Cees P. M. van der Vleuten

Aim: This paper reviews changes that are underway in postgraduate medical education in various European countries. Training in the workplace is a very effective way of learning, but it has many imperfections. Changes in in‐training assessment are proposed to remedy some of these.Assessment tools: The focus is on a set of assessment tools for performance in authentic work‐based contexts. These tools include direct performance measures of single clinical events (mini‐Clinical Evaluation Exercise, Direct Observation of Practical Skills, Objective Structured Assessment of Technical Skills, Case‐based Discussion, Mini‐Peer Assessment Tool) and performance measures over a period of time (Multi‐Source Feedback), based on judgement by one or more knowledgeable assessors (supervisor, other healthcare professional, patient, trainee himself/herself). Quantitative and qualitative information from single assessments is first and foremost used to promote learning, but also aggregated across a large sample of contexts and assessors in order to obtain an overall picture of a trainee's progress. Aggregating instruments, such as the portfolio, can be used to collect, support and assess outcomes in terms of competencies achieved. We will describe this set of instruments and provide theoretical background as well as our own practical experiences.Discussion: A central message is that the utility of assessment methods lies very much in the (understanding of) the users. Therefore, our concern is more with the actual implementation of change than with the assessment technology per se. If we fail in our efforts to implement real change, postgraduate education may be at risk for bureaucratization and trivialization. We nevertheless are excited to see change happening in the right direction, but remain patient, not expecting very quick wins.

The role of deliberate practice in medical students' development from novice to expert was examined for preclinical skill training.

Available evidence suggests that improvements in genetics education are needed to prepare primary care providers for the impact of ongoing rapid advances in genomics. Postgraduate (physician training) and master (midwifery training) programmes in primary care and public health are failing to meet these perceived educational needs. The aim of this study was to explore the role of genetics in primary care (i.e. family medicine and midwifery care) and the need for education in this area as perceived by primary care providers, patient advocacy groups and clinical genetics professionals.

Public pressure has increasingly emphasized the need to ensure the continuing quality of care provided by health professionals over their careers. Health profession's regulatory authorities, mandated to be publicly accountable for safe and effective care, are revising their quality assurance programs to focus on regular evaluations of practitioner performance. New methods for routine screening of performance are required and the use of administrative data for measuring performance on quality of care indicators has been suggested as one attractive option. Preliminary studies have shown that community pharmacy claims databases contain the information required to operationalize quality of care indicators. The purpose of this project was to determine the feasibility of routine use of information from these databases by regulatory authorities to screen the quality of care provided at community pharmacies.