Gersten Jonker

Summary   209 A elements that satisfy the psychological need for competence. The learning community of congenial peers fulfils the need for relatedness. By creating a supportive environment, with peers, teachers and mentors, the need for autonomy is partly met. With the needs largely satisfied students’ natural tendency for growth is stimulated. Chapter 4 takes a closer look at the simulation pre-test at the start of the ACTY. Vygotsky’s Zone of proximal development (ZPD) refers to the space between what learners have mastered and what they should master in the next developmental stage. Did the solo management of critically ill cases in the simulation pre-test, at the far edge of their ZPD, cause destructive friction and demoralization? The phenomenological study aims to understand the psychosocial and educational effect of the simulation pre-test by in- depth interviewing of individual ACTY students on their simulation experience. The essence of the students’ experience is that they struggled to deal with the simulated acute care situations, leading to stress, stirred up by uncertainty about medical management, deterioration of the simulation patients, and disappointment about their performance. The stress impeded cognitive functioning. However, the formative practice setting, anticipation of poor performance, debriefing, a safe environment, and the prospect of training opportunities regulated the emotional response to stress, turning a tense simulation into a motivating educational experience. The main finding of the study is that in a safe formative pre-test setting, simulations at the far edge of the ZPD do not cause demoralization and destructive friction, but rather cause constructive friction and instill motivation to develop. The finding implies that simulation pre-testing at the far edge of the ZPD, which represents simulation beyond traditional borders, can be used safely. Chapter 5 appraises the effect of the ACTY on learning and preparedness for practice, i.e. whether graduates meet postgraduate acute care expectations. The chapter describes a quasi-experimental study with a pre-test & post-test design in which participants took part in a multimodal assessment of acute care knowledge, clinical reasoning and case- management, practical skills, and performance in simulations. The study compares ACTY students’ test results with those of non-track students – with an interest in acute care – and with junior doctors with six months of clinical acute care experience. The test consisted of a written knowledge exam, case-based discussions, Objective Structured Clinical Examinations of skills, and high-fidelity simulations of critically ill patients requiring urgent care. Each assessment element yielded a checklist score, calculated as the awarded points as percentage of the maximum points. In addition, assessors reported a gestalt, expert evaluation of overall participant