Gersten Jonker

The ACTY: acute care transitional year   31 2 INTRODUCTION The goal of undergraduate medical training is to deliver doctors who are ready to practice within a postgraduate training program [1]. Students, graduates and program directors have identified gaps in the preparedness for postgraduate training in areas such as carrying responsibility and working at near intern-level, attributed to lack of educational focus in the final year of medical school [4-6]. A well-designed final year can bridge these gaps and facilitate the transition to residency [5, 7]. In the Netherlands, following the Bologna declaration [2], medical education consists of a three year Bachelor phase, which is mainly theoretical in nature, and a three year Master phase, which is largely devoted to clinical rotations [3]. Master years one and two comprise compulsory rotations in a wide range of disciplines. In the third and final year of the Master phase, all medical students at University Medical Center (UMC) Utrecht, follow a transitional year. This is a composite of one to three clinical electives and a research elective, which should ease the transition from undergraduate to postgraduate training. In this transitional year, students should work in clinical settings, integrate and apply knowledge and skills from previous years, grow into bearing clinical responsibility, deepen their understanding within areas of interest, acquire early specialty-specific expertise, and explore career options [4-7]. Some students, who are determined about their choice of specialty focus in an undergraduate transitional year on preparation for residency in one single specialty. It allows them to acquire early expertise, which may optimize their chances of getting into the desired residency program. However, a transitional year aiming at one single discipline may not suit the numerous students who are undecided about their choice of specialty and wish to explore career options or want to work in more generalist fields. Moreover, during their final year, students initially convincedof their choice for a specialty may change their minds, or found to be ineligible or to lack aptitude. Additionally, a narrow, ‘overly dedicated’ transitional year may not be the broad capstone of medical school that integrates knowledge and skills acquired in preceding years [5]. Purpose of this article is to describe the design of a final year of medical school shaped as a multidisciplinary, yet dedicated transitional year that addresses the above issues. Its goals are the acquisition of competence in acute care at an introductory level and to offer preparation for the responsibilities of postgraduate training in a range of specialties. We chose these goals as recently graduated doctors are often called upon to provide care in emergency situations.