Gersten Jonker

Certification decisions in anesthesiology training   149 7 INTRODUCTION Postgraduate medical education culminates in the certification of trainees as medical specialists. Certification is a profession’s self-regulation process to assure the public that specialists are qualified to deliver safe, high-quality care [1]. The high-stakes decision to certify a trainee entails the credentialing of training and its assessment [1]. We recently observed considerable variation in assessment procedures and certification in postgraduate anesthesia training across Europe [2]. With the aim to better understand the variation in certification processes and the basis of certification decisions, we performed an interview study and explored whether programs meet the requirement of public accountability to deliver competent specialists. Ahead of a full report, the focus of this letter is on the competence of trainee anesthetists at completionof training, framed as entrustment of care for patients close to the supervisor, summarized as “Would you trust your loved ones to each trainee you certify?”. METHODS This qualitative study used constructivist Grounded theory principles and followed standards for reporting qualitative research [3, 4]. Following approval by the ethical review board of the Netherlands Association for Medical Education (NERB file 847, March 2017) and informed consent, we conducted semi-structured interviews with 26 senior anesthetists from 21 European countries. Each of the participants was directly involved in certification decisions, e.g. as program director. We purposively sampled participants to represent the different assessment and certification practices, identified previously [2], to ascertain divergent perspectives from a range of countries. Between June 2017 and December 2018, two anesthetists (GJ, APM) and one trainee (AO), conducted the interviews. The initial interview guide reflected our research questions and the literature. A professional service transcribed the audio-recorded interviews. Two authors (GJ and AO) performed open coding individually and axial coding through several discussions. Subsequently, GJ and AO independently established respondents’ position with regards to readiness of trainees to be entrusted with the care of loved ones at completion of training, and resolved any discrepancies through discussion. A web-based application (www.dedoose.com) facilitated collaborative analysis. In several iterations of data collection and constant comparative analysis we achieved saturation after 26 interviews. Findings fromour prior study [2] helped to maintain reflexivity regarding our presuppositions.