Ensuring quality in postgraduate medical education: competency testing is the key

The changes made to the curricula and assessment systems in the UK have resulted in pathology specialty-training programmes which assess trainees on a regular (weekly or monthly) basis. An end of first year assessment tests their aptitude for the specialty, the FRCPath examinations taking place after at least one to two (part 1) and three to four (part 2) years of training respectively, and multi-source feedback is undertaken in years 1, 3 and 5. With regular educational appraisal, this constitutes cohorts of well-assessed and supported trainees. The assessments are blueprinted to the curriculum, ensuring adequate assessment coverage of curriculum content within workplace-based assessments (WPBA), objective structured pathology examinations and the FRCPath examinations. Notably, generic non-clinical attributes and behavioural skills such as leadership and management skills can be covered in the WPBA. Many of these changes are evolutionary in nature, but some have been imposed by continuously increasing regulatory requirements. Whilst additional information is generated, the increased amount of assessment of trainees has led to complaints that trainees do not acquire enough practical experience in the laboratory. It will be important to find the balance between didactic teaching with formal assessment, and apprenticeship-style, practical hands-on learning.