Gersten Jonker

General discussion   191 9 Outside the clinical workplace, learning is supportedby teachingand simulation training. Intensive simulation training for complex procedural skills according tomastery learning principles, with structured assessments, detailed feedback and repeated exercise is an effective and patient-safe way to build initial expertise [27], prior to patient exposure and the accumulation of experience to reach proficiency. Simulation training and assessment is also used in undergraduate [15] and postgraduate stages of training to practice and evaluate the management of rare but critical situations and crisis resource management competencies, e.g. communicating around clinical deterioration of patients [160]. 5. Programmatic assessment The observation and evaluation of performance with a diversity of tools in a developmental model of assessment is at the heart of a programof assessment in CBME. To foster continuity and increase applicability of faculty development, the same or highly similar assessment tools are to be used across the continuum [5]. Longstanding relationships are helpful in establishing mutual trust; both in the trainee to carry out tasks with an appropriate level of supervision, as in the supervisor as an acceptable source of feedback. Programmatic assessment requires quantitative and qualitative data from multiple assessors with multiple complementary tools at multiple time points and wants all individual assessments to be low-stakes and supportive of learning. In addition to live observation in direct supervision situations, video-recorded cases can be retrospectively reviewed when indirect supervision is applied. Furthermore, a case-based discussion, i.e. chart-based recall, with the application of what-if questions, assesses readiness for unfamiliar situations and anticipation of risks and complications, making it an entrustment-based discussion [161]. A user-friendly electronic portfolio with learning analytic features makes development visible and supports decisions to withdraw supervision. After the group entrustment or promotion decision, trainees continue to receive feedback on their performance.