Table 3.

Summary of the current practice on the assessment of competences for each of the five countries, including quotes

	The Netherlands	Spain	Slovenia	Denmark	United Kingdom
Portfolio	-Mandatory electronic portfolio -Entrustable professional activities† -Portfolio incorporates CanMeds framework*	-Mandatory portfolio, resident’s book -Checklist of the main competences	-Electronic portfolio -Checklist of rotations, mandatory procedures and description of the final licencing exam	-Electronic portfolio -Checklist of learning objectives, formal assessment and approval of competencies	-Mandatory electronic portfolio -Portfolio incorporates CanMeds framework*
Formative feedback	-Meeting with the supervisor every 3–6 months -Strong culture of work-based assessment -Personal reflection about progress and learning goals	-Meeting with supervisor every 3 months -Yearly assessment	-No formal feedback procedure -Work-based assessment -Yearly assessment	-Regular evaluation discussions before the “Final discussion” -the plan uses the CanMeds* roles	-Meeting with the supervisor at least 3 times a year -Case based discussions
Quotes	‘You learn most from people, not from the portfolio. It doesn’t drive me at all, but I use it to order my thoughts.’ The Netherlands Trainee	‘Feedback on clinical learning is the most important thing for trainees.’ Spanish Trainee ‘Reviewing with the resident what is going well and what is problematic and how to improve or overcome difficulties is very important.’ Spanish Trainer	‘I have so many other things to be done first and then I’ll think about it’ Slovenia Trainee ‘Feedback is really vital to a trainee so you know what to keep doing and what you need to stop doing or improve on.’ Slovenia Trainee	‘The portfolio is the way to make everybody see the minimum standards’ Danish Trainee	‘The portfolio provides the framework for a common standard that can be applied nationally (…) and includes the curriculum which is crucial.’ UK Trainer
Summative assessment	-Decision based on portfolio and supervisor’s assessment -EULAR course is mandatory -No publication requirement -No national exams	-Annual assessment which comprises of mini-CEX 2–3 times a year -Voluntary OSCE -No publication requirement -No national exam	-Interview at the end of each rotation -National exam: Final licencing exam which includes practical, oral and theoretical questions. Three examiners, two rheumatologists and one from different specialty.	-Decision based on portfolio and supervisors’ assessment - No publication requirement - No national exams	-National exam: Specialty Certificate Examination
Clinical practice and skills	- Entrustable professional activities† - Short practical assessment	- Mini-CEX -Voluntary OSCE	-Workplace-based assessments	-Competency cards	-Workplace-based assessments - Direct Observation Procedural Skills
Quotes	‘Skills are important, but always in clinical context.’ The Netherlands Trainee	‘Some test of theoretical understanding is good but an OSCE is a much better approach’ Spanish Trainer	‘It was 10 years ago, and I still remember it!’ Slovenia Trainer	‘I focus on acquiring the appropriate competency to a high level in the clinical setting. I didn’t realise it was summative.’ Danish Trainee
Professionalism	-Multisource feedback	-None	-None	-Multisource feedback	-Multisource feedback
Knowledge tests	-None	-None	-None	-Final oral knowledge test	-None
Quotes	‘Knowledge tests are useful as a way of measuring your progress but they are not the best way at this level; you need to show you can apply your knowledge in clinical practice.’ The Netherlands Trainee	‘Knowledge tests are not a good way to judge between trainees at this level’ Spanish Trainer ‘I don’t think professional behaviours would just emerge alone. We have to teach it. Poor models don’t teach professionalism.’ Spanish Trainer	‘If you did something unprofessional, then somebody would discuss it with you.’ Slovenian Trainee		‘Everyone judges your professionalism on a daily basis, so do you need it assessing as well formally? I don’t think so.’ UK Trainee ‘We love the professional attitude, that’s vital!’ UK Trainer
National standards	-National portfolio -Central body checking standards across the country -National audits for traineeships organised by the Dutch central organisation	-Central body checking standards across the country	-No national standard	-The assessment is similar across the country. -Regulation by the Danish Society of Rheumatology	-All summative points are specified centrally by the Royal College. -Training is supported nationally.
Trainers certification	-University Teaching Qualification course recommended but not mandatory. -Supervisors should do faculty development in the university hospitals	-Supervisors should do faculty development in the university hospitals -Each mentor should have a maximum of four trainees	-Each main mentor has to have at least 50 CME points each year -A teacher should have a maximum of three trainees -No formal certification to become a trainer	-Courses in supervision are mandatory for all physicians who train trainees. -Train the trainer course	-Requirement for all supervisors to receive a minimum training in Teaching and assessing. -Review on a regular cycle and registration of the trainers within their region.

*CanMeds is an educational framework that describes the abilities physicians require to effectively meet the healthcare needs of the people they serve. It is the basis for the educational and practice standards of the Royal College of Canada.

†An entrustable professional activity is a key task that an individual can be trusted to perform in a given healthcare context, once sufficient competence has been demonstrated.

mini-CEX, Clinical Evaluation Exercise; CME, Continuing Medical Education; OSCE, Objective Structured Clinical Examination.