Volume 17, Number 4, December 2005
| | Specialty Education and Training — Is Global Standardisation Achievable? |
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For any clinical specialty, education and training followed by certification, and life-long learning or continuing professional development with periodic recertification, represent the core requirements for the provision of high-quality care. In any society, educational standards are set by an expert body chartered by government, and reviewed periodically both to maintain pace with developments in the field and to retain relevance to available and expected services. This is a well-established system in individual countries. However, it is known that such standards vary enormously between different countries.
It would be a great advantage, in today's world of frequent travel and global communication and access, if the same standard of education and training, and therefore the quality of care, could be more broadly accessed across international borders. This would provide assurance to patients that a defined level of knowledge and skill (competency) is brought to bear on their medical condition when an individual surgeon with such an accredited standard of education is consulted. After all, this is just what we expect every time we step onto an aeroplane! Not only the aviation industry, including personnel and equipment, is governed by international standards, but also the building industry, the manufacturing industry, and others. So when, or why not, specialty education, along with quality of care?
It is easy to decide what trainees need to know in terms of subjects and topics but much harder to decide the depth of knowledge required. In practice, the standard is set by the pass mark in a knowledge test, yet this is an area of variability because of the tendency to norm referencing (i.e., ensuring that a certain percentage of candidates will pass) by the local examining body. Consequently, there is an inherent variation in standard that would result if the same test were to be applied in different countries. On the other hand, performance-based tests applicable to evaluating clinical skills are more apt to standardisation, but only if external assessors representing the international specialist community are recruited by the local standard setting body.
In an attempt to come closer to a global standard in oral and maxillofacial surgery education, international courses have been initiated and national and regional examining boards have been set up. However, in the final analysis, the attributes of a good surgeon, like empathy, effective communication, analytical acumen, and responsible decision-making cannot be 'trained into' a person because education can never be about the simple transfer of knowledge. Education is about the transformation of self, and training is about helping young colleagues reach their professional potential, develop their values, and become passionate members of our specialty in their contribution to the health care of patients.
Can such an agenda be realistically written for every training centre in every region in the world? It should be.
Nabil Samman
Editor-in-Chief
Asian Journal of Oral and Maxillofacial Surgery
Asian J Oral Maxillofac Surg. 2005;17:209.
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