Gersten Jonker

General introduction   19 1 medical education prepares for work as a doctor by a graded increase in clinical care responsibilities during an individually assembled set of electives. It is referred to as a transitional year [19, 72-74]. The object of study in the first part of the thesis is an innovative approach to the transitional year at the University Medical Center Utrecht that students can elect to follow. It applies horizontal integration by offering a multidisciplinary track around the theme of acute care, with interdisciplinary learning outcomes. The track aims to enhance competence development and improved preparedness for work in this area. The students commence the track by taking a multimodal pre-test in acute care that includes managing critically ill patients in a high-fidelity simulator. Simulation can be stressful, all the more when it involves medical emergencies [75, 76]. On the other hand, a formative pre-test may clarify learning objectives and may be very valuable and motivating to students [77]. The overarching research question is: is an elective transitional year track dedicated to acute care helpful in easing the transition from student to doctor and in building an education continuum in a specialty where acute care is relevant? Contributing research questions are: • Does such an elective final year, focused on acute care, have a beneficial effect on the development of competence and preparedness for the next stage, i.e. working as a doctor in an acute care specialty? • If the innovation has effect, can its effect be understood by looking at learning theory, like Communities of practice, and motivational theory, such as Self- determination theory? And if the innovation does not sort effects, do these theories require adaptation? • What is the psychosocial and educational effect on students of simulation pre- testing beyond the competence level of graduates? Postgraduate anesthesiology training The secondpart of the thesis aims toestablishwhat current postgraduate anesthesiology training in Europe looks like and to gauge the progression to CBME. In addition, it explores the role of EPAs in operationalizing CBME in postgraduate anesthesiology training.