Gersten Jonker

An agenda for development and research   163 8 outcome [40]. Moreover, standards of good performance have to be defined [37], and judges should be trained and ‘calibrated’ with examples of performance levels for an EPA [1, 23]. Progress in mastery of EPAs together with reports, records and comments can be kept in a digital portfolio and used to assist formal decisions to delegate. Learning analytics technology can be used to inform learners about their progress and to establish benchmarks for justified delegation. Learning analytics may provide insight into training performance at the institutional or (inter-) national level, and can make comparison of institutions possible. Finally, apart from knowledge and skill, factors affecting trustworthiness of a resident need further investigation [18, 28]. Trustworthiness is difficult to quantify, but incorporates understanding of one’s limitations, conscientiousness and truthfulness [16, 41]. Although resident proficiency might be the central issue, trustworthiness remains a significant factor in delegation, but its exact role needs to be elucidated. A research anddevelopment agenda (Table 4) should therefore include the identification and sharing of essential EPAs for anesthesiology training, the identification or construction of instruments to allow for justification of delegation and the adaptation of training programs, gearing them to qualify anesthesiologists with established high levels of competence. Directly linked to the development of an EPA-based training program are the challenges that come with the implementation of any new training system. Theremay be resistance at the introductory level before residents and supervisors accept the proposed changes [42]. Organizational challenges might include dealing with allowing a variable time spent in training and problems with subsequent enrolment planning in subspecialty training posts [42]. Residents’acceptance depends on clear expectations of the program and explicit learning objectives. Also, program directors need to have a well-defined view on stimulating and rewarding advancement in training [42]. It is essential that supervisors are convinced of the advantages of the new system and are well instructed in its use [42].