An elective entrustable professional activity-based thematic final medical school year: an appreciative inquiry study...

The transition from undergraduate to postgraduate training can be facilitated by offering electives that focus on increased patient care responsibilities. This transitional year model in the Netherlands has recently been expanded to offer packages of electives geared to specific residencies and was called "dedicated transitional year" (DTY). At University Medical Center Utrecht, an entrustable professional activity (EPA)-based multidisciplinary DTY in acute care (DTY-AC), rooted in self-determination theory (SDT), has been implemented. The current study aimed to understand strengths and challenges regarding the implementation of this specific DTY.

An explorative qualitative study among students, graduates, and faculty was conducted using an appreciative inquiry methodological approach. We gathered first-hand accounts of experiences with the DTY-AC in focus groups and interviews with students and interviews with graduates, supervisors, and mentors. Transcripts were analyzed with a directed content analysis approach.

Participants found the DTY-AC to focus learning, offering coherence by clear learning objectives, aligned assessment, and teaching sessions and offering a congenial learning community. However, EPAs were not the focal point of workplace assessment and evaluation. Providing sufficient hands-on student engagement in actual acute care situations was another challenge.

The concept of the thematic DTY is embraced, and it seems to help in meeting the SDT needs. Enhancing delivery in the workplace by improving formal implementation with information and faculty development, expanding EPA-focused workplace assessment, and extending hands-on experience of students could further unlock the potential of this final medical school year design. Our lessons learned may help in the development and implementation of similar programs, other models of DTYs, and final-year redesigns.