAs (Figure 1). FIGURE 1: Lackofrelationshipbetweencore,ACTY,andpostgraduateacutecareEPAs.ACTYEPAs1-3aretheEPAs‘Recognition and initial treatment of patients with vital instability’, ‘Evaluation and initial management of patients with respiratory insufficiency’, and ‘Evaluation and initial management of patients with circulatory insufficiency’, as described in Table 1. At the time, they were neither supported by a core undergraduate EPA (lower light blue box), nor were they connected to postgraduate EPAs (upper dark blue box) as they did not yet exist. In retrospect, the ACTY EPAs could have been designed at specialty-specific undergraduate EPA levels, describing smaller tasks that are entrusted on day one of a job in the domain of ACTY specialties. Specialty-specific EPAs are meant to improve preparedness and to inform specialty advice [42]. The“domain-specific”interdisciplinary