Training, assessment and accreditation in anaesthesiology and the implications for the European Union.

Training, assessment and accreditation of anaesthesiologists within the European Union (EU) is generally well organized and of a high standard. However, variations occur, both within and between countries, for a number of reasons, almost all of which are related to issues outside the control of the medical profession. I believe that the quality aspirations of all those involved in anaesthesiology training in the EU would, given optimal circumstances, be the same. At present, each Member State organizes its own manpower planning, training schemes, assessment and accreditation processes, awarding national certificates of completion of anaesthesiology training, which in turn lead to inclusion on the country’s ‘Specialist Medical Register’. This degree of national independence is to be welcomed. Such training programmes vary in intensity, duration and assessment. Some include examinations, others include the testing of general and specific skills, and others still, have less clear end-points. The crucial factor is that, once a doctor is included on the Specialist Register, and provided these doctors obtained their primary medical qualification in an EU Member State, they are legally able to apply for inclusion on the Specialist Register of another EU Member State. Ironically, other anaesthesiologists, equally well qualified and on the Specialist Register of an EU Member State, but with their primary medical qualification in a non-EU country, cannot enjoy this freedom of exchange. To many of us, this is simply bureaucratic nonsense! So while centralized ‘approval’ of national training schemes would be welcome, the imposition of a single centralized and international training programme would be inappropriate. As European anaesthesiologists, should we be concerned about this, and if so what should we be doing? Perhaps we should ask, what does the EU need and who should take the lead? Should it be the European Board of Anaesthesiology, under UEMS, or the proposed new confederation of ESA, European Academy of Anaesthesiology (EAA) and CENSA, or even a new body altogether? I believe that our objectives should be to raise the standards of anaesthesiology and its related disciplines, in Europe for the benefit of our patients, to improve training and assessment and to encourage scientific meetings and research. Greater uniformity of training, accreditation and assessment would facilitate additional opportunities for integration and harmonization, enhancement of professional standards, movement of professionals between countries and development of the speciality. The current methods of assessment, training and accreditation in Europe vary between and even within countries. Individual Diplomas are awarded, different criteria for specialist recognition are used, different periods of training are required and there is variable recognition of other countries’ qualifications and accreditation. In addition, Europe has some unique problems related to language, variable individual practice and resources and the supply and demand for doctors. I believe that the European Academy should have a major role in the assessment of training and specialist recognition within Europe. There is great potential and opportunity for the expansion and use of the European Diploma, either as part of a national qualification process or as an internationally recognized qualification. It could be linked to hospital accreditation through the joint process, which already exists between the Academy and UEMS. The European Board, under UEMS, could and should establish criteria of Fellowship and even Membership, which would be open to all anaesthesiologists in Europe and would facilitate professional harmonization. However, the European Diploma is only testing knowledge. If we accept that, in future, competence in a trainee should be assessed as the possession of the knowledge, skills and attitudes required to undertake safe clinical practice at a level commensurate with their stage of training, then the EDA would certainly fulfil the requirement for a test of knowledge, as part of competency-based training. Clinical skills would Correspondence to: Peter Simpson, Royal College of Anaesthetists, 48–49 Russell Square, London, UK, WC1B 4JY. E-mail: [email protected]; Tel: 44 (0)20 7813 1900; Fax: 44 (0)20 7813 1875