What is the role of accreditation in the era of competency-based specialist training - a perspective from the United Kingdom

Abstract

Higher specialist training in cardiology has undergone significant reform across numerous countries in recent years. A number of factors have driven these changes, from the legal requirement to reduce working hours (i.e., the European Working Time Directive) to the increasing sub-specialisation within cardiology and the need for appropriately focussed training within these sub-specialties. Cardiac imaging provides a neat framework in which to examine the effect of such changes. Technological advances in echocardiography, nuclear cardiology, computed tomography and magnetic resonance imaging have seen an unprecedented increase in the utilisation of all techniques. The need to deliver appropriate training is recognised and numerous accreditation schemes exist within cardiovascular imaging, with the aim of demonstrating that specified levels of experience and expertise have been attained. However, in the United Kingdom, there has been a change from the traditional experience-based training scheme to a new, competency-based training program, with regular use of workplace-based assessments to prove competence in a specified area or procedure. As this training model is implemented, it will produce a generation of trainees for whom individual accreditation schemes carry less value, given the competency assessment inherently present within their new training system. This article discusses the role of accreditation in the era of competency-based specialist training from a cardiac imaging perspective using the UK experience to highlight the challenges facing trainees and to encourage a debate around how best to ensure cardiac imaging specialists are fully competent at the end of their specific training programs.