Gersten Jonker

150   Chapter 7 RESULTS Questions on the theme “Would you trust your loved ones to each trainee you certify?” equally evoked affirmative, irresolute and negative responses (see Table 1 for quotes). TABLE 1: Sample quotes of responses to questions on the theme“Would you trust your loved ones to each one of them?” Response Quote (participant no.) Affirmative I would absolutely have no qualms about them anesthetizing me or my children (12) The exams are particularly challenging. If somebody is not up to the job, they will not get through the exams. I have got a lot of faith in the examination system. (13) He has been assessed for five years, so we can say: he’s safe. […] We can put our hands on our heart and say he’s ready, for sure. (16) Irresolute I cannot guarantee you 100% that everyone who passes this final exam will be 100% in their practice. (18) Although we have run national courses for supervisors, it might be that we don’t have the same idea of the level needed. (11) I think in standard deviations. The certification cut-off is not the mean, but at -2 standard deviations. We always try to bring you to the middle. (23) Negative There are some strict criteria. If they meet those they pass. Even if I would not like to have them treat me. (7) We don’t have a bedside evaluation. The examination is just theory. We don’t evaluate formally the way of thinking, the way of doing. (6) She’s a problematic person. We know she’ll be a very problematic anesthesiologist after the exam […], but the only criterion is knowledge. (22) I have no right to forbid a trainee to go to the board exam; pass the oral after five years, and then you’re certified. (8) The main weakness is the detection of problems with trainees; in other words, to ensure that they are ready is very difficult (25) My chief advises me to be lenient. Because if I am too strict, my institution will get less money. (5) Participants who answered affirmatively labelled it the most vital issue in certification. They expressed confidence in their assessment processes to establish competence, relying on ‘big hurdle’ exams or longitudinal holistic assessment. Some participants, however, were hesitant to answer this question affirmatively for all trainees and felt unsure whether some trainees met competence standards. Ten interviewees admitted having certified trainees they did not deem competent enough to anesthetize their relatives. They blamed deficient evaluation criteria (e.g. assessment focusing solely on knowledge), ignoring important aspects such as clinical competence or professionalism. Other reasons included an inability to stop trainees from getting certified, poor methods to detect underperforming trainees, staff shortages, and the financial consequences to the department of failing a trainee.