Gersten Jonker

Simulation at the frontier of the ZPD   69 4 Context In an effort to ease the transition to postgraduate training, medical schools in the Netherlands have redesigned the sixth (the final year) into a “transitional year” [24]. The transitional year includes dedicated elective tracks to enable students to develop early residency-level competence and a specialty preference [24,25]. The University Medical Center Utrecht introduced a multidisciplinary elective track in the transitional year aimed at providing students the opportunity to acquire acute care competence, preparing them for postgraduate training in anesthesiology, cardiology, emergency medicine, intensive care, or pulmonary medicine [26, 27]. Students in this themed final year program take multiple electives from these specialties. Another specific feature is a formative pretest of acute care competence. This junior residency-level test is meant to focus students on acute care elective entrustable professional activities (EPAs) that are objectives of the year ahead and to provide insight into the students’ strengths and weaknesses at the outset of the track. Themultimodal assessment measures knowledge, skills, clinical reasoning, and clinical performance in high-fidelity simulations of acute care settings. Students take a similar posttest at the end of the year to measure their individual development. All data are used both to provide feedback to students and for research purposes. The introduction of the pretest gave rise to the research question of this study. The simulation pretest The Simulation Center of Rijnstate Hospital, Velp, the Netherlands, hosted the simulation pretest, which took 3 ½ hours for groups of 4 students concurrently. Anesthesiologists, anesthetic nurses, and an anesthesiology resident, who were all EUSim-certified simulation facilitators [28] ran the test. Every student took part in 3 simulations, each lasting approximately 12 minutes. Scenarios required acute care in emergency room and ward settings (e.g. anaphylaxis, postoperative hemorrhage, acute myocardial infarction). A nurse was present and acted on instruction of the student only. Using a scenario-specific checklist, an anesthesiologist assessed students from behind a one- way screen. The resident debriefed each student after the scenario in private, allowing the student to vent emotions and to ask questions about medical or technical aspects. Debriefing was nonevaluative, pinpointing positive performance and highlighting poor performance as learning opportunities. To adhere to simulation research reporting guidelines [29] we have provided a detailed description of the simulation context, a typical scenario, and the assessor’s checklist (Appendix 1).