Comprehensive evaluation of specialist training: an alternative to board examinations in Europe?

Demands for specialist examinations grow in a new Europe with open borders for labour force, including medical doctors. Significant mechanisms stimulating this development are outlined. In the light of an analysis of the purpose of evaluation of postgraduate medical education, a warning is expressed against simplistic approaches and solutions. The measurement of clinical competence is complex and requires clarification of concepts, unveiling of needs, understanding of methodology, acceptance of consequences, and consideration of resource aspects of the different types of evaluation available. In order to emphasize the educational purpose of specialist training, a comprehensive formative evaluation process is suggested as an alternative to specialist examinations. This should involve both the trainee and the institution. Europe should not automatically imitate North America, and a supernational examination system with its many pedagogical, methodological, legal, and resource problems may not be the right approach to the assurance of quality in postgraduate medical education in Europe.