Gersten Jonker

20   Chapter 1 At the start of the research project leading to this thesis (late 2013), EPAs began to emerge around the globe as curricular building blocks in postgraduate specialty training in obstetrics & gynecology [78], psychiatry [79], family medicine [80], and internal medicine [81]. Within anesthesiology, there is an important lack of clarity what the current approaches to training and in particular assessment and certification are. In the European Union, member states have to mutually acknowledge equivalent diplomas, making migration of professionals, including doctors, possible. This assumes comparability of training outcomes, but whether training outcomes or competence levels are equivalent is unknown. The studies in this thesis aim to map the present state and to explore whether we can be content with the level of competence of the specialists we have trained and how we ascertain this level. The research questions are: • What is the structure, or are the structures, of Europeanpostgraduateanesthesiology training and to what degree have training programs transitioned to CBME and to EPAs? • What is the foundation or justification of the ultimate entrustment decision of certification 2 granted to trainees at completion of training in anesthesiology in Europe? • How can CBME, operationalized with EPAs, be applied to postgraduate anesthesiology training, and what research is required to assist competency-based anesthesiology training with EPAs? 2 certification is defined as the process of all steps in meeting requirements and in decision making that eventually leads to the completion of training and access to registration as a medical specialist.