An elective entrustable professional activity-based thematic final medical school year: an appreciative inquiry study among students, graduates, and supervisors

Figures & data

Table 1 Key features of the Utrecht DTY-AC

Key features of the Utrecht DTY-AC
Thematic rather than narrowly specialty focused
Three clinical electives and one research elective, limited to anesthesiology, cardiology, emergency medicine, intensive care medicine, and respiratory medicine
Three transdisciplinary EPAs related to acute care  EPA 1: Recognition and initial treatment of vitally threatened patients  EPA 2: Evaluation of respiratory compromised patients  EPA 3: Evaluation of circulatory compromised patients Performance target: (near) independent supervision
Workplace assessments linked to EPAs Tailored observation forms in conjunction with existing general observation forms
Pretest and post-test of knowledge, know-how, skills, and (simulated) clinical performance Written examination, case-based discussions, objective structured clinical examination, and simulated management of critically ill patients
Monthly teaching sessions Interactive small group teaching, peer supervision, integration, and deepening of knowledge
Senior residents acting as mentors Longitudinal developmental support and buddy

Abbreviations: DTY-AC, dedicated transitional year in acute care; EPAs, entrustable professional activities.

Table 2 Interview topics with examples of questions for St and Su

Topic	Sampled question
Relatedness to DTY-AC	St: Do you identify yourself as a DTY-AC student?
	Su: To what degree do you feel connected to DTY-AC?
Competence	St: Are you able to build competence on junior doctor level in the domain of acute care?
	Su: What would you say regarding DTY students’ knowledge, skills, and attitudes within the domain of acute care?
Curriculum	St: What were your main reasons to choose DTY-AC?
	Su: Can you elaborate on the DTY-AC philosophy?
Assessment	St: How are you being evaluated in your rotations?
	Su: Which sources of information and tools do you use in evaluating your DTY students?
DTY-AC in the workplace	St: Do you feel engaged with the department or department’s work?
	Su: How do you facilitate DTY students in reaching their learning objectives?
EPAs	St: Can you explain the role of the EPAs in your workplace learning?
	Su: What is your opinion on the DTY EPAs? (Prompt: regarding utility, feasibility, and clarity)
Organization and logistics	St: What are the strengths of DTY-AC?
	Su: What would you like to see improved in DTY-AC?
Professional identity and future	St: What is occurring with regard to your orientation on the job market and choice for a specialty?
	Su: How do you view DTY students, as compared to non-DTY final-year students?

Abbreviations: DTY, dedicated transitional year; DTY-AC, DTY in acute care; EPAs, entrustable professional activities; St, students; Su, supervisors.

Figure 1 Overview of students, graduates, and faculty participating in the study.

Note: Supervisors were from all five specialties.
Abbreviation: UMC, University Medical Center.

Table 3 Successes and challenges with design and delivery of DTY-AC

Strengths
DTY-AC 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 DTY-AC 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

Abbreviations: DTY-AC, dedicated transitional year in acute care; EPAs, entrustable professional activities.

Table 4 Lessons learned regarding medical school’s final-year designs

Lessons learned
A thematic final year may selectively attract motivated students
Teaching sessions foster a learning community and the need of relatedness
EPAs as learning objectives and aligned assessment help in meeting the need of competence
Invest in a community of teachers as well to stimulate their motivation and relatedness
Invest in faculty development and timely information to stimulate teachers’ competence

Abbreviation: EPAs, entrustable professional activities.