title: Vertically integrated medical education and the readiness for practice of graduates.
abstract: BACKGROUND
  Medical curricula become more and more vertically integrated (VI) to prepare graduates better for clinical practice. VI curricula show early clinical education, integration of biomedical sciences and focus on increasing clinical responsibility levels for trainees. Results of earlier questionnaire-based studies indicate that the type of the curriculum can affect the perceived preparedness for work as perceived by students or supervisors. The aim of the present study is to determine difference in actual performance of graduates from VI and non-VI curricula.
  
  
  METHODS
  We developed and implemented an authentic performance assessment based on different facets of competence for medical near-graduates in the role of beginning residents on a very busy day. Fifty nine candidates participated: 30 VI (Utrecht, The Netherlands) and 29 non-VI (Hamburg, Germany). Two physicians, one nurse and five standardized patients independently assessed each candidate on different facets of competence. Afterwards, the physicians indicated how much supervision they estimated each candidate would require on nine so called "Entrustable Professional Activities (EPAs)" unrelated to the observed scenarios.
  
  
  RESULTS
  Graduates from a VI curriculum received significantly higher scores by the physicians for the facet of competence "active professional development", with features like 'reflection' and 'asking for feedback'. In addition, VI graduates scored better on the EPA "solving a management problem", while the non-VI graduates got higher scores for the EPA "breaking bad news".
  
  
  CONCLUSIONS
  This study gives an impression of the actual performance of medical graduates from VI and non-VI curricula. Even though not many differences were found, VI graduates got higher scores for features of professional development, which is important for postgraduate training and continuing education.
authors.affiliation: Department of Education and Training, Leiden University Medical Center, Leiden, The Netherlands. m.wijnen-meijer@lumc.nl.|Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands. m.wijnen-meijer@lumc.nl.
authors.forename: Marjo
authors.initials: M
authors.lastname: Wijnen-Meijer
authors.affiliation: Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands. T.J.tenCate@umcutrecht.nl.|Department of Medicine, University of California, San Francisco, USA. T.J.tenCate@umcutrecht.nl.
authors.forename: Olle
authors.initials: O
authors.lastname: Ten Cate
authors.affiliation: Department of Education, Utrecht University, Utrecht, The Netherlands. M.F.vanderSchaaf@uu.nl.
authors.forename: Marieke
authors.initials: M
authors.lastname: van der Schaaf
authors.affiliation: Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands. c.h.m.burgers@gmail.com.
authors.forename: Chantalle
authors.initials: C
authors.lastname: Burgers
authors.affiliation: Center for Innovation and Research in Medical Education, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands. j.c.c.borleffs@med.umcg.nl.
authors.forename: Jan
authors.initials: J
authors.lastname: Borleffs
authors.affiliation: III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. harendza@uke.de.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Harendza
mesh_terms: D000328:Adult; D002982:Clinical Clerkship / Q000379:methods / Q000458:organization & administration*; D002983:Clinical Competence / Q000592:standards*; D003162:Competency-Based Education / Q000379:methods / Q000458:organization & administration*; D003479:Curriculum / Q000592:standards / Q000639:trends; D004504:Education, Medical, Undergraduate / Q000379:methods / Q000458:organization & administration*; D004521:Educational Measurement / Q000379:methods / Q000592:standards; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D009426:Netherlands; D013337:Students, Medical / Q000523:psychology*; D055815:Young Adult