Gersten Jonker

58   Chapter 3 DISCUSSION This study investigated successes and challenges associated with the current design and delivery of a dedicated final year of medical school and aimed to formulate options to unlock further potential. The main findings (Table 3) and steps for improvement are discussed below. TABLE 3: Successes and challenges with design and delivery of the ACTY Strengths The ACTY focuses learning in a coherent program with clear learning objectives Educational sessions contribute to coherence and focused learning and create a congenial learning community The ACTY program attracts highly motivated and proactive students Possibilities for change and improvement Possibilities Improvement strategies Heterogeneity in involvement of supervisors Just in time information Faculty development Supervisor network events Position of EPAs Expand workplace assessments Entrustment decision Hands-on experience in acute care Bed-side teaching Legitimate workplace roles Entrustment-based discussion Simulation Foremost, the ACTY program focuses students’learning, as intended. It offers a coherent curriculum with learning objectives (EPAs) that transcend rotations and disciplines. Starting the year with a multimodal pre-test makes expectations explicit, and reinforces the focus of personal learning. Second, the ACTY-exclusive teaching sessions contribute greatly to the impact of the program. They are perceived as a valuable and appealing asset of the ACTY. As intended, they provide coherence and focus for learning. Above all, students value to be part of a learning community. The ACTY class may be seen as a community of practice [23]: a group that shares common interests, tasks and activities in which participatory learning occurs. Students feel part of a distinct and exclusive group of peers who are on the same wavelength. From a social identity theory perspective, this “in-group” perception provides a highly accessible and fitting group identity [24]. The close class creates a congenial climate for peer supervision, i.e. learning from an exchange of experiences and reflections.