Gersten Jonker

208   Appendices prepared for work as a doctor in a selection of specialties. The Acute Care Transitional Year (ACTY) has clearly articulated, advanced level learning objectives formulated as three EPAs on the evaluation and initial management of critically compromised patients. The ACTY elective profile EPAs offer directed preparation for authentic tasks that junior doctors face in a range of specialties. The thematic orientation and the learning objectives provide coherence in a year that normally consists of a personal selection of elective rotations. The ACTY, introduced in a preliminary form in 2014/2015 and in full form in 2015/2016 attracts approximately 24 students per year (7% of the annual cohort). Of these students, 92% aim for a specialty that takes part in the ACTY, but only 16% are determined which specialty. Moreover, 68% also consider a career outside of the ACTY specialties. The ACTY is object of study in the research described in Chapters 3, 4, and 5. After the implementation of the ACTY, we gathered information from students, graduates, and faculty about successes and challenges of the new track (Chapter 3). In an explorative qualitative study with Appreciative inquiry as amethod, we spoke to end- users of the ACTY in individual interviews and focus groups, using Self-determination theory as an interpretive lens. End-users saw three strengths: 1) the ACTY focuses learning in a coherent program with clear learning objectives, 2) the teaching sessions contribute to the coherence and focus of learning, but above all create a congenial learning community, 3) the ACTY attracts highly motivated and proactive students. As opportunities for change and improvement participants named: 1) heterogeneity in involvement of clinical supervisors, 2) subordinate position of the EPAs, and 3) limited hands-on experience in acute care. Heterogeneity in local understanding of the ACTY track, variation in workplace uptake, and disparity in supervisor commitment are signs of an imperfect implementation. Participants suggest just-in-time information, faculty development and creating a supervisor network as improvement strategies. Participants feel that EPAs could be positioned more central in the ACTY curriculum, by making EPAs the focal point of workplace assessment and student evaluation, and by working toward entrustment. The advent of the new EPA-based core clinical curriculumwill likely ease the adoption of ACTY EPAs. Fundamental is providing sufficient hands-on engagement in actual acute care situations by affording legitimate workplace roles, supported by bedside teaching, case-based discussions and simulation training, participants propose. Self-determination theory provides insight in how the ACTY produces effect. The coherent curriculum with EPAs and the pre-test yielding explicit personal feedback are