As has been the tradition for several years now, on 18th and 19th September, the conference organised by the Spanish Society for Medical Education (SEDEM), the Medical Education Foundation (FEM) and the General Council of Official Medical Associations (CGCOM) on topics of interest in medical education took place within the framework of the Menorca Public Health School. This year?s conference was entitled ¿Evaluating doctors: who and how?. The purpose of the encounter was to discuss the processes for evaluating doctors in the different stages of the educational continuum: the bachelor?s degree, specialised training and continuing medical education.

In order to stimulate debate and discussions, the conference was honoured with the presence of four keynote speakers: Professor C. van der Vleuten, Chair of the Department of Educational Research and Development in the Faculty of Health, Medicine and Life Sciences at Maastricht University, Scientific Director of the School of Health Professions Education and a world-renowned expert in medical education evaluation; Dr P. Garrido, President of the Spanish National Health Specialties Advisory Board; Dr A. Martín Zurro, Vice-Chairman of the FEM, and Dr V. Papalois, recently appointed President of the European Union of Medical Specialists (UEMS). The conference was structured in three tables, each of them dedicated to one of the different periods of the educational continuum.

At the table devoted to evaluation during the undergraduate degree, Prof. van der Vleuten discussed the concept of programmatic evaluation, which has been the subject of several editorials and articles in previous issues of this journal. Van der Vleuten pointed out the need to move away from the old concept of assessment of learning towards the new approach of assessment for learning. He also stressed the need to establish holistic and longitudinal assessment throughout the training process that includes the use of various instruments at different times, which would increase the validity and reliability of the assessment.

Van der Vleuten insisted on the fact that isolated assessments without any feedback are of little use and that, when high responsibility decisions have to be made (high stakes assessment), different kinds of information from different assessment times have to be available using a variety of instruments. He also referred to the importance of the mentor in this new approach to assessment.

In the discussion, the difficulties of implementing this type of assessment in our medical schools were raised, with traditional curricula that are not integrated and not really based on competencies, with a highly compartmentalised model of assessment or with rigid structures in terms of teaching staff and administration.

The second session addressed the evaluation of specialised training residents/professionals. The speakers emphasised the need to evaluate residents due to social responsibility and to adapt assessment to the different contexts of specialised training. Attention was also drawn to the fact that the evaluation of residents is of little or no importance, especially when it is negative, and to the discrepancies between what assessment should be at this stage and what the administration itself requires regarding evaluation.

Topics that arose during the discussion included whether or not it is convenient to issue, for each resident, a document specifying details of all their evaluation history. Special emphasis was placed on the fundamental role of the tutor in assessment and the low extent to which they are acknowledged. Finally, it was considered that, in our context, programmatic assessment could be more easily applied to the assessment of residents than of undergraduates.

In the third session, the key message given by Dr Papalois was that ¿continuing medical education and professional development are a moral and ethical obligation for doctors and should be promoted, sponsored, protected and facilitated, structurally and functionally, by all national public and private health systems in the European Union?.

While assessment in undergraduate studies or for access to specialised training is strongly regulated, continuing medical education and continuing professional development have traditionally been regarded as voluntary actions and an individual ethical duty of medical professionals.

Papalois stated that the goals of the UEMS include the promotion of quality medical care, by harmonising and improving the quality of the medical care delivered by specialists throughout the European Union, and encouraging and facilitating continuing medical education for European specialists. He also indicated that the drive to change the nature of continuing medical education and continuing professional development from voluntary to compulsory has been instrumental in the creation of the European Council for Accreditation for Continuing Medical Education (EACCME) by UEMS in October 1999. This accreditation offers a guarantee of high quality, impartial and didactic continuing medical education and, for European doctors, ensures that this quality will be recognised in their country of origin.

In response to the question as to ¿who? should evaluate doctors during their professional practice, in terms of the scientific content of continuing medical education, Papalois indicated that it should be ¿the corresponding specialised section?, and in relation to ¿how?, he stated that ¿UEMS-EACCME offers a well proven and complementary European accreditation tool?.

In the discussion, other aspects raised included the time that the administration should grant a specialist doctor for continuing training and whether it should be one of the key recommendations that the UEMS ought to promote. Other issues that were considered were the fact that continuous medical training, although necessary, is not sufficient to ensure professional competencies, and the question as to who should lead the planning, coordination and recording of continuous professional development activities.

Undoubtedly, this year?s conference contributed new ideas on the evaluation of professionals and raised new issues and new ways of addressing these problems, which should lead to improvements in the evaluation of doctors, one of the chief unresolved issues of our education system.

We are grateful to the three organising institutions for the efforts made to ensure the meeting ran smoothly and their ongoing commitment to the promotion of all those activities that aim to improve the training of medical professionals