Certification of specialists: survey of candidates and review of the literature.

To evaluate the specialty certification process, the Canadian Association of Internes and Residents (CAIR) surveyed 634 candidates who had attempted the written and oral exams of the Royal College of Physicians and Surgeons of Canada. The results suggest that in-training evaluation is a more reliable and valid assessment of competence than the written and oral exams. There is a lack of well defined program objectives that are coordinated with the examinations. CAIR recommends that the present concept of an examination "hurdle" be replaced by different, integrated methods of assessment during training, and that an effective appeal mechanism be developed.