Gersten Jonker

Variations in anesthesiology training   141 6 competency-based training, tend to use a larger number of assessment tools. However, the survey only provides information on which tools are used, and not on how often they are used. Certification is the “ultimate hurdle after many years of training” [3] to qualify for working unsupervised as a medical specialist. This study confirmed previous statements that no uniform certification process exists in Europe for anesthesiology training [3, 10]. Although similar studies in other medical specialties are unknown to the authors, the literature indicates that other disciplines face comparable issues. Assessment is often mainly focused on knowledge and know-how and less on skills, competencies or roles [16-18]. In those specialties, uniform European certification processes do not exist and harmonizationof assessment (e.g. a Europeanexam) and trainingappears tobe adifficult goal to achieve because of differences in practices and cultures [16-19]. Differences in health care systems, anesthetic team compositions and roles (such as the inclusion of intensive care or chronic pain therapy) call for diversity in learning objectives and their assessment. These factors may preclude full harmonization of requirements [1]. Nevertheless, the globalization of healthcare and free movement of EU doctors require agreement on minimal standards of competence [1, 3]. Also, these standards could stimulate sharing best practices in assessment and certification processes [1]. All countries represented at UEMS/EBA participated, offering a complete overview of the current situation regarding assessment and certification. Information provided by the national representatives to UEMS/EBA is assumed to be accurate, as they are knowledgeable in current status and developments in postgraduate training in their countries. Further clarifying information was found in official documents provided by the participants or retrieved from national societies’ websites, where available. No discordance between survey results and document information was encountered. Triangulation by comparing to another source supports the assumption of reliability of the data and credibility of the results [20]. Investigator triangulation, comparing the independent analyses of more than one investigator, enhances quality in qualitative research by improving credibility [20]. The diagrammatic representation process has inherent limitations, as there are no numerical data available to calculate a position in the diagram. We consider the positioning of a country primarily to be relative to other countries. Although our study gives an overview of the design of assessment and certification practices it does not provide insight into its quality. Future research could zoom in on the certification decision, defining crucial elements in and robustness of the certification process.