Training and Assessment in Urology: Perspective From a Third World Country
This paper aims to evaluate the current status and governance of formative assessment during surgical training in our country and compare this to the systems for formative assessments in developed countries, in particular the General Medical Council (GMC). Although continuous formative assessment is an essential component of quality surgical training, considering a lack of formal structures for such assessments and academic trends, it is often hard for institutions to conduct and/or monitor such activities and is thus often neglected and not given its due importance  . With regard to the current trend in postgraduate medical education in Pakistan, the quality of training programs is often measured by how well trainees perform during their assessments in exit examinations. Conventional surgical training has come a long way from the Halstedian model of the early 20th century. The curricula of the various postgraduate training programs offered by the surgical training programs are principally tailored to the needs and requirements of the local accrediting body, the College of Physicians and Surgeons Pakistan (CPSP). In order for an institution to be approved by the College, they must adhere to such criteria, after which a formal visitation of the campus by college officials is conducted. The College has set the guidelines and the benchmark standards and monitors and ensures standardization of training among various affiliated institutions in Pakistan.
To grasp how candidate assessments are encouraged by the CPSP, a detailed review of the urology handbook was done to see how the assessment has been carried out in this specialty. The CPSP is not much involved in how each individual training institution conducts its programs. For the specialty of urology, after clearing intermediate modules and doing their specialty training for 3-4 years, they are required to complete certain defined scholarly tasks, as well as regularly update their electronic procedure log [5,6]. Although the CPSP considers itself to follow a competency-based curriculum, has defined different competencies required for each level of trainees (observer, assistant, performed under supervision, and performed independently), and has made a recommendation that candidate competence should be structured by their level of training, there is no recommendation on how these candidates should be assessed through their training, as its essential focus is to certify that a candidate satisfies the minimum criteria to be a safe practitioner. In contrast to the CPSP, which focuses primarily on postgraduate training, the GMC covers a multitude of functions relating to clinical practice. As evident in their “Guidance on Assessments in Undergraduate Medical Education,” medical schools are encouraged to design their curricula and make appropriate provisions for both summative and formative assessments in their courses . The GMC makes sure to carry this approach toward assessment over into postgraduate training, and professional practice, as is described in “Excellence by design: standards for postgraduate curricula guidance on implementation for colleges and faculties” .
According to their guidance on “Designing and maintaining postgraduate assessment programs,” formative assessments should require and enable interaction between learners, assessors, teams, and patients . The GMC describes formative assessment as “Supervised Learning Events” (SLE) and summative assessment as “Assessments of Performance” (AoP) . In terms of assessment strategies and functionality, the GMC is very robust and well structured and offers guides and recommendations at multiple levels of training and practice. From a more practical standpoint, it is probably unjust to compare the CPSP to the GMC. Taking a glance at institutional practices in Pakistan, it should be emphasized that the programs have been structured to reflect the requirements of the CPSP in general.
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