Gersten Jonker

188   Chapter 9 Since 2019 the Dutch national curriculum for anesthesiology training is EPA-based. A curriculum evaluation might contain a replication of the Delphi study [50], to confirm or adapt the set of EPAs now in use. Such work could include the evaluation of the quality of the EPAs [82, 114, 134, 135]. Comparing local implementations of the national curriculum may reveal differences in interpretation, sequencing, and assessment practices. Portfolio learning analytics can assist the comparison of programs for benchmarking and allows review of assessment data from entire programs. An easy example for the use of learning analytics is provided by the evaluation of the impact of the Covid-19 pandemic on workplace assessment and feedback of anesthesiology trainees [136]. Database analysis revealed that trainees requested 1 to 2 fewer assessments per month, with a shift from perioperative to acute care EPAs, but completion rates were unchanged. In addition, both direct observations and case-based discussions were employed and quality remained stable with timely rich feedback [136]. Comparing EPA-based anesthesiology curricula internationally may reveal influences of context, culture, and regulations on EPA descriptions and sequencing. Furthermore, a formal comparison with EPA-based training curricula in other specialties may provide insights in the issue of granularity of EPAs and size of sets in serving as attainable goals during training. FUTURE DIRECTIONS: BUILDING AN EDUCATION CONTINUUM Presently, the training of doctors consists of a series of independent silos “haphazardly pieced together”[1, 5]. In the future, a seamless continuumof aligned CBME stages, with EPAs as a unifying framework, can be envisioned [1, 2, 5, 42, 61, 73, 137, 138], that leads to improved healthcare quality and safety by ensuring that graduates of undergraduate and postgraduate education meet the delineated standards of competence. A continuumcan be built adhering to the five key components of CBME implementation: clearly articulated competencies for practice as outcome, sequenced progression in a path of expertise development, tailored learning experiences to facilitate the developmental acquisition of competence, competency-focused instruction to promote the acquisition of competence, and programmatic assessment to support and document development [139].