Gersten Jonker

The ACTY: acute care transitional year   43 2 The design and implementation of the ACTTY has been a labor-intensive, albeit satisfying, process. It took considerable time and effort to collaboratively develop and describe the three EPAs, transcending traditional specialty boundaries, with faculty from five disciplines. We feel that it did reduce thinking in silos in the specialties. The EPAs are the focus of assessment. The multimodal exam at the start and end of the ACTY may be an important way to demonstrate attained competence. However, it is labor-intensive as well and may not be a sustainable undertaking at larger scale. Workplace assessment has been linked to the EPAs by using the themed short clinical observation forms. In 2014, the ACTY adopted an EPA approach in a medical school curriculum that was not EPA-based at the time. Therefore, entrustment decisions have not yet been part of summative evaluations of ACTY students. An entrustment decision relies on multiple observations of clinical performance and takes test results of required knowledge and skills into account. After an entrustment decision the student is permitted to execute the activity with indirect supervision. With the advent of our new EPA-based medical school curriculum, entrustment decisions will inevitably become part of evaluating students in the clinical phase, including the ACTY. The attainment of EPAs, even at the undergraduate level of near-independence, may help to justify decisions to delegate tasks or to reconsider the appropriateness of delegation to entering residents in the light of patient safety [10, 17]. ACTY students do their rotations in the five specialties in several partnering regional teaching hospitals around the region. Uptake of the ACTY concept and principles will likely not be homogenous. In addition, several kinds of clinical students may do rotations in hospitals – even at the same time. It is therefore the principal responsibility of students themselves to continuously draw the attention of local supervisors to the DTY and its special objectives. At the same time, investments should be made to adequately prepare supervisors and mentors and inform them on a continuing basis. CONCLUSION In this article we describe the development and design of a multidisciplinary dedicated transitional year, around the theme of acute care, with entrustable professional activities as learning objectives. After the ACTY, students have learned to bear responsibility for patients, have refreshed, enhanced, and integrated knowledge and skills from previous years, and will have acquired a profile of competence in acute care at the level of near- independent performance; this should be useful preparation for residency in the participating specialties. A similar set-up could be used to design other multidisciplinary