1 Bijlage I. Uit: Carraccio et al. 2008.

Principles of the Dreyfus and Dreyfus Model of Skill Development Applied to the Development of a Physician’s Competence

1.1 Novice

  • Is rule driven

  • Uses analytic reasoning and rules to link cause and effect

  • Has little ability to filter or prioritize information, so synthesis is difficult at best and the big picture

  • Is elusive

1.2 Advanced beginner

  • Is able to sort through rules and information to decide what is relevant on the basis of past experience

  • Uses both analytic reasoning and pattern recognition to solve problems

  • Is able to abstract from concrete and specific information to more general aspects of a problem

1.3 Competent

  • Emotional buy-in allows the learner to feel an appropriate level of responsibility

  • More expansive experience tips the balance in clinical reasoning from methodical and analytic to morereadily identifiable pattern recognition of common clinical problem presentations

  • Sees the big picture

  • Complex or uncommon problems still require reliance on analytic reasoning

1.4 Proficient

  • Breadth of past experience allows one to rely on pattern recognition of illness presentation such that clinical problem solving seems intuitive

  • Still needs to fall back to methodical and analytic reasoning for managing problems because exhaustive number of permutations and responses to management have provided less experience in this regard than in illness recognition

  • Is comfortable with evolving situations; able to extrapolate from a known situation to an unknown situation (capable)

  • Can live with ambiguity

1.5 Expert

  • Thought, feeling, and action align into intuitive problem recognition and intuitive situational responses and management

  • Is open to notice the unexpected

  • Is clever

  • Is perceptive in discriminating features that do not fit a recognizable pattern

1.6 Master

  • Exercises practical wisdom

  • Goes beyond the big picture and sees a bigger picture of the culture and context of each situation

  • Has a deep level of commitment to the work

  • Has great concern for right and wrong decisions; this fosters emotional engagement

  • Is intensely motivated by emotional engagement to pursue ongoing learning and improvement

  • Reflects in, on, and for action

2 Bijlage II. Voorbeeld bekwaamverklaring.

2.1 Bekwaamverklaring professionele activiteit […vakgebied…]

Bekwaamverklaringen worden verstrekt aan de aios van wie de opleider en gecommitteerde stafleden hebben vastgesteld dat deze de competenties bezit die noodzakelijk zijn om de betreffende professionele activiteit zelfstandig uit te voeren, ook indien er geen supervisie aanwezig is.

Table 1
Full size table

2.2 * Entrustable Professional Activity

De bekwaamverklaring wordt opgenomen in het portfolio van de aios en geregistreerd door de opleider. Hieraan kan een overzicht toegevoegd worden van aantallen malen dat de aios naar tevredenheid is geobserveerd op de verschillende niveau’s