Connecting undergraduate and postgraduate medical education through an elective EPA-based transitional year in acute care: an early project report.

Objective: A well-designed final year may ease the transition from medical school to postgraduate training, if it has enough depth to enable the acquisition of early specialty expertise, while keeping enough breadth to support the graduation as all-round physician. Aim of this article is to describe the design of a multidisciplinary dedicated transitional year (DTY) around the theme of recognition and initial treatment of vitally threatened patients. Methods: Undergraduate and postgraduate training directors from the departments of Anaesthesiology, Cardiology, Emergency Medicine, Intensive Care Medicine and Respiratory Medicine at UMC Utrecht and partnering hospitals have collaboratively developed and implemented a curriculum for a final year focusing on three entrustable professional activities (EPAs) in the domain of acute care. These EPAs represent authentic tasks of starting residents in each of the participating specialties, align student training objectives with postgraduate expectations, and are the primary focus of learning, teaching, and assessment throughout the year. Students are developmentally supported by a mentor and educationally supported by monthly academic half days. Results: Between October 2014 and November 2016,, 47 students chose DTY Acute Care. The set-up of our DTY is inspiring other specialties to develop multidisciplinary DTYs. Attainment of clinical competence, experience of students and staff, and exploration of graduates' early careers are subjects of current research projects. Conclusion: This multidisciplinary dedicated transitional year aims to graduate students with profile-specific competence in acute care. It prepares for residency in a range of specialties.

A rapid prototyping model for biomechanical evaluation of pelvic osteotomies.

The biomechanical consequences of Salter pelvic osteotomy are difficult to assess due to the complex three-dimensional anatomy of the pelvis. Therefore, models of the dysplastic pelvis are required to allow realistic biomechanical simulation of possible outcomes. A polyamide reversed-engineering model of the left hemipelvis and proximal femur was produced from a computed tomography dataset of an 8-year-old child with severe dysplasia of both hips using selective laser sintering. Hip joint forces before and after Salter osteotomy of the hip were measured using an experimental setup in which an industrial robot was exerting hip joint forces and moments representing one-legged stance. Hip extensor and abductor actuator forces were measured which counterbalanced the joint moments. The preoperative hip joint resultant force was 583 N (270% body weight), while after the operation a mean force of 266 N (120% body weight) was measured. The resulting bony model was geometrically accurate, while apparent joint incongruencies were due to the neglected cartilaginous structures in the model. The preoperative joint resultant force was within the limits reported in the literature. The results suggest that Salter innominate osteotomy not only increases joint contact area but also reduces the hip joint force.