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Background: True competency-based medical education should produce graduates meeting fixed standards of competence. Current postgraduate programmes are usually based on a pre-determined length of time in training making them poorly suited for an individual approach. The concept of entrustable professional activities (EPAs) enables a more flexible, personalised and less time-dependent approach to training programmes. An EPA is a unit of professional practice, to be entrusted to a trainee to execute without supervision once they demonstrate sufficient competence. As EPAs relate competencies to clinical practice, they structure training and assessment more logically according to the way clinicians actually work. A first step in building an EPA-based curriculum is to identify the core EPAs of the profession.Objectives: The aim of this study was to identify EPAs for postgraduate training in anaesthesiology and to provide an example of how an existing curriculum can be transformed into an EPA-based curriculum.Design: A modified Delphi method was used as a consensus approach applying three Delphi rounds.Setting: Postgraduate specialty training in anaesthesiology in the Netherlands.Participants: All programme directors in anaesthesiology in the Netherlands except for a single programme director who was involved as a researcher in this study and could not participate.Main Outcome Measures: Agreement among participants on a list of EPAs. Agreement was specified as a consensus rate of more than 80%.Results: In this study, 27 programme directors (69% overall response rate) reached consensus on a set of 45 EPAs that describe a curriculum in anaesthesiology for the Netherlands.Conclusion: This study is a first step toward a more contemporary curriculum in competency-based postgraduate anaesthesiology training. [ABSTRACT FROM AUTHOR]

Purpose: Vygotsky's zone of proximal development (ZPD) refers to the space between what learners have mastered and what they should master in the next developmental stage. Physicians' tasks are ZPD activities for medical students, with high-acuity tasks such as resuscitation representing activities at the ZPD's frontier. This type of task can be taught and assessed with simulation but may be demanding and stressful for students. Highly challenging simulation may lead to a negative simulated patient outcome and can affect the participant's emotional state, learning, and motivation. This study aimed to increase understanding of the psychosocial and educational impact of simulation at the frontier of the ZPD., Method: The authors conducted 11 phenomenological interviews between September 2016 and May 2017, to describe medical students' experiences with a challenging residency-level simulation test of acute care competence at the start of the final undergraduate year at University Medical Center Utrecht. Interviews took place within 2 weeks after the participants' simulation experience. The authors analyzed transcripts using a modified Van Kaam method., Results: Students experienced a significant amount of stress fueled by uncertainty about medical management, deterioration of critically ill simulated patients, and disappointment about their performance. Stress manifested mainly mentally, impeding cognitive function. Students reported that awareness of the practice setting, anticipation of poor performance, the debriefing, a safe environment, and the prospect of training opportunities regulated their emotional responses to stress. These stress-regulating factors turned stressful simulation into a motivating educational experience., Conclusions: Simulation at the ZPD's frontier evoked stress and generated negative emotions. However, stress-regulating factors transformed this activity into a positive and motivating experience.