Readiness for clinical practice : studies about transitions in medical education, the influence of vertically integrated curricula and the assessment of readiness for practice

The main goal of the thesis is to determine whether a vertically integrated curriculum at medical school enhances the transition to work and postgraduate medical training. A fully vertically integrated curriculum is defined as follows: 1. Basis science teaching in conjunction with a clinical context; 2. Real patient contacts from the first year of training; 3. Clinical clerkships from halfway or earlier during the curriculum; 4. A progressive increase of clinical responsibility of students over the course of all clerkships and 5. Clinical clerkships (3 months or longer) with an elective nature and substantial responsibility for patient care in the final year of the curriculum. Based on the results of the distinctive studies, it can be concluded that vertical integration of undergraduate medical curricula seems to have a positive influence on the readiness for clinical practice of medical trainees, although not all studies confirm this hypothesis as clear as we had expected. We found that, compared with graduates from a traditional curriculum, graduates who followed a vertically integrated curriculum had made their definite career choice earlier. In addition, they were more positive about the preparedness for work as a physician and postgraduate training, after finishing medical school. Further, they needed less time and fewer applications to obtain residency positions. In addition,graduates from a vertically integrated curriculum were evaluated higher by their supervisors with respect to the capability to work independently, to solve medical problems, to manage unfamiliar medical situations, to prioritize tasks, to collaborate with other people, to estimate when they have to consult their supervisors and to reflect on their activities. In addition, we developed a new authentic assessment instrument to determine the readiness for clinical practice of medical trainees, called UHTRUST (Utrecht Hamburg Trainee Responsibility for Unfamiliar Situations Test). For the development of the assessment, it is relevant to know which general features of trainees facilitate supervisors’ trust in trainees to perform critical clinical tasks. To uncover essential “facets of competence” (FOCs) we conducted a Delphi study among experienced clinical educators in the Netherlands. This study resulted in a list of 25 FOCs. The next step was to determine the generalizability of these FOCs. We asked physician educators in The Netherlands and Germany to rank the FOCs. A rank-order comparison showed almost full agreement about the top 10 FOCs across counties. The further development of UHTRUST was based on these FOCs. During this assessment, near-graduates were placed in the role of beginning residents on a very busy day. They were assessed by clinicians, nurses and standardized patients. We provided a validity argument for UHTRUST, according to Kane’s argument based approach to validity. The conclusion was that UHTRUST can be used for the assessment of the readiness for clinical practice of medical graduates. We were not able to draw clear conclusions on the superiority of vertically integrated undergraduate medical education on the readiness for clinical practice, based on the UHTRUST assessmen