Gersten Jonker

General introduction   21 1 OUTLINE OF THIS THESIS We will address the research questions as follows. The first part of the thesis focuses on the final year of undergraduate medical education and the role of competency-based education in the transition from student to doctor. Chapter 2 presents the idea of the multidisciplinary elective final year dedicated to acute care. The descriptive study discusses the design and establishment of the track. It links the theory of Communities of practice to the thinking behind the track. It also coins the idea of elective profile EPAs as advanced level and specific objectives, offering targeted preparation for postgraduate training in a range of specialties. After implementation of the acute care final year elective track, an explorative qualitative study looks at strengths and challenges of the track and how it produces effect (Chapter 3). The study uses appreciative inquiry as a method for interviews and focus groups with end-users of the track. It uses Self-determination theory as an interpretive lens. Chapter 4 zooms in on the use of simulations in the pre-test at the start of the elective final year focused on acute care. The study aims to provide understanding of the psychosocial and educational effect that high-fidelity simulations of critically ill patients has on students. Such overly challenging scenarios happen at the student’s far edge of the zone of proximal development. The findings of this phenomenological study are to be linked to Vygotsky’s Zone of proximal development theory. Chapter 5 evaluates the effect of the elective final year focused on acute care on learning and preparedness for practice, measured as performance of students in a multimodal assessment. The quasi-experimental study uses a pre-test & post-test design and compares track students’performance with that of non-track students – with an interest in acute care – and with junior doctors working in acute care specialties. The second part of the thesis relates to postgraduate anesthesiology training. Chapter 6 seeks to establish the current state of affairs in European postgraduate anesthesiology training. A survey study, with quantitative and qualitative data, compares national programs with regards to assessment and certification processes to evaluate the current place of CBME. Chapter 7 aims to provide a better understanding of the foundation and justification of certification decisions in European postgraduate anesthesiology training. In an