Gersten Jonker

General discussion   181 9 A THEMATIC TRANSITIONAL YEAR TRANSFORMS STUDENTS INTO DOCTORS The ACTY embodies a track that balances breadth and depth by graduating broadly- trained physicians with a profile of competence in acute care. This profile represents useful preparatory competence for a variety of specialties without cutting off opportunities in other specialties by being overly focused. The ACTY attracted 7% of the annual cohort (Chapter 2) and offered a moderate form of pre-specialization. Pre- specialization has the supposed benefits of shortening the developmental trajectory, augmenting learning curves, and make students stand out from the crowd of graduates [60]. A limitation is that the ACTY is a singlemedical school initiative pertaining to one domain of medicine. The ACTY principles of thematic coherence with horizontal integration and interdisciplinary learning objectives, and a supportivemotivating environment could be easily transferred to tracks aiming to optimize preparedness of a subset of learners for a selection of specialties in a particular domain of medicine, facilitating the “remarkable transformation of students to doctors” [61]. POSTGRADUATE ANESTHESIOLOGY TRAINING IS INTERNATIONALLY FAR FROM UNIFORM Just as in other medical specialties, CBME has been making an advance in postgraduate anesthesiology training. In 2003 Ringsted and colleagues described a changeover to competency-based training in anesthesiology inDenmark, including a shift toworkplace assessment of competencies and tasks [62, 63]. Since then, and especially in the last decade, many publications have addressed CBME in anesthesiology (e.g. [64-66]). A recent systematic review of the literature on CBME in anesthesiology [67] noticed that the evidence on achieving outcomes was limited to improved procedural skills, rather than overall competence. However, the improved procedural performance resulted in improved patient outcomes and cost-effectiveness [68]. The review concluded that the existing research provides a base to address the many identified gaps in knowledge about CBME in anesthesiology [67]. The studies in the second part of the thesis add to this base. Chapter 6 provides a complete overview of current anesthesiology training programs in Europe with respect to assessment and certification processes. Chapter 6 shows that there is no uniform approach to assessment and certification and the adoption of CBME is far from