Gersten Jonker

140   Chapter 6 All countries report to have time-based programs composed of rotations, sometimes referred to as the apprenticeship model [8, 9]. This is in accordance with earlier reports describing anesthesiology training [3, 10]. Postgraduate training in anesthesiology in Europe has evolved in many different ways. There appear to be two main streams of orientation towards training underlying the diversity. The first one is an apprenticeship model with a knowledge orientation. Assessment focuses on securing a certain level of knowledge in the trainee, often evaluatedwith a final exam. During curricular reforms, many countries have added other assessment modalities, including the exam for EDAIC and workplace based assessment. This evolution is exemplified by countries along the A – C axis of the triangle in Figure 1. The second main stream is the procedural orientation within an apprenticeship model. Here, expertise of the trainee is evidenced by completing a logbook with required numbers of procedures. Just as in the first main stream, in more recent times, other assessment modalities have been adopted for use in conjunction with the achievement of specified numbers of anesthetics. Countries on the B – C axis are examples of this approach. In the 2001 and 2008 UEMS/EBA Guidelines on training such a procedural orientation was advocated [3]. The 2008 Guidelines indicate a reorientation towards competencies, with the 2012 Guidelines promoting competency-based training in anesthesiology. In the past 15 years, competency-based medical education has been a major force influencing thinking on medical training and giving direction to curricular change [9, 11]. Competency-based medical education intends a shift from the time- based apprenticeship model, with variable learning outcomes, to an outcome-based model that deemphasizes fixed durations of training but focuses on outcomes, i.e. learningobjectives, tobemet [9, 11]. Interestingly, competency-based trainingprograms in anesthesiology have fixed durations of training. Allowing variable time spent in rotations is an organizational challenge that has not been settled [12]. An outcome- basedmodel offers transparency of what meaningful capabilities, competencies or roles are expected from graduates. These transparent outcomes may facilitate comparison of programs and harmonization of curricula [3, 9, 11, 13]. Competency- and outcome- based training set in motion a concurrent shift of assessment methods from mainly knowledge focused to an additional orientation on skills, competencies and clinical performance. Assessing competence implies using a variety of tools such as workplace assessments (clinical evaluation exercise (mini-CEX), direct observation of procedural skills), case-based discussions, simulation etcetera [14, 15]. In our study, countries closer to the C-end of the triangle (Figure 1), with an adoption of or orientation towards