Gersten Jonker

Summary   211 A procedures, assessed with a logbook. Countries within these orientations displayed, to different extents, the adoption of elements of a third orientation, i.e. a competency- based approach to training. This spectrum of diversity and evolution is depicted graphically by positioning countries along two sides of a triangle. Whereas UEMS/EBA training guidelines havemoved froma procedural to a competency- based orientation, current training in Europe is changing at varying speed toward competency-based training. The move to competency-based training is accompanied by the use of a larger number of assessment tools to support an ultimate summative decision on trainees’ competence. There is no uniform certification practice in Europe. The diversity in learning outcomes, assessment, and certification makes international comparison of training standards difficult. While Chapter 6 provides a complete overview of current assessment and certification practices, it does not address the quality of these processes. Chapter 7 deals with the quality of assessment and certification processes in European postgraduate anesthesiology training and aims to improve understanding of the basis of certification decisions. The chapter is a short report – preceding a full report - from an interview study using a constructivist Grounded theory approach. The chapter focuses onwhether decision-makers think that trainees have reached the competence level of a medical specialist, framed as entrustment of care for the supervisor’s loved ones. Participants were 26 anesthesiologists directly involved in certification decisions, purposively sampled from the different approaches to assessment and certification established in Chapter 6. The study finds that decision-makers’ answers to the question “Would you trust your loved ones to the trainees you certify?” were, disconcertingly, equally affirmative, irresolute, and negative. Some participants labelled it as the most important question around certification. Participants expressed varying levels of confidence in their assessment systems. Ten participants disclosed to have certified trainees they would not entrust with the unsupervised care of their loved ones, blaming deficiencies in the assessment system, impossibilities in regulations, and incentives to pass trainees. Flawed assessment and certification systems, that fail to consider all facets of competence, lead to “false positives”: certified but not fully competent. Chapter 8 starts with declaring the importance of justified decisions in delegating tasks to trainees for reasons of quality of care, patient safety, supervisor liability, and educational appropriateness. It continues to describe the role of competency-based