Gersten Jonker

Variations in anesthesiology training   137 6 Seventeen countrieswere categorized identically by all three researchers. On four further countries immediate consensus was reached after discussion. Three countries were in group A, five in group B, six in group C, and seven in group D. For thirteen countries the D category was considered, but there was no direct consensus on classification. Thus, in total, 20 countries could be classified as D, meaning they have features of two or three categories. This led to an extensive discussion on the appropriateness of the D category, being a hybrid category and containing the majority of countries. All countries categorized as group D were therefore reconsidered. For these countries further information was gathered from the representatives. On one country there was insufficient information to allow for classification. When reviewed more closely, many countries appeared to have evolved, or be evolving, from categories A or B towards C, albeit in different ways and to different extents. It was decided that a rigid four-category classification did not do justice to the diversity in evolution of training programs in Europe. We agreed to use a more fluid classification instead, which could depict this diversity and evolution graphically. This led to a triangular spectrum in which most countries could be positioned along the A – C or B – C axes (Figure 1). A few countries are positioned in the middle of the triangle, essentially representing remains of the former group D. Assessment The median duration of training programs was 5 years (range 2.75 – 7). In six countries duration of training was less than the minimum of five years recommended by UEMS/ EBA [2]. All countries but three had national uniform certification processes. The mean number of different assessment tools mentioned per country was 7.45 (range 4 – 13). The mean number of tools used nationally as prescribed by the national training program was 6.2 (range 1 – 12) per country. The application of various assessment tools is shown in Table 3. The most frequently mentioned assessment tools were direct clinical observation and feedback, oral and MCQ examinations, logbook, and portfolio. The European Diploma in Anaesthesiology and Intensive Care examination (EDAIC), that is a multilingual, end-of- training, two-part examination covering the relevant basic sciences and clinical subjects appropriate for a specialist anesthesiologist, was used in a minority of countries: six