Gersten Jonker

18   Chapter 1 balance safe and effective patient care with robust experiential, workplace learning [17, 57, 65]. This is the task of the community of practice in which the learner participates in working and learning [57]. A CBME curriculum to construct a continuum “starts with the end in mind”: physicians who consistently provide safe effective patient-centered care to the population they serve [3, 18]. That requires the delineation of the requisite competencies of specialists and the design of a developmental assessment system to observe and evaluate learners across the continuum in meeting the competencies [3, 18]. Subsequently, the expected outcomes for a phase, such as undergraduate medical education, in the continuum can be reverse engineered. PURPOSE OF THE THESIS Forging the transition to an education continuum is an evolutionary and iterative process [65]. The objects of study of this thesis take a place in this evolution. The overall aim of the thesis is to explore the role of competency-based medical education and entrustable professional activities in creating an educational continuum that fosters the development of competence. Final year of medical school The first part of the thesis regards the final year of medical school and the role of competency-based education in the transition from student to doctor. Graduation from medical school has become an intermediate station in a long educational trajectory, rather than an end point [68]. Most doctors continue the educational trajectory in some form of postgraduate training. This transition could be eased by explicit preparation for tasks in the next stage; not only for general tasks of a doctor, but specifically for the direction the student is aspiring to continue in [25, 69-71]. In the Netherlands, undergraduate medical education is a six year vertically integrated curriculum [19, 20]. In the first stage, a three-year bachelor phase, the emphasis is on basic sciences, but these are integrated with clinical application and reasoning, as well as with skills and communication training. Clinical rotations start in the third year of the bachelor. In the subsequent three-year master phase, clinical rotations are combined with preparatory courses [19, 20]. The sixth and final year of undergraduate