Gersten Jonker

Delivery and adoption of the ACTY   59 3 A third ACTY strength is that it succeeds in attracting highly motivated pro-active final year students. We believe that the ACTY offers a motivating environment for student growth. Self-determination theory states that people’s natural tendency to develop is stimulated when the need for confidence and effectance (competence), the need for volition, i.e. choosing what a person desires or finds useful (autonomy), and the need to belong to a group or community (relatedness) are satisfied [25]. This organismic- dialectic framework of psychological needs [26] is mirrored in the findings of the study. Despite the strengths of the ACTY, the quality of programdelivery in theworkplace could be improved. Supervisors appeared to feel only marginally involved with the program. The fact that ACTY students do rotations in parallel to non-ACTY students decreases the visibility of the ACTY. Provision of more and timely information could increase familiarity of supervisors and departments with the intentions of the ACTY and convey a clear message on what is expected from supervisors and mentors. Support should be offered to increase rotation sites’ readiness to supervise ACTY students [27]. Faculty development sessions providing tailored training on how supervisors can contribute to the learning of students by exploiting learning opportunities potentially improves quality of delivery and may improve involvement of supervisors. Such sessions would provide networking opportunities as well. Another avenue for unlocking potential regarding quality of delivery is reinforcing workplace assessment with ACTY-specific observation forms. Moreover, the EPAs could play a more central role in the evaluation of students. Mapping a developmental trajectory in an e-portfolio would raise the awareness of and growth towards the learning objectives and would be an essential condition for entrustment decisions. Also, the repertoire of workplace assessments could be expanded by adding multisource feedback [28] and entrustment-based discussions [29]. The theme of acute care with learning objectives described as professional activities for (junior) doctors in acute care settings is perceived as relevant. Students expressed the desire to have more hands-on experience in the ACTY EPAs. However, in practice, the care of instable or acutely deteriorating patients is in many settings a situation in which trainees or more experienced doctors are at the helm. Possibly, restricted workplace affordances, because of norms of practice, seniority, and unfamiliarity of teammembers with the learner [30], preclude students from engagement in acute care. This has impact on the feasibility of the program’s goals and intentions. Supervisors could be encouraged to exploit acute care situations as learning opportunities. First of all, supervisors could debrief students observing the management of acute care [31], provide bedside teaching [32, 33], and have case-based discussion to teach and evaluate