Gersten Jonker

190   Chapter 9 144]. This requires sustained relationships with supervisors, in undergraduate education and postgraduate training, in more longitudinal horizontally integrated attachments. Entrustment leads to a change in trainee responsibilities, i.e. in the right to act [133]. The continuum of competence development persists after certification at completion of postgraduate training. Generally, the largest part of a doctor’s career is after certification as a medical specialist. Competence is not permanent, it may decay with disuse and grow further with continued usage [148, 149]. Longer-term competence requires continuing deliberate practice, an attitude of self-regulated lifelong learning, including reflexivity [138, 148, 150]. Recertification as a specialist based on continuing professional development can be competency-based if activities and their appraisal are authentic [73, 150], and may well be linked to EPAs. Multisource feedback [151], peer observation [152], and simulations [153-156] can have a role in recertification. Similar activities can be used for re-entry into the field or into a subspecialty. 3. Tailored learning experiences to facilitate development Instead of specialty-oriented rotations, clinical learning experiences are sequenced primarily from an educational perspective to facilitate development. Learner- centeredness applied to the active participation in provision of patient care increases opportunities for meaningful learning experiences [157]. It eases transitions and exploits the transformative potential of experiential learning [3, 45, 157, 158] to boost the development of competence and professional identity formation [159]. With the restricted working hours, no trainee time can be wasted on inappropriate tasks, but all effort goes into tailored experiences to efficiently navigate the zone of proximal development. 4. Competency-focused instruction Faculty development is critical in successfully implementing CBME programs [37-40]. It includes teaching faculty how to teach, how to assess [107], but also how to coach and support trainee development, reflective practice, and wellbeing. Workplace learning across the continuum is supported by formative assessment and constructive feedback. Supervisors and learners are ready to exploit the learning benefit of each day in clinical work. The choice of activities may alter the balance between training and service provision.Workplace instruction can occur in high-intensity settings with a team of interprofessional learners and supervisors. Workplace instruction also includes debriefing of situations, ad hoc bedside teaching, and case-based discussions.