Gersten Jonker

Summary   207 A SUMMARY The main objective of the thesis is to explore the role of competency-based medical education (CBME) and entrustable professional activities (EPAs) in forging an educational continuum that fosters the development of competence. Chapter 1 is a general introduction to the thesis. It describes how learners develop through a series of stages with challenging transitions into doctors. A pathway that spans the continuum from student to medical specialist would improve learners’ development. CBME, applied to both undergraduate and postgraduate stages of the trajectory, is a promising approach to build a continuum. Chapter 1 takes a closer look at the development of competence from a theoretical perspective. The purpose of the thesis is elaborated and framed in research questions. The first part of the thesis concerns the role of a thematic transitional year of medical school in forging an educational continuum. The research questions pertaining to this part are: Does an elective transitional year, dedicated to 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? The second part of the thesis is involved with CBME in postgraduate anesthesiology training. The research questions related to this part of the thesis are: What is the structure, or are the structures, of European postgraduate anesthesiology training and to what degree have training programs transitioned to CBME and to EPAs? What is the foundation or justification of the ultimate entrustment decision of certification, granted to trainees at completion of training in anesthesiology in Europe? How can CBME, operationalized with EPAs, be applied to postgraduate anesthesiology training, and what research is required to assist competency-based anesthesiology training with EPAs? Chapter 2 lays out the idea of a multidisciplinary elective thematic final year. Anesthesiology, cardiology, emergency medicine, intensive care medicine, and pulmonology collaborated in the design of a coherent track that balances breadth with depth and graduates generalist doctors with a useful profile of acute care competence,