Building a continuum. Competence development from student to medical specialist

Abstract

This thesis aims to contribute to the evolution toward a medical education continuum from student to specialist and increases the understanding of competency-based medical education and entrustable professional activities as tools for building that continuum. The thesis describes an elective track in the final year of medical school to enhance competence development and prepare learners for work as a doctor in the domain of acute care. This variant of a transitional year delivers graduates who score higher than a comparison group on performance tests and resemble junior doctors better, indicating better preparedness for work in acute care. Even while the implementation of this track could have been more complete with more affordances to practice acute care, their sense of belonging to a learning community and their agency proved important determinants of the success of the innovation. In addition, a simulation pre-test exceeding the competence level of graduates instilled their determination for learning. The thesis then turns to current postgraduate anesthesiology training, finding substantial variation in European approaches to assessment and certification. The existing certification systems do not always offer a solid foundation for the decision to certify, which may lead to the certification of trainees who are not fully competent. A continuum is envisioned with students graduating well-prepared for work in the area of their preference and for further training to become a lifelong learning specialist who meets the requirements to provide safe and high quality patient care. Entrustable professional activities are promising building blocks for such a continuum.