Modificaciones en los estatus fitosanitarios

The future of assessment through the process of recertification depends on the appropriateness and thoroughness of revalidation systems. There are number structural and organisational questions that require answers before establishing the acceptability and feasibility of the assessment tools (Figure 1.5): (1) Do the results of the existing

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recertification process comply with the level of experience of an individual specialist in cardiovascular practice? (2) Are the results of the assessment process (knowledge and skills) compatible with morbidity and mortality outcomes of the individual physicians and surgeons? (3) What types of assessment tools will be used for the specialist assessment process in the absence of any data on reliability and validity of the tools evaluating technical and non-technical skills? (4) What do specialists think about the structure and frequency of the assessment process?

Geographical variation in the standards of assessment is another factor that can affect the international recognition of maintenance of certification across regions. For instance, many of the nations within the European Union (EU) have certification and recertification programmes with a noticeable difference in terminology, guidelines and assessment frequency. This may cause confusion as specialists within the EU are recognized to have ‘equivalency’ in knowledge and skills when working in any of the nations within this union.

In order to address this, a recent EU Directive 2004/36/EC has been introduced to allow the exchange of in-depth information on individual specialists regarding their fitness to practise (51). This new regulatory system is envisaged to address cultural, linguistic and medical competence issues associated with the increased doctor movement within the EU. The ultimate aim of this directive is to ensure patient safety across the union.

To further ensure the efficiency of this legislation whilst avoiding any potential ambiguity, the UK’s General Medical Council has proposed a ‘Healthcare Professionals Crossing Borders’ initiative that gives a frameworkfor exchanging licensing data and regulatory best practice (51). _{However despite these efforts, few European countries have yet to offer full} cooperation and information for this process. This may be explained by incomplete databases

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and unstandardized quality of care in some countries. Furthermore, a discrepancy also exists in the monitoring and enforcement of performance assessment at the specialist level(2, 51).

A complex assessment system without established reliability and validity will not last and may ultimately restrict the freedom of medical professionals (Table 1.4) (32). The assessment process needs to be acceptable to examiners, examinees, healthcare organisations and the public. At present the acceptability of the current assessment systems for specialists are not yet known. Specialist recertification is currently in the process of implementation and any possible shortcomings have yet to be reported. Similarly, although there are studies demonstrating the feasibility of individual assessment tools, there are none that consider the use of a combination of tools in a particular assessment framework. Further research is therefore required to clarify the efficacy of combining various assessment tools for specialist recertification. As a result, speciality-specific guidelines need to be drawn-up by the governing bodies for each of the craft specialities.

A positive association between board certification status and clinical outcomes has been reported although the correlation between recertification and clinical outcomes still remains unknown (52). Moreover, the guidelines for practitioners who are unsuccessful in recertification are not fully developed and a proposed path for further training or supervised practice is still under review.

At present, a perfect assessment tool does not exist (32). A consensus between what is desirable and achievable is needed. Assessment governing bodies need to implement systems with the highest validity, acceptability and cost-effectiveness.

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Table 1.4: Definitions of terms related to competence and assessment Competence (37)

Competence is the habitual and judicious use of communication,knowledge, technical skills, clinical reasoning,

emotions, values,and reflection in daily practice for the benefit of the individualand community being served. Competence builds on a foundationof basic clinical skills, scientific knowledge, and moral development.

Assessment (37)

Assessment is the process of documenting, usually in measurable terms, knowledge, skills and attitudes. The purpose of assessment in an educational context is to make a judgement about mastery of skills or knowledge; to measure improvement over time; to arrive at some definitions of strengths and weaknesses; to rank people for selection or exclusion, or perhaps to motivate them.

Characteristics of an ideal assessment tool (32, 53)

Feasibility: Measure of whether an assessment process is capable of being done or carried out.

Validity:

Validity determines whether an exam or a test actually

succeeds in testing the

competencies that it is

designed to test. Valid

assessment method covering all the facets of clinical competence needs to have following attributes:

Face validity is the extent to which the examination resembles the situation in

the real world. Complexity and level of interaction in a real environment is the best for performance assessment.

Content validity is extent to which the intended content domain is being

measured by the assessment exercise - for example, while trying to assess technical skills we may actually be testing knowledge.

Construct validity is the extent to which a test measures the trait that it purports

to measure. One inference of construct validity is the extent to which a test discriminates between various levels of expertise. Performance assessment exercise should be able to identify poorly performing practitioners.

Concurrent validity is extent to which the results of the test correlate with the

gold standard tests known to measure the same domain.

Predictive validity, the extent to which this assessment will predict future

performance

Reliability: Reliability is a measure of the reproducibility or consistency of performance, and is affected by factors such as examiner judgments, cases selection, candidate nervousness, and test conditions. Reliability is a measure of a test to generate similar results when applied at two different points (test-retest) or consistency of marking among examiners (inter-rater).

Acceptability: The extent to which an assessment procedure is accepted by the subjects involved in the assessment. Assessment system that threatens to affect credibility of practitioners is unlikely to be accepted by them.

Educational Impact: The extent to which assessment tool/process matches the pre-defined educational objectives. Assessment drives learning through its contents, format, given information and programming (frequency, timing & number of repeat examinations).

Cost Effectiveness: Implementation of assessment tool depends on ability of certain organization to generate sufficient funds plus technical and non-technical resources. Resource limitations are universal, even more for single institutions or individual test developers.

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